Background
Patient safety risk related to telecare services
Patient safety research in the homecare setting
The role of training in the mitigation of patient safety risks
Aim
Methods
Design
Search methods
#1 | Telecare OR telehealth OR telemedicine OR telehomecare OR telenursing OR videophone OR video conferencing OR video visits OR virtual visits OR televisits OR telecommunication |
#2 | Patient risk OR patient safety OR patient harm OR quality OR adverse event OR undesired event OR medical error |
#3 | Homecare OR Home care services OR home-based care OR community health service OR community dwelling |
#4 | Training* OR education* OR simulation* |
#5 | 1 AND #2 AND #3 AND #4 |
#6 | Limit #5 to English language |
Search outcome
Data extraction
Quality appraisal
Synthesis
Results
Included studies
Risks to patient safety
Author and year | Purpose of study | Study design (& methods) | Study participants | Type of telecare service/system described | Source of potential risk to patient safety |
---|---|---|---|---|---|
To investigate perceptions of the safety, security and privacy of a telecare monitoring system | Survey | 127 different stakeholders | Telecare monitoring for adults with developmental disabilities | Change in nature of clinical work | |
To analyse the impact of telehealth implementation on front-line nursing staff | Systematic review | Nursing staff | Telehealth technologies for the management of COPD and CHF | Change in nature of clinical work | |
Changes to staff workload | |||||
To examine the acceptability, effectiveness and reliability of home telemonitoring | Controlled pilot study | 20 patients | Pulse and blood pressure devices, video consultation equipment | Technology issues | |
Patient dependency | |||||
To explore constituents and challenges related to innovation of technology-based services in the long-term homecare sector | Case study (Focus groups, interviews, observation) | Home-help managers and home-help staff and 10 operational/managerial staff | Sensor-based telemonitoring system | Lack of user knowledge (patients and staff) | |
Changes to workload | |||||
Lack of guidelines | |||||
To explore experiences of users taking part in a RCT of remote blood pressure (BP) tele-monitoring. To identify facilitators or barriers to the effectiveness and routine uptake of the intervention | Qualitative interview study | 25 patients, 11 nurses and 9 doctors | A home BP monitor and mobile phone technology for transfer of BP readings via SMS to a secure website | Patient anxiety | |
Patient dependency | |||||
Poor system integration | |||||
Changes to workload | |||||
Accessibility issues | |||||
To document responses of nurses using telehealth equipment and identify service integration issues | Ethnography (observation) | 12 nurses | A home telehealth nursing service for COPD patients, using videophone and vital signs monitoring | Technology issues | |
Change in nature of clinical work | |||||
To examine staff perceptions of opportunities and barriers of home-based telemedicine services for chronic illness care | Qualitative interview study | 37 direct telemedicine providers, primary care providers and hospital administrators | Store-and-forward devices, video conferencing devices | Lack of user knowledge (patients and staff) | |
Technology issues | |||||
Poor patient compliance | |||||
Change in nature of clinical work | |||||
Changes to workload | |||||
To evaluate a home telecare service for COPD patients | Qualitative study (focus groups and case study) | 4 home care team and social care staff and 6 patients | Daily monitoring of patients’ condition via call centre with community response service | Technology issues | |
Lack of user knowledge (patients and staff) | |||||
To describe the use of home telehealth care for chronic disease management from users’ perspective | Qualitative study (focus groups and interviews) | 20 patients | Telemonitoring of BP and/or blood sugar, provision of health care/consultations with healthcare professionals via computer or telephone | Lack of user knowledge (patients) | |
To perform a process evaluation of a RCT of home telecare for the management of COPD | Qualitative interview study | 9 patients and 11 nurses | A videophone link and attachments for remote physiological monitoring of vital signs | Change in nature of clinical work | |
Changes to workload | |||||
To assess frequencies of reporting adherence to professional practice standards and research ethics in studies of technology-based home healthcare programmes | Systematic review | 107 articles describing studies on the use of telecare, featuring a variety of staff and/or service users | Medical symptom monitoring using synchronous technology | Lack of guidelines | |
To describe two district nurses’ experiences of using ICT to communicate with chronically ill people in their homes | Qualitative interview study | 2 district nurses | An electronic messaging system to communicate with patients | Technology issues | |
To explore perceptions on effectiveness of telehealth for heart failure management in a homecare setting | Mixed-methods (focus groups, interviews and questionnaire) | 44 nurses and 4 patients | A centralized model of daily telemonitoring of vital signs by a telehealth nurse, with in-person follow-up if needed | Patient anxiety | |
Patient dependency | |||||
Lack of user knowledge (patients) | |||||
Changes to workload | |||||
Change in nature of clinical work | |||||
Lack of guidelines | |||||
To evaluate a telehealth programme for long-term conditions | Mixed-methods (questionnaire and interview) | Patients, carers and 10 medical, healthcare and managerial staff | Home-based touch screen facilities for clinical monitoring for COPD and hypertension patients | Changes to workload | |
To understand the experiences of providers and the factors perceived to contribute to the success of telehealth interventions and user satisfaction | Qualitative interview study | 10 telemedicine providers (nurses and dietitians) | A telemedicine unit with video-conferencing, blood glucose and blood pressure readings and educational materials | Technology issues | |
Lack of user knowledge (patients) | |||||
Change in nature of clinical work | |||||
To examine the relationship between communication and information integration into the daily lives of patients with chronic illnesses and offer best practice recommendations for telehomecare nurses | Descriptive, correlational study | 43 patients and 9 telehomecare nurses | Telemonitoring; patients interact with nurses using a telestation that collects and transfers data via telephone lines | Lack of user knowledge (patients and staff) | |
To investigate how project risk management was applied in 9 mobile computing projects and how it shaped project outcomes | Case studies (mixed-methods) | 57 project leaders, nurse users and nurse pilots from 9 homecare units | Mobile technology software for planning and organization of homecare nursing activities | Technology issues | |
Poor system integration | |||||
Changes to workload | |||||
To describe influences, benefits, and limitations in using ICT to meet chronically ill patients’ needs when living at home | A descriptive, exploratory pilot study | 2 patients, 1 relative, 1 district nurse and 5 personal assistants | An application for information and communication between chronically ill people and the district nurse | Change in nature of clinical work | |
Technical issues | |||||
To describe the reasoning among general practitioners about the use of mobile distance-spanning technology (MDST) in care at home and in nursing homes | Qualitative interview study | 17 doctors | Mobile distance-spanning technology for communication and diagnostic purposes | Change in nature of clinical work | |
Lack of user knowledge (patients) | |||||
To describe how people in need of health care at home view technology | Qualitative interview study | 9 patients | Distance-spanning technology with mobile devices to measure vital signs | Poor patient compliance | |
Lack of user knowledge (patients) | |||||
Accessibility issues | |||||
Change in nature of clinical work | |||||
To seek accurate patient perspectives about benefits and challenges of a care coordination/home telehealth program | Mixed-methods (survey and interviews) | 25 patients | Messaging devices, monitoring and measuring devices, video-phones and PCs | Accessibility issues | |
To analyse human factors and ergonomics issues encountered during the design and implementation of home-based consumer IT applications | Case studies (analysis of documents and discussion notes) | 5 home-based consumer IT application projects | Various IT applications including videophone, messaging systems and health monitoring devices | Technology issues | |
Unsafe device arrangements |