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

Cooper, Alison; Edwards, Adrian; Williams, Huw; Evans, Huw P.; Avery, Anthony; Hibbert, Peter; Makeham, Meredith; Sheikh, Aziz; Donaldson, Liam J.; Carson-Stevens, Andrew


Alison Cooper

Adrian Edwards

Huw P. Evans

Peter Hibbert

Meredith Makeham

Aziz Sheikh

Liam J. Donaldson

Andrew Carson-Stevens


© 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.


Cooper, A., Edwards, A., Williams, H., Evans, H. P., Avery, A., Hibbert, P., …Carson-Stevens, A. (2017). Sources of unsafe primary care for older adults: A mixed-methods analysis of patient safety incident reports. Age and Ageing, 46(5), 833-839.

Journal Article Type Article
Acceptance Date Feb 14, 2017
Online Publication Date Apr 11, 2017
Publication Date Sep 1, 2017
Deposit Date Jun 21, 2017
Publicly Available Date Jun 21, 2017
Journal Age and Ageing
Print ISSN 0002-0729
Electronic ISSN 1468-2834
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 46
Issue 5
Pages 833-839
Keywords Patient safety; Quality improvement: Older adults; Primary care
Public URL
Publisher URL
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: doi:10.1093/ageing/afx044


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