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pdfNursing Home Survey on
Resident Safety
Draft—Not for Circulation
This questionnaire may not be used or cited
without permission
This document includes a draft nursing home safety culture survey and a related
dimensions list that groups the survey items according to the safety culture areas they
are intended to measure. Since safe care is a critical component of healthcare quality,
there is growing recognition of the importance of establishing a culture of safety in
healthcare settings. Achieving a culture of safety in nursing homes requires an
understanding of the values, beliefs, and norms that exist around what is important, and
what attitudes and behaviors related to resident safety are supported, rewarded, and
expected. This draft survey is designed to assess staff opinions about important areas
of safety culture in nursing homes.
The survey was developed by Westat under the direction of the Agency for Healthcare
Research and Quality (AHRQ) and has undergone cognitive pretesting with nursing
home staff and review by experts in nursing home research as well as nursing home
stakeholders. There are plans to pilot test the instrument with staff in 40 nursing homes
in 2007.
This nursing home survey is an expansion of AHRQ’s Hospital Survey on Patient Safety
Culture (HSOPSC) which was released to the public in November 2004
(www.ahrq.gov/qual/hospculture).The nursing home version contains new and revised
questions and safety culture areas that more accurately apply to the nursing home
setting.
This questionnaire should not be used or cited by any individual or organization for any
purpose without written permission. If you have any questions about the document,
please contact:
Deborah Carpenter, RN, MSN, CPHQ, PMP
Senior Study Director
Westat
1650 Research Blvd.
Rockville, MD 20850
Phone: 301-314-2475
Fax: 301-315-5912
Email: [email protected]
NURSING HOME SURVEY ON RESIDENT SAFETY DRAFT 10-27-06 DO NOT DISTRIBUTE
Nursing Home Survey on Resident Safety
“Resident safety” means preventing resident injuries, incidents, and harm in the nursing home.
This survey asks for your opinions about resident safety issues in your nursing home. It will take about 15
minutes to complete. To mark your answer, just put an X or a √ in the box: x or √ .
If a question does not apply to your job or you do not know the answer, please mark the box in the last column.
If you do not wish to answer a question, you may leave your answer blank.
SECTION A: Working in This Nursing Home
How much do you agree or disagree with the
following statements?
Neither
Agree
Strongly
nor
Disagree Disagree Disagree
Agree
Does Not
Apply or
Strongly
Don’t
Agree
Know
1. Staff in this nursing home treat each other with
respect................................................................
1
2
3
4
5
9
2. Staff support one another in this nursing home...
1
2
3
4
5
9
3. We have enough staff to handle the workload ....
1
2
3
4
5
9
4. Staff follow standard procedures to care for
residents.............................................................
1
2
3
4
5
9
5. When taking care of residents, staff ask for help
if they need it ......................................................
1
2
3
4
5
9
6. Staff get in trouble for making small mistakes .....
1
2
3
4
5
9
7. Staff feel like they are part of a team...................
1
2
3
4
5
9
8. This nursing home uses more agency staff than
is best for resident care......................................
1
2
3
4
5
9
9. Staff know how to use equipment and supplies to
do their jobs ........................................................
1
2
3
4
5
9
10. Departments in this nursing home work well
together to care for residents..............................
1
2
3
4
5
9
(Go to next page)
NURSING HOME SURVEY ON RESIDENT SAFETY DRAFT 10-27-06 DO NOT DISTRIBUTE
1
SECTION A: Working in This Nursing Home (Continued)
Neither
Agree
nor
Strongly
Disagree Disagree Disagree
Agree
Does Not
Apply or
Don’t
Strongly
Agree
Know
11. Staff use shortcuts to get their work done
faster ...............................................................
1
2
3
4
5
9
12. Staff get the training they need in this nursing
home ...............................................................
1
2
3
4
5
9
13. Staff have to hurry because they have too
much work to do ..............................................
1
2
3
4
5
9
14. When someone gets really busy in this nursing
home, other staff help out ................................
1
2
3
4
5
9
15. Staff are blamed when a resident is harmed....
1
2
3
4
5
9
16. Staff have enough training on how to handle
difficult residents..............................................
1
2
3
4
5
9
17. To make work easier, staff often ignore
procedures ......................................................
1
2
3
4
5
9
18. Staff are afraid to report their mistakes............
1
2
3
4
5
9
19. To keep residents safe, staff must follow
standard procedures........................................
1
2
3
4
5
9
20. Staff are asked to do things they are not
trained to do ....................................................
1
2
3
4
5
9
21. It is hard to keep residents safe here because
so many staff quit their jobs .............................
1
2
3
4
5
9
22. Staff are treated fairly when they make
mistakes ..........................................................
