Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports
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...
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| Format: | Article |
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Oxford University Press
2017
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| Online Access: | https://eprints.nottingham.ac.uk/43680/ |
| _version_ | 1848796743019266048 |
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| author | Cooper, Alison Edwards, Adrian Williams, Huw Evans, Huw P. Avery, Anthony Hibbert, Peter Makeham, Meredith Sheikh, Aziz Donaldson, Liam J. Carson-Stevens, Andrew |
| author_facet | Cooper, Alison Edwards, Adrian Williams, Huw Evans, Huw P. Avery, Anthony Hibbert, Peter Makeham, Meredith Sheikh, Aziz Donaldson, Liam J. Carson-Stevens, Andrew |
| author_sort | Cooper, Alison |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T19:52:49Z |
| format | Article |
| id | nottingham-43680 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:52:49Z |
| publishDate | 2017 |
| publisher | Oxford University Press |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-436802020-05-04T19:03:13Z https://eprints.nottingham.ac.uk/43680/ 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 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. Oxford University Press 2017-09-01 Article PeerReviewed Cooper, Alison, Edwards, Adrian, Williams, Huw, Evans, Huw P., Avery, Anthony, Hibbert, Peter, Makeham, Meredith, Sheikh, Aziz, 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, 46 (5). pp. 833-839. ISSN 1468-2834 Patient safety; Quality improvement: Older adults; Primary care https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/afx044 doi:10.1093/ageing/afx044 doi:10.1093/ageing/afx044 |
| spellingShingle | Patient safety; Quality improvement: Older adults; Primary care Cooper, Alison Edwards, Adrian Williams, Huw Evans, Huw P. Avery, Anthony Hibbert, Peter Makeham, Meredith Sheikh, Aziz Donaldson, Liam J. Carson-Stevens, Andrew Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports |
| title | Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports |
| title_full | Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports |
| title_fullStr | Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports |
| title_full_unstemmed | Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports |
| title_short | Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports |
| title_sort | sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports |
| topic | Patient safety; Quality improvement: Older adults; Primary care |
| url | https://eprints.nottingham.ac.uk/43680/ https://eprints.nottingham.ac.uk/43680/ https://eprints.nottingham.ac.uk/43680/ |