Using the Delphi Method to Identify Risk Factors Contributing to Adverse Events in Residential Aged Care Facilities

Abstract

Purpose

This study aimed to identify risk factors associated with adverse events in residential aged care facilities in China.

Patients and Methods

After compiling a list of risk factors for adverse events generated from in-depth interviews with managers of residential aged care facilities, a three-round Delphi method was used to reach consensus. The synthesized risk factors were presented on a Likert scale to the expert panelists three times to validate their responses.

Results

The list identified 67 items as risk factors for adverse events, attached to four first-level indexes (ie, environmental facility, nursing staff, older adults’ characteristics, and management factors). The experts’ authority coefficient was 0.87. The positive coefficients were 82.76%, 91.67%, and 100%, and the coordination coefficients were 0.154, 0.297, and 0.313 in the first, second, and third rounds, respectively.

Conclusion

Using a Delphi method, this study established a consensus on risk factors contributing to adverse events and developed a risk assessment grade for use in future aged care practice and research. The resulting list is useful in prioritizing risk-reduction activities and assessing intervention or education strategies for preventing adverse events in residential aged care facilities.

Impact

This study fills the gap in risk identification in the Chinese residential aged care system to ensure provision of best-practice care to this vulnerable population. Nursing staff and management factors at the top of the list are not only the most common causes of adverse events but also the core elements in creating a secure and error-free environment. This list was intended to support predictive and prevention-oriented decision-making by managers and nursing supervisors to reduce preventable adverse events.

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Keywords:

• residential aged care facilities
• Delphi survey
• risk factors
• Aged care
• adverse events

Acknowledgments

First, we would like to thank the Affiliated Hospital of Xiangnan University for approving and supporting this study. Second, we are grateful for our colleagues, Changbin Lei, Qun Yuan, and Qing Lin. Third, we thank the Ministry of Education, the Education Department of Hunan Province, and the Social Science Planning Fund Office in Hunan Province for providing the financial and material support. Finally, we express our gratitude to all the experts for participating in the expert panel and their contribution to consensus the index system on risk factors.

Ethical Approval

The Ethics Review Committee of Affiliated Hospital of Xiangnan University approved the study (reg. no. KY-201508001).

Disclosure

There are no conflicts of interest to report.

Additional information

Funding

This study was supported by the youth fund project for Humanities and Social Sciences Research of the Ministry of Education [grant numbers 18YJC630065, 15YJC630179], the General Project of Hunan Philosophy and Social Science Fund [grant numbers 17Y3A361, 15YBA299], and 2018 key scientific research projects of Hunan Provincial Department of Education [grant number 18A459].