1
2
3
4
5
9
23. Staff understand the training they get in this
nursing home...................................................
1
2
3
4
5
9
24. Residents’ needs are met during shift
changes...........................................................
1
2
3
4
5
9
25. Staff feel safe reporting their mistakes.............
1
2
3
4
5
9
(Go to next page)
NURSING HOME SURVEY ON RESIDENT SAFETY DRAFT 10-27-06 DO NOT DISTRIBUTE
2
SECTION B: Communications
Never
Rarely
Sometimes
Most of
the time
Always
Does Not
Apply or
Don’t
Know
1. Staff are told what they need to know before
taking care of a resident for the first time ............
1
2
3
4
5
9
2. Staff in this nursing home are asked what they
think about resident care.....................................
1
2
3
4
5
9
3. Staff are afraid to ask questions when something
does not seem safe for residents ........................
1
2
3
4
5
9
4. Staff are told right away when there is a change
in a resident’s care plan ......................................
1
2
3
4
5
9
5. We have all the information we need when
residents are transferred from the hospital..........
1
2
3
4
5
9
6. When staff report something that could harm a
resident, someone takes care of it ......................
1
2
3
4
5
9
7. Important information about residents gets
missed between shifts.........................................
1
2
3
4
5
9
8. Staff are told about incidents that happen in this
nursing home......................................................
1
2
3
4
5
9
9. In this nursing home, we talk about ways to keep
incidents from happening again ..........................
1
2
3
4
5
9
10. Staff tell someone if they see something that
might harm a resident .........................................
1
2
3
4
5
9
11. Staff ideas and suggestions are valued in this
nursing home......................................................
1
2
3
4
5
9
12. In this nursing home, we discuss ways to keep
residents safe from harm ....................................
1
2
3
4
5
9
13. Staff opinions are ignored in this nursing home ..
1
2
3
4
5
9
14. Staff are given all the information they need to
care for residents ................................................
1
2
3
4
5
9
15. It is easy for staff speak up about problems in this
nursing home......................................................
1
2
3
4
5
9
How often do the following things happen in
your nursing home?
(Go to next page)
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SECTION C: Your Supervisor
How much do you agree or disagree with the
following statements?
Neither
Agree
Strongly
nor
Disagree Disagree Disagree
Agree
Does Not
Apply or
Don’t
Strongly
Know
Agree
1. My supervisor listens to staff ideas and
suggestions about resident safety ..................
1
2
3
4
5
9
2. My supervisor lets some safety problems
happen over and over......................................
1
2
3
4
5
9
3. My supervisor says a good word to staff who
follow the right procedures ..............................
1
2
3
4
5
9
4. My supervisor wants us to work faster, even if
it means taking shortcuts................................
1
2
3
4
5
9
5. My supervisor pays attention to safety
problems in this nursing home........................
1
2
3
4
5
9
SECTION D: Your Nursing Home
How much do you agree or disagree with the
following statements?
Neither
Agree
nor
Strongly
Disagree Disagree Disagree
Agree
Does Not
Apply or
Don’t
Strongly
Know
Agree
1. In this nursing home, we learn from our
mistakes .........................................................
1
2
3
4
5
9
2. Management in this nursing home seems
interested in resident safety only after a
problem happens............................................
1
2
3
4
5
9
3. Residents are well cared for in this nursing
home ..............................................................
1
2
3
4
5
9
4. Management asks staff how the nursing home
can improve resident safety............................
1
2
3
4
5
9
5. This nursing home lets the same mistakes
happen again and again .................................
1
2
3
4
5
9
6. It is easy to make changes to improve resident
safety in this nursing home .............................
1
2
3
4
5
9
(Go to next page)
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4
SECTION D: Your Nursing Home (Continued)
Neither
Agree
Strongly
nor
Disagree Disagree Disagree
Agree
Does Not
Apply or
Strongly
Don’t
Agree
Know
7. This nursing home is always doing things to
improve resident safety....................................
1
2
3
4
5
9
8. This nursing home does a good job keeping
residents safe ..................................................
1
2
3
4
5
9
9. Management talks with staff about the
importance of resident safety ...........................
1
2
3
4
5
9
10. This nursing home needs to do a better job
of caring for its residents..................................
1
2
3
4
5
9
11. Management listens to staff ideas and
suggestions to improve resident safety ............
1
2
3
4
5
9
12. This nursing home is a safe place for
residents ..........................................................
1
2
3
4
5
9
13. Management often walks around the nursing
home to check on resident care .......................
1
2
3
4
5
9
14. This nursing home has problems keeping
residents safe from harm .................................
1
2
3
4
5
9
15. When this nursing home makes changes to
improve resident safety, it checks to see if the
changes worked...............................................
