Integrative review: Patient safety among older people with diabetes in home care services

Abstract

Aims To identify diabetes specific patient safety domains that need to be addressed to improve home care of older people; to assess research from primary studies to review evidence on patient safety in home care services for older people with diabetes. Design An integrative review. Data Sources Domains for patient safety in diabetes home care settings were identified by conducting two searches. We performed searches in: CINAHL, Medline, Embase, and Cochrane Library for the years 2000–2017. Review Methods The first search identified frameworks or models on patient safety in home care services published up to October 2017. The second search identified primary studies about older people with diabetes in the home care setting published between 2000–2017. Results Data from the 21 articles populated and refined 13 predetermined domains of patient safety in diabetes home care. These were used to explore how the domains interact to either increase or reduce risk. The domains constitute a model of associations between aspects of diabetes home care and adverse events. The results highlight a knowledge gap in safety for older persons with diabetes, influenced by e.g. hypoglycaemia, falls, pain, foot ulcers, cognitive impairment, depression, and polypharmacy. Moreover, providers’ inadequate diabetes‐specific knowledge and assessment skills contribute to the risk of adverse events. Conclusion Older persons with diabetes in home care are at risk of adverse events due to their reduced ability to self‐manage their condition, adverse medication effects, the family's ability to take responsibility or home care service's suboptimal approaches to diabetes care.

Polypharmacy in Type 2 Diabetes Mellitus: Insights from an Internal Medicine Department

“…Moreover, suboptimal management of diabetes is frequent in the elderly who are, in many instances, homebound and are unable to control their disease in a proper manner. This increases their risk of both hypo- and hyperglycemia, which are also factors that lead to polypharmacy in advanced age [11]. Poor self-care directly influences elderly patients’ ability to achieve glycemic control, since it renders the patients unable to appropriately self-manage their disease [12].…”

Continuous glucose monitoring in older people with diabetes receiving home care—a feasibility study

“…This instrument demands more comprehensive training for study nurses to be able to perform. A recent review article highlights the gap between knowledge and understanding of safety for older people with diabetes in a home care setting [ 11 ]. The McKellar risk assessment tool identified three instances of hypoglycemia unawareness that can lead to serious complications and decreased safety, especially for those living alone.…”

“…WHO has defined patient safety as “prevention of errors and adverse effects to patients associated with health care” [ 10 ]. According to a recent literature review, there seems to be a gap between knowledge and understanding of patient safety and the risk of adverse events [ 11 ]. For people with diabetes living at home receiving secure health care, it is required that the health care personnel are able to identify symptoms to be able to take action.…”

Hypoglycemia in older people with diabetes receiving home care: A feasibility-study

“…This instrument demands more comprehensive training for study nurses to be able to perform. A recent review article highlights the gap between knowledge and understanding of safety for older people with diabetes in a home care setting (12,25). The…”

“…WHO has defined patient safety as "prevention of errors and adverse effects to patients associated with health care" (11). According to a recent literature review, there seems to be a gap between knowledge and understanding of patient safety and the risk of adverse events (12). The paper identified several interactive domains as a tool for systematic reviewing of services and to point out improvement areas.…”