Evidence-Based Tool Dissemination to Assess Bruising as a Forensic Bio-Marker of Abuse in Nursing Homes

Sunday, 30 July 2017

Brenda Sheingold, PhD, MBA
School of Nursing, Geore Washington University, Washington, DC, DC, USA

Purpose: To improve the assessment of bruising as a forensic biomarker of abuse in older adults receiving healthcare in long- term care facilities.

Problem Statement: Older Americans experience between 2-5 million episodes of abuse annually in multiple forms which is under-reported.

Background: Long term care facilities are required to report allegations of abuse per the Center for Medicare and Medicaid Services. All alleged violations involving resident abuse as well as injuries of unknown origin are required to be reported no later than 24 hours following discovery (CMS, 2016). A bruise is a recognized sign of physical abuse, (DHHS, 2015), however some bruises are accidental and no effective assessment of whether bruising is indicative of abuse currently exists.

The Elder Justice Roadmap (DHHS, 2014) identifies that a strategic investment of resources toward research can expand the knowledge needed to better understand abuse and “make a difference.” A valid and reliable assessment tool would not identify all cases of physical abuse; however, the tool should assist in identifying causes that are not abuse related and wide-reaching education is needed.

Aim: To improve patient safety and support the delivery of efficient, effective, timely, and equitable patient centered care by improving the ability of all stakeholders to assess bruising as a possible sign of abuse by disseminating web-based education.

Methodology (Tool development) - Literature Search: An extensive literature review utilizing PubMed, Medline Ovid, and Cinahl databases was conducted with key words, yielding 399 articles for review. The application of inclusion and exclusion criteria narrowed the yield to 78.

Expert Identification: From the literature review, characteristics of bruises associated with intentional bruising (vs. accidental) were identified; potential experts with respect to bruise assessment and analysis also were identified within the clinical, legal, and social science disciplines.

Delphi Consensus: A list of 100 potential experts identified through the literature was narrowed to 74 based on self and/or investigator elimination. The pool was further narrowed to 68 due to poor contact information; The survey sent in one round resulting in 23 responses.

 Focus Groups: Ten groups were scheduled to review the draft bruise assessment tool.

Field Testing: Testing of the resultant tool occurred in two long term care facilities.

This phase has been completed and was funded by the Center for Medicare and Medicaid through the State of Maryland Office of Healthcare Quality.

Methodology (Tool dissemination) - The dissemination phase is to provide wide-spread education on the instrument for assessing bruises experienced by nursing home residents to determine if they may or may not have been caused by abuse.

A 20-minute documentary style educative video has been scripted and designed in partnership with WETA television studios. The aim of the video will be to raise awareness of bruising as a forensic bio-marker of abuse in nursing homes and to introduce the newly developed Bruising Assessment Rubric (BAR) to variety of stakeholders. An overview of how to utilize the tool will be included. The roll-out of this evidence based deliverable will include in-studio and field shoots, still shots of bruises, and the acquisition of all permissions/releases for production in preparation of video distribution for educational purposes.

Hosting of Video Online Training via Website will be sponsored by the Beacon Institute, 10280 Old Columbia Road, #220, Columbia, Maryland 21046. The Beacon Institute is the largest provider of education for elder care on the East Coast of the United States and trains thousands of providers annually.

Online provision of an expert educational video program to professionals, caregivers, providers and other relevant stakeholder groups with supportive competency-based testing is also planned. This phase is a work-in-progress and is currently funded by the Center for Medicare and Medicaid through the State of Maryland Office of Healthcare Quality.