1
2
3
4
5
9
SECTION E: Overall Ratings
1. I would tell friends that this is a safe nursing home for their family.
a.
b.
c.
Yes
Maybe
No
2. Please give this nursing home an overall grade on resident safety.
A
Excellent
B
Very Good
C
Acceptable
D
Poor
F
Failing
(Go to next page)
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SECTION F: Background Information
1. What is your job in this nursing home? Check ONE box that best applies to your job. If more than one
category applies, check the highest-level job.
a.
Administrator/Manager
Executive Director/Administrator
Medical Director
Director of Nursing/Nursing
Supervisor
Department Head
Unit Manager/Charge Nurse
Assistant Director/Assistant Manager
Minimum Data Set (MDS)
Coordinator/Resident Nurse
Assessment Coordinator (RNAC)
b.
Physician (MD)
c.
Other Provider
Nurse Practitioner
Clinical Nurse Specialist
Physician Assistant
d.
Licensed Nurse
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Wound Care Nurse
e.
Nursing Assistant/Aide
Certified Nursing Assistant (CNA)
Geriatric Nursing Assistant (GNA)
Nursing Aide/Nursing Assistant
f.
Direct Care Staff
Activities Staff Member
Dietician/Nutritionist
Medication Technician
Pastoral Care/Chaplain
Pharmacist
Physical/Occupational/Speech/
Respiratory Therapist
Podiatrist
Social Worker
g.
Administrative Support Staff
Administrative Assistant
Admissions
Billing/Insurance
Secretary
Human Resources
Medical Records
h.
Support Staff
Drivers
Food Service/Dietary
Housekeeping
Laundry Service
Maintenance
Security
i.
Other (Please write the title of your job):
______________________________
2. How long have you worked in this nursing home?
a.
b.
c.
Less than 2 months
2 to 11 months
1 to 2 years
d. 3 to 5 years
e. 6 to 10 years
f. 11 years or more
(Go to next page)
NURSING HOME SURVEY ON RESIDENT SAFETY DRAFT 10-27-06 DO NOT DISTRIBUTE
6
SECTION F: Background Information (Continued)
3. How many hours per week do you usually work in this nursing home?
a.
b.
c.
d.
15 or fewer hours per week
16 to 24 hours per week
25 to 40 hours per week
More than 40 hours per week
4. When do you work most often? Check ONE answer.
a.
c.
d.
Days
Evenings
Nights
5. Are you paid by a staffing agency when you work for this nursing home?
a.
b.
Yes
No
6. In your job in this nursing home, do you work directly with residents most of the time?
Check ONE answer.
a.
b.
YES, I work directly with residents most of the time.
NO, I do NOT work directly with residents most of the time.
7. In this nursing home, where do you spend most of your time working? Check ONE answer.
a.
b.
c.
d.
e.
Many different areas or units in this nursing home / No specific area or unit
Alzheimer’s / Dementia unit
Rehab unit
Skilled nursing unit
Other area or unit (Please specify): ___________________________
8. Overall, what language do you read, write, and understand best?
a.
b.
English
Other (Please write the name of the other language): _____________________________
9. This survey uses some special terms and words. How difficult was it to understand the questions
in this survey?
a.
b.
c.
d.
Very difficult
Difficult
A little difficult
Not difficult
(Go to next page)
NURSING HOME SURVEY ON RESIDENT SAFETY DRAFT 10-27-06 DO NOT DISTRIBUTE
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SECTION G: Your Comments
Please feel free to write any comments about resident care and safety in this nursing home.
THANK YOU FOR COMPLETING THIS SURVEY.
Please mail your completed survey directly to Westat in the enclosed postage-paid envelope.
OMB Number XXXX-XXXX, Expiration Date XX/XX/XXXX
Agency for Healthcare Research and Quality (AHRQ)
NURSING HOME SURVEY ON RESIDENT SAFETY DRAFT 10-27-06 DO NOT DISTRIBUTE
8
NURSING HOME SURVEY ON SAFETY CULTURE: DIMENSIONS
In this document, the items in the Nursing Home Survey on Resident Safety are grouped
according to the safety culture dimensions they are intended to measure. The item’s survey
location is shown to the left of each item. Negatively worded items are indicated.
TEAMWORK
A1.
A2.
A7.
A10.
A14.
Staff in this nursing home treat each other with respect.
Staff support one another in this nursing home.
Staff feel like they are part of a team.
Departments in this nursing home work well together to care for residents.
When someone gets really busy in this nursing home, other staff help out.
STAFFING
A3.
A8.
A13.
A21.
A24.
We have enough staff to handle the workload.
This nursing home uses more agency staff than is best for resident care. (Negatively worded)
Staff have to hurry because they have too much work to do. (Negatively worded)
It is hard to keep residents safe here because so many staff quit their jobs. (Negatively worded)
Residents’ needs are met during shift changes
COMPLIANCE WITH PROCEDURES
A4.
