@article { , title = {Sources of unsafe primary care for older adults: A mixed-methods analysis of patient safety incident reports}, abstract = {© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. 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.}, doi = {10.1093/ageing/afx044}, eissn = {1468-2834}, issn = {0002-0729}, issue = {5}, journal = {Age and Ageing}, pages = {833-839}, publicationstatus = {Published}, publisher = {Oxford University Press}, url = {https://nottingham-repository.worktribe.com/output/879896}, volume = {46}, keyword = {Patient safety, Quality improvement: Older adults, Primary care}, year = {2017}, author = {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} }