Safety incident reporting: policy review in English care homes to improve learning and safety

Background
Care homes provide permanent or temporary accommodation with personal care and / or nursing care, meals and medication for frail older people who are not capable of living independently. Care homes may be owned by public, private or third sector organisations. Common statutory and regulatory requirements exist regarding the provision of safe care and working environments for staff. However, there is no standardised approach to safety incident reporting across the sector and little research is available on safety incident reporting practice and care home policies.

Aims of the study
A policy review of safety incident reporting policies in care homes was undertaken. We aimed to develop understanding regarding policy content, methods of reporting and recording safety incidents, how data was captured and how this could contribute to improving safety and learning across the sector.

Methodology
A qualitative documentary analysis of safety incident reporting policies was undertaken. Policies were provided by twenty-three organisations whose staff participated in interviews (n=75) about safety incident reporting between January 2021 until June 2022. Between April 2022 and May 2022, an internet search with stipulated search terms was conducted. Policy inclusion criteria specified the policy needed to refer to safety incident reporting in any capacity in English care or nursing homes, could refer to residents, staff, contractors and visitors and be written in English. Data was extracted and tabulated using a framework developed from study objectives. The Care Quality Commission (CQC) website was also searched for the latest inspection report for homes whose policy was reviewed.

Analysis
Few interview participants shared polices and few were available online. Forty-one policies 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 were differences in policy length and breadth. Twenty-two policies named a specific person or job role with responsibility for the safety incident reports and all referred to post-incident monitoring or investigation. Twenty policies identified post-incident learning to minimise risk of recurrence. Most (19, 76%) relied on paper reporting systems. Only one referred to incorporating resident perspectives and 14 (56%) to a duty of candour.

Project outcomes
Although policy content and focus varied, common aims and purpose were evident suggesting there is scope to share and develop practice and learning. Governance, reflected through policy development and implementation, is important in safety incident reporting and for developing a systems-based approach. Limited policies were available. Most homes where policies were reviewed obtained good overall CQC regulatory scores. Consequently, the review may not be reflective of the wider care home sector.

Conclusions and recommendations
Willingness to share policies may present an opportunity for sector-wide learning. Standardisation may be useful as a mechanism to improve learning, safety and promote transparency for providers, residents and families. The CQC focuses on inspection feedback. Multiple and competing providers makes sharing practice difficult. Future research could investigate how incident reporting is used in daily practice and focus on policies from care homes rated as requiring improvement or failing.