Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review

Abstract

ObjectivesTo produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting.DesignScoping review with narrative synthesis.MethodsThe review followed the six stages of the Arksey and O’Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria—patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms.Results45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities.ConclusionPeople with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.

Responding to safe care: Healthcare staff experiences caring for a child with intellectual disability in hospital. Implications for practice and training

“…Early identification and prevention of adverse events, poor communication and management of these events such as reporting delays and omissions of care (as reported in adult, parent and child literature) or specific issues such as medication and procedural adverse events have not been identified in this review (Oulton et al, 2016, 2020; Tuffrey‐Wijne, Goulding, Giatras, et al, 2014; Tuffrey‐Wijne, Goulding, Gordon, et al, 2014). A recent scoping review by Louch et al (2021) reports the need for further research in understanding patient safety and adverse events including exploring protective factors and potential explanatory mechanisms: identifying patient safety interventions, improvement initiatives, recommendations and examples of good clinical practice for children and adults with intellectual disability (Louch et al, 2021).…”

“…A recent scoping review by Louch et al (2021) reports the need for further research in understanding patient safety and adverse events including exploring protective factors and potential explanatory mechanisms: identifying patient safety interventions, improvement initiatives, recommendations and examples of good clinical practice for children and adults with intellectual disability(Louch et al, 2021).…”

Reported clinical incidents of children with intellectual disability: A qualitative analysis

“…In a narrative synthesis of academic and grey literature by Louch et al, people with learning disabilities experienced poorer safety outcomes in hospital. However, these were ameliorated when family and carers were involved and informed staff were able to meet the needs of people with intellectual disability 32 . A scoping review conducted by Kokorelias et al 33 found that using a family‐centred care approach improved the well‐being of those with illness and/or disability and their family/caregivers through mutual inclusion, communication, and partnerships.…”

Attitudes of Registered Nurses caring for adults with intellectual and developmental disabilities in an acute care setting: A mixed method study

“…Discriminatory practices have even led to fatalities for a number of patients with I/DD (Spassiani et al, 2020). The literature highlighted: (a) persons with I/DD experienced variations in the quality of care received, (b) healthcare providers and society at large shared negative perceptions regarding disabilities, (c) knowledge deficits and attitudes were related, (d) exposure to these patients led to positive attitudes, and (e) patients with I/DD and nurses could benefit from including disability teaching in the nursing curriculum (Appelgren et al, 2018;Desroches et al,, 2019;Doyle et al, 2016;Louch 2021). Gaps in intellectual disability education resulted in inconsistencies in the preparation of nurses and quality-of-care for these patients (Appelgren et al, 2018).…”

“…Assessment problems led to nurses identifying these patients as demented or babies. With identification and assessment issues in mind, nurses would find it difficult to tailor care for this group(Louch, 2021;Spassiani, 2020). Nurses in this study reported organizational policies and systems obstacles to providing care, such as nurse-patient ratios and heavy workloads.…”