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

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.

Citation

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. https://doi.org/10.1093/ageing/afx044

• 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
• DOI: https://doi.org/10.1093/ageing/afx044
• Keywords: Patient safety; Quality improvement: Older adults; Primary care
• Public URL: https://nottingham-repository.worktribe.com/output/879896
• Publisher URL: https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/afx044
• 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