March 8, 2022

BACKGROUND: Inappropriate health care leads to negative patient experiences, poor health outcomes and inefficient use of resources. We aimed to conduct a systematic review of inappropriately used clinical practices in Canada. METHODS: We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level. RESULTS: We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%-56.6%). Underuse (median 43.9%, IQR 23.8%-66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%-30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%-85.7%, n = 9) and thyroid-stimulating hormone (overused, range 3.0%-35.1%, n = 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%-71.0%, n = 6) and potentially inappropriate medications (overused, range 13.5%-97.3%, n = 9). INTERPRETATION: We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada.

Quality of care in long-term care is a worldwide issue given the growing numbers of dependent older people. This book presents international research, 22 varied papers, exploring quality of care from several different angles. Important themes include: (1) workforce issues, such as staff training and support; job competencies, satisfaction, and intention to stay in work; staff burnout; effects of personal- and work-related factors on quality of care; (2) intervention studies: for depressive symptoms in nursing home residents; adjustment for new residents; social and psychological support; and loneliness and isolation; (3) methodology, including: developing and testing quality indicators; measuring residents’ experience of quality; and assessing partnership between staff and families; and (4) older people’s experiences, such as dry eyes and using ocular lubricants; associations between length of stay and end of life care; palliative care service use and comfort at end of of life; and causes of infection-related hospitalization. The book concludes with a systematic review of the current evidence base of care home research in Brazil.

The purpose of this primer is to provide updated information to the patient safety community about the challenges of ensuring the safe care of older adults in Medicare and Medicaid certified nursing homes (NHs) associated with the COVID-19 pandemic, and the federal and state efforts taken to mitigate these challenges. This serves as an update to the original primer, “Coronavirus Disease 2019 (COVID-19) and Safety of Older Adults Residing in Nursing Homes,” originally appearing in PSNet on April 21, 2020, and updated July 30, 2020. This primer is a compilation of information that has impacted the safety of older adults and has been published on federal websites, in professional and academic literature, and in the press. It puts into perspective that, while less than 1% of the U.S. population live in long-term care facilities (e.g., NHs, assisted living) and comprise only 1% of total positive U.S. cases, older adult residents in NHs accounted for 37% of COVID-19 deaths overall until the vaccines became available in December 2020 (CMS COVID-19 Nursing Home Data website). Various factors associated with COVID-19 that negatively impacted patient safety and resulted in poor outcomes for nursing home residents are discussed in this primer, including NH staffing, racial and ethnic disparities, and poor quality of care.

BACKGROUND: COVID-19 has significant impact on long-term care (LTC) residents and staff. The purpose of this paper is to report the data gathered during a COVID-19 outbreak in a Canadian LTC home regarding staff experiences, challenges, and needs, to offer lessons learned and implications. METHODS: A total of 30 staff from multiple disciplines participated in the study, including nurses, care workers, recreational staff, and a unit clerk. Focus groups (n = 20) and one-on-one interviews (n = 10) were conducted as part of a larger participatory action research (PAR) study in a Canadian LTC home. All data collection was conducted virtually via Zoom, and thematic analysis was performed to identify themes. RESULTS: Four main themes were identified: We are Proud, We Felt Anxious, We Grew Closer to Residents and Staff Members, and The Vaccines Help. CONCLUSIONS: This research details the resilience that characterizes staff in LTC, while highlighting the emotional toll of the pandemic, particularly during an outbreak. LTC staff in this study found innovative ways to connect and support residents and this resulted in stronger connections and relationships. Leadership and organizational support are pivotal for supporting team resilience to manage crisis and adapt positively in times of COVID-19 pandemic, especially during the period of outbreak.