A5.
A11.
A17.
A19.
Staff follow standard procedures to care for residents.
When taking care of residents, staff ask for help if they need it.
Staff use shortcuts to get their work done faster. (Negatively worded)
To make work easier, staff often ignore procedures. (Negatively worded)
To keep residents safe, staff must follow standard procedures.
NONPUNITIVE RESPONSE TO MISTAKES
A6.
A15.
A18.
A22.
A25.
Staff get in trouble for making small mistakes. (Negatively worded)
Staff are blamed when a resident is harmed. (Negatively worded)
Staff are afraid to report their mistakes. (Negatively worded)
Staff are treated fairly when they make mistakes.
Staff feel safe reporting their mistakes.
TRAINING & SKILLS
A9.
A12.
A16.
A20.
A23.
Staff know how to use equipment and supplies to do their jobs.
Staff get the training they need in this nursing home.
Staff have enough training on how to handle difficult residents.
Staff are asked to do things they are not trained to do. (Negatively worded)
Staff understand the training they get in this nursing home.
HANDOFFS
B1.
B4.
B5.
B7.
B14.
Staff are told what they need to know before taking care of a resident for the first time.
Staff are told right away when there is a change in a resident’s care plan.
We have all the information we need when residents are transferred from the hospital.
Important information about residents gets missed between shifts. (Negatively worded)
Staff are given all the information they need to care for residents.
NURSING HOME SURVEY ON RESIDENT SAFETY DRAFT 10-27-06 DO NOT DISTRIBUTE
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COMMUNICATION OPENNESS
B2.
B3.
B11.
B13.
B15.
Staff in this nursing home are asked what they think about resident care.
Staff are afraid to ask questions when something does not seem safe for residents.
(Negatively worded)
Staff ideas and suggestions are valued in this nursing home.
Staff opinions are ignored in this nursing home. (Negatively worded)
It is easy for staff to speak up about problems in this nursing home.
FEEDBACK & COMMUNICATION ABOUT INCIDENTS
B6.
B8.
B9.
B10.
B12.
When staff report something that could harm a resident, someone takes care of it.
Staff are told about incidents that happen in this nursing home.
In this nursing home, we talk about ways to keep incidents from happening again.
Staff tell someone if they see something that might harm a resident.
In this nursing home, we discuss ways to keep residents safe from harm.
SUPERVISOR EXPECTATIONS & ACTIONS PROMOTING RESIDENT SAFETY**
C1.
C2.
C3.
C4.
C5.
My supervisor listens to staff ideas and suggestions about resident safety.
My supervisor lets some safety problems happen over and over. (Negatively worded)
My supervisor says a good word to staff who follow the right procedures.
My supervisor wants us to work faster, even if it means taking shortcuts. (Negatively worded)
My supervisor pays attention to safety problems in this nursing home.
ORGANIZATIONAL LEARNING
D1.
D5.
D6.
D7.
D15.
In this nursing home, we learn from our mistakes.
This nursing home lets the same mistakes happen again and again. (Negatively worded)
It is easy to make changes to improve resident safety in this nursing home.
This nursing home is always doing things to improve resident safety.
When this nursing home makes changes to improve resident safety, it checks to see if the changes worked.
MANAGEMENT SUPPORT FOR RESIDENT SAFETY
D2.
D4.
D9.
D11.
D13.
Management in this nursing home seems interested in resident safety only after a problem happens.
(Negatively worded)
Management asks staff how the nursing home can improve resident safety.
Management talks with staff about the importance of resident safety.
Management listens to staff ideas and suggestions to improve resident safety.
Management often walks around the nursing home to check on resident care.
OVERALL PERCEPTIONS OF RESIDENT SAFETY
D3.
D8.
D10.
D12.
D14.
Residents are well cared for in this nursing home.
This nursing home does a good job keeping residents safe.
This nursing home needs to do a better job of caring for its residents. (Negatively worded)
This nursing home is a safe place for residents.
This nursing home has problems keeping residents safe from harm. (Negatively worded)
**Partially adapted from Zohar (2000). A group-level model of safety climate: Testing the effect of group climate on
microaccidents in manufacturing jobs. Journal of Applied Psychology, (85) 4, 587-596.
NURSING HOME SURVEY ON RESIDENT SAFETY DRAFT 10-27-06 DO NOT DISTRIBUTE
10
| File Type | application/pdf |
| File Title | Microsoft Word - Attachment B-NH Survey on Resident Safety 1-24-07.doc |
| Author | Sorra_j |
| File Modified | 2007-02-07 |
| File Created | 2007-02-05 |