Department of Health- and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
Centre for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.
J Adv Nurs. 2019 Nov;75(11):2449-2460. doi: 10.1111/jan.13993. Epub 2019 Apr 30.
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.
An integrative review.
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.
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.
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.
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.
确定需要解决的糖尿病特定患者安全领域，以改善老年人的家庭护理；评估来自初级研究的证据，以审查为患有糖尿病的老年人提供家庭护理服务的患者安全情况。
综合审查。
通过进行两次搜索确定了糖尿病家庭护理环境中患者安全的领域。我们在 2000 年至 2017 年期间在 CINAHL、Medline、Embase 和 Cochrane Library 中进行了搜索。
第一次搜索确定了截至 2017 年 10 月发布的家庭护理服务中患者安全的框架或模型。第二次搜索确定了 2000 年至 2017 年期间在家庭护理环境中患有糖尿病的老年人的原始研究。
21 篇文章中的数据充实和完善了 13 个糖尿病家庭护理患者安全的预定领域。这些领域用于探讨这些领域如何相互作用以增加或降低风险。这些领域构成了糖尿病家庭护理各个方面与不良事件之间关联的模型。研究结果突出表明，由于低血糖、跌倒、疼痛、足部溃疡、认知障碍、抑郁和多药治疗等因素，患有糖尿病的老年人在安全方面存在知识差距。此外，提供者对糖尿病的知识不足和评估技能不足也会增加不良事件的风险。
由于自身管理病情的能力下降、药物不良反应、家庭承担责任的能力或家庭护理服务对糖尿病护理的方法不当，家庭护理中的老年糖尿病患者有发生不良事件的风险。
