Because nursing home residents often have cognitive deficits and complex health conditions, they are at increased risk for medical errors and adverse events (Castle, 2012). There are also the potential for errors in transferring resident information, which is frequently neglected during shift or institutional transitions (Castle, 2012). To further complicate patient safety issues in the nursing home setting is the increased propensity toward an organizational culture of distrust and blame. An environment that promotes safety by learning from errors is recommended by the Institute of Medicine (IOM) over an environment that places blames on individuals.

The Joint Commission’s accreditation impact on nursing homes has been examined in the literature. For example, nursing homes that were accredited by the Joint Commission had fewer medication errors, and less frequent use of restraints (Castle, 2012). Organizations that have a focus on organizational processes and those that develop a quality management system have more possibilities for making patient safety culture improvements. Voluntary accreditation is structured in a way that care processes are organized which can energize quality improvements, which potentially improves the safety culture of the organization (Castle, 2012).

Interventions that have a focus on promoting a safety culture have shown to be effective in improving patient safety outcomes (Wagner, McDonald, & Castle, 2012). In their study, Wagner, McDonald, and Castle (2012) used a randomized sample of 6,000 nurses from every state in the US to determine if voluntary accreditation stimulates organizational safety culture improvements. Specifically, the perceptions of senior managers in nursing homes on organizational safety culture were assessed. The researchers collected data from participants’ responses to the Nursing Home Survey on Resident Safety Culture. The results of the study suggest that Joint Commission accreditation was associated with more favorable perceptions of resident safety culture (RSC). This study is relevant because it demonstrates the importance of assessing a nursing homes safety culture.

In addition to the problem of resident safety culture in nursing homes, healthcare-associated infections (HAIs) are also of concern. One problem related to HAIs in nursing homes is the inconsistencies noted in implementing evidence-based practice initiatives to control infection rates (Bradley, Segal, & Finley, 2012). In their study, Bradley, et al. (2012) sought to identify the barriers to implementing infection control interventions in the nursing home setting. On-site assessments were done in ten nursing homes that had high HAI rates and ten nursing homes with low HAI rates. These nursing homes were compared on the impact of the implementation levels on preventing HAIs. The implementation of the HAI interventions were assessed against 50 evidence based best practice criterion to mitigate HAI in practice. Those nursing homes with the highest HAIs were deficient in most of the 50 best practices. This study highlights the need for increased interventions that focus on decreasing HAI infection rates in nursing homes. The study also highlights the need for infection control standardized protocols. Further research is needed to identify other barriers in implementing the infection control best practice processes. As mandated by the Center for Medicare and Medicaid services, nursing homes and other long-term facilities must have programs for infection control.

As previously noted, poor transitions can result in poorer health outcomes for nursing home patients (Castle, 2012). The most common of these negative consequences are related to injuries during transition, medication errors, infections, and falls. With the enactment of the Affordable Care Act in 2012, the Centers for Medicare and Medicaid Services penalize organizations with high readmission rates under three conditions: heart attack or heart failure, infection, and pneumonia (Bradley, Segal, & Finley, 2012). Best practices in transitioning include a comprehensive discharge planning protocol, effective and timely communication of patient information, medication reconciliation, patient and caregiver education, open communication between health care providers, and timely follow-up visits with a provider after discharge (Bradley, et al. 2012).