Designing safer systems of care delivery for older patients

A new study published in Age & Ageing, the scientific journal of the British Geriatrics Society, identified incidents when poor communication between secondary and primary care and failures within primary care led to patient harm and highlights how improved communications systems could help protect older patients from harm. Timely electronic transfer of information with standardised formats could reduce medication and clinical decision-making incidents. Electronic alerts and expanded use of bar-coding are examples of systems which could tackle drug administration incidents.

Older adults are frequent users of primary healthcare services and account for half of all 340 million general practice consultations in the United Kingdom each year.  The study was conducted by researchers at Cardiff University School of Medicine and examined 1,591 patient safety reports relating to patients aged over 65 in England and Wales over an eight year period.

Previous studies have described other potential solutions to prevent medication incidents including ‘deprescribing’ to address polypharmacy, as well as shared decision-making including with family and carers. Validated medication review tools are available to assist this process, which can include pharmacists. Emerging technology that permits community-based point of care testing is reducing unsafe anticoagulation treatments, and could be expanded to other treatments.

This study suggests that new multidisciplinary community-based care communications, with improved access to specialist geriatric advice, may improve complex clinical decision-making and management of multiple serious health conditions, thereby reducing harm to older patients. The study recommends that local protocols within the multidisciplinary team should ensure an effective system of investigation result follow-up, especially for those patients unable to take ownership of their own results.

Dr Andrew Carson-Stevens, Patient Safety Research Lead at the Primary and Emergency Care Research Centre at Cardiff University School of Medicine, and author of the Age & Ageing paper, said:

“Safe, high quality care is delivered in primary care every day. However, patient safety incident reports provide us with a means of learning about what changes could be needed, and how we might go about designing safer systems of care delivery for older patients. The study highlights weaknesses in the current healthcare system that must now form the basis of further research and improvement activity. As more older adults are being treated in community settings, healthcare systems must be designed to meet the needs of the population served.”

The Age & Ageing paper can be viewed here: https://academic.oup.com/ageing/article-abstract/doi/10.1093/ageing/afx044/3572914/Sources-of-unsafe-primary-care-for-older-adults-a?redirectedFrom=fulltext

 

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