Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports

Cooper, Alison and Edwards, Adrian and Williams, Huw and Evans, Huw P. and Avery, Anthony and Hibbert, Peter and Makeham, Meredith and Sheikh, Aziz and Donaldson, Liam J. and Carson-Stevens, Andrew (2017) Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports. Age and Ageing . ISSN 1468-2834

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Abstract

Background: Older adults are frequent users of primary healthcare services, but are at increased risk of healthcare-related harm in this setting.

Objectives: To describe the factors associated with actual or potential harm to patients aged 65 years and older, treated in primary care, to identify action to produce safer care.

Design and Setting: A cross-sectional mixed-methods analysis of a national (England and Wales) database of patient safety incident reports from 2005 to 2013.

Subjects: 1,591 primary care patient safety incident reports regarding patients aged 65 years and older.

Methods: We developed a classification system for the analysis of patient safety incident reports to describe: the incident and preceding chain of incidents; other contributory factors; and patient harm outcome. We combined findings from exploratory descriptive and thematic analyses to identify key sources of unsafe care.

Results: The main sources of unsafe care in our weighted sample were due to: medication-related incidents e.g. prescribing, dispensing and administering (n = 486, 31%; 15% serious patient harm); communication-related incidents e.g. incomplete or non-transfer of information across care boundaries (n = 390, 25%; 12% serious patient harm); and clinical decision-making incidents which led to the most serious patient harm outcomes (n = 203, 13%; 41% serious patient harm).

Conclusion: Priority areas for further research to determine the burden and preventability of unsafe primary care for older adults, include: the timely electronic tools for prescribing, dispensing and administering medication in the community; electronic transfer of information between healthcare settings; and, better clinical decision-making support and guidance.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record [Cooper A, Edwards A, Williams H, Evans HP, Avery A, Hibbert P, Makeham M, Sheikh A, Donaldson LJ, Carson-Stevens A. Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports. Age and Ageing 2017; Epub ahead of print: 16 May 2017] is available online at: https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/afx044 doi:10.1093/ageing/afx044
Keywords: Patient safety; Quality improvement: Older adults; Primary care
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Primary Care
Identification Number: 10.1093/ageing/afx044
Depositing User: McCambridge, Mrs April
Date Deposited: 21 Jun 2017 11:00
Last Modified: 12 Oct 2017 23:57
URI: http://eprints.nottingham.ac.uk/id/eprint/43680

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