Review of residential and nursing care home policies on safety incident reporting in England.

ObjectivesIn care homes, safety incident reporting, and the policy framework that surrounds safety incident reporting, is not well understood. This study aims to review safety incident reporting and safety policies in residential and nursing care homes in England. It aims to better understand safety incident reporting practices and identify lessons for the sector regarding approaches to safety incident reporting to improve safety. The objectives were to investigate what policies exist, identify the methods and any technology used for safety incident reporting and consider the data captured in safety incident reports. It aims to contribute to discussions regarding developing systems-based approaches to safety management in care homes.MethodsA qualitative documentary analysis of safety incident reporting policies in residential and nursing care homes in England was undertaken. Policies were collected from 23 organisations whose staff participated in interviews (n = 75) regarding safety incident reporting between January 2021 until June 2022 and from a structured internet search using specified search terms between April 2022 and May 2022. To be included, a policy needed to refer to safety incident reporting in any capacity and be partially or wholly related to care homes or nursing homes in England. Safety incidents could include staff, residents, contractors, and visitors to the home. Data, extracted using a bespoke framework based on study objectives, were tabulated and analysed deductively and inductively. For the selected policies, the Care Quality Commission website was searched for the latest inspection report and the overall rating was extracted.ResultsForty-one policy documents were retrieved and screened for inclusion. Twenty-five policies (from 23 organisations) were reviewed. Three were from the internet search and 22 were obtained from interview participants. There was considerable variability in the length and comprehensiveness of the policies, with some homes using untailored, 'off-the-shelf' standardised policies produced by a specialist company. Twenty-two (88%) referred to other policy and legislative documents important to safety incident reporting and all but three (12%) policies identified a designated person or role with responsibility for the reports. Only one policy incorporated resident accounts and views into the incident report. Two policies referred exclusively to electronic recording systems with most (n = 19) referring to paper-based reporting systems.ConclusionsThe study identified the extent of, and gaps, in safety incident reporting policies, with reporting practices situated within a broad framework of governance. Incident reporting is as much a matter of governance as practice and there may be a greater opportunity to learn from incident reports than there is currently. Further research about how staff navigate multiple risks, develop adaptive approaches for the contextual conditions, and use safety incident reporting mechanisms within and across care homes to minimise harm may help improve standards, practices and safety in care homes, along with a greater understanding of how policy is utilised in practice.