Patient safety risks associated with telecare: a systematic review and narrative synthesis of the literature

Abstract

Background: Patient safety risk in the homecare context and patient safety risk related to telecare are both emerging research areas. Patient safety issues associated with the use of telecare in homecare services are therefore not clearly understood. It is unclear what the patient safety risks are, how patient safety issues have been investigated, and what research is still needed to provide a comprehensive picture of risks, challenges and potential harm to patients due to the implementation and use of telecare services in the home. Furthermore, it is unclear how training for telecare users has addressed patient safety issues. A systematic review of the literature was conducted to identify patient safety risks associated with telecare use in homecare services and to investigate whether and how these patient safety risks have been addressed in telecare training. Methods: Six electronic databases were searched in addition to hand searches of key items, reference tracking and citation tracking. Strict inclusion and exclusion criteria were set. All included items were assessed according to set quality criteria and subjected to a narrative synthesis to organise and synthesize the findings. A human factors systems framework of patient safety was used to frame and analyse the results.

Safety for older adults using telecare: Perceptions of homecare professionals

“…However, a previous review of health technologies and their impact on the quality and safety of healthcare delivery identified a large gap between the postulated and empirically demonstrated benefits (Black et al, 2011). Furthermore, another review performed to identify patient safety risks associated with telecare use in homecare identified a need for more research to avoid or minimize potential harm to patients (Guise, Anderson, & Wiig, 2014). Qualitative research concerning safety in telecare use has addressed specific telecare interventions such as safety alarms (Melander-Wikman, Fältholmand, & Gard, 2008;Melkas, 2010), fall detectors and bed occupancy sensors (Horton, 2008) and smoke detectors (Doughty & Orton, 2014).…”

Evaluating a simulation-based telecare training program for home healthcare professionals: A trainee perspective

“…Regarding the first issue, it has indeed been found that technical problems and poor device quality can adversely affect the quality and safety of telecare services. [30] As this is doubtless a very real concern for healthcare professionals faced with the implementation and use of telecare services, [8] it needs to be taken seriously by home healthcare managers, telecare implementation managers, and technology providers alike. In regard to the second concern, the participants themselves were quick to note that the potential for medication errors, where patients miss a dose, take it at the wrong time, take an incorrect dose, or the incorrect medication, is not exclusive to the telecare context but rather a very common patient safety issue within the home healthcare setting in general.…”

“…[29] There have however been very few reports of simulation-based telecare training initiatives aimed at qualified healthcare professionals. [30] We have found one such study, by Rutledge and colleagues, [12] which notes positive outcomes in using standardized patient simulations to introduce registered nurses to remote nursing care via audiovisual technology. In addition, a handful of studies have found simulation to be a useful approach to telecare training aimed at pre-registration nursing students.…”

NHS in 2017: A medical profession in step with today’s NHS?

“…40 In the UK, barriers to adoption have included fears that technology may compromise patient confidentiality and undermine patient safety. [41][42][43] There are also cultural and behavioural barriers, 44 including concerns about the possible erosion of clinicians' autonomy.…”