Clinical Risk Management in Long-Term Healthcare Facilities (LTHFs) in Northern Italy: Empirical Evidence from the Lombardy Region.

内容摘要

Background Quality and patient safety policies in Italy are constantly evolving. Given the rapidly aging population and the increased vulnerability, it is essential to consistently ensure high levels of attention to quality and risk assessment in long-term healthcare facilities, providing medical and social care to elderly residents or to adults with disabilities (LTHFs). Objective The objective was to identify critical issues that persist in (LTHFs) in Lombardy despite the prevention and containment strategies currently in place or ongoing, and to identify areas for improvement. Materials and Methods The cross-sectional study was based on a questionnaire developed and applied by the Risk Managers of the eight Local Agencies for Health Protection, in the LTHFs in their respective geographical areas. Descriptive, correlation, and factorial analyses were performed. Results and discussion The response rate was 82% (674 LTHFs). Results for 2022 indicate that only 43.8% of the LTHFs had designated a Risk Manager, while 67.2% had established an Incident Reporting System. No incidents were reported in half of the LTHFs. Overall, the number of reported incidents varied greatly (mean: 13.8 ± 38.9). While data protection and ethical-behavioural risks were mapped in more than 80% of the LTHFs, risks concerning internal or external communication (53.5%), litigation (47.8%) and reputation (41.1%) were mapped in fewer LTHFs. The level of implementation of the Ministerial Recommendations applicable to LTHFs ranged from 94.6% for fall prevention, to 43.8% for prevention of violence against staff, to 43.4% for prevention of transfusion reactions caused by AB0 incompatibility, and to 34.3% for prevention of suicide in the facility. Most LTHFs implemented a range of risk prevention strategies, but those concerning the use of benzodiazepines (50.7%), the prevention of antibiotic resistance (47.8%), the antibiotic consumption (42.6%), and the provision of personalized packaging for safety and medication adherence (28.6%) were implemented in less than half of the LTHFs. The formal appointment of a Risk Manager was significantly correlated with the level of implementation of best practices related to risk management, quality of care, and communication. The psychometric properties of the questionnaire were acceptable for a model with 46 items grouped into 5 distinct domains: "General risk mapping"; "Main Ministerial Recommendations"; "Risk management strategies"; "Particular events and special medications" and "Quality and communication." Therefore, the authors encourage its widespread application in other LTHFs. Conclusion The study highlights both positive aspects and critical issues concerning risk management in LTHFs in the Lombardy region as well as opportunities for improvement. The collaboration between the Regional Centre for Management of Clinical Risk and Patient Safety, the Risk Managers of the Local Agencies for Health Protection, and the LTHFs remains essential for improving quality and resident safety.