Article Figures & Data
Tables
- Table 1
Treatment in Primary Care Causing Injury and Serious and Sentinel Injury in the Elderly (Aged ≥65 Years), Adults (Aged 18–64 Years), and the Young (Aged <18 Years)
Treatment All Treatment Injuries No. (%) Serious and Sentinel Injuries No. (%) ≥65 y n = 861 18–64 y n = 2,525 <18 y n = 458 Total N = 3,844 ≥65 y n = 78 18–64 y n = 152 <18 y n = 29 Total N = 259 Medication 294 (34) 928 (37) 201 (45) 1,423 (37) 56 (72) 88 (58) 7 (24) 151 (58) Minor surgical procedures 127 (15) 207 (8) 28 (6) 362 (9) 0 (0) 4 (3) 0 (0) 4 (2) Cryotherapy 57 (7) 85 (3) 28 (6) 170 (5) 0 (0) 0 (0) 1 (3.5) 1 (0) Ear syringing 51 (6) 56 (2) 5 (1) 112 (3) 0 (0) 2 (1) 0 (0) 2 (1) Dental treatment 50 (6) 450 (18) 34 (8) 534 (14) 0 (0) 10 (7) 0 (0) 10 (4) Venipuncture 47 (5) 169 (7) 7 (1) 223 (6) 0 (0) 0 (0) 0 (0) 0 (0) Podiatry 36 (4) 14 (1) 0 (0) 50 (1) 0 (0) 0 (0) 0 (0) 0 (0) Injection 35 (4) 171 (6) 8 (2) 214 (6) 7 (9) 6 (4) 0 (0) 13 (5) Vaccination 34 (4) 83 (3) 121 (26) 238 (6) 3 (4) 2 (1) 11 (38) 16 (6) Physical examination 32 (4) 12 (0) 0 (0) 44 (1) 0 (0) 0 (0) 0 (0) 0 (0) Physiotherapy 30 (3) 114 (5) 5 (1) 149 (4) 0 (0) 2 (1) 0 (0) 2 (1) Delay or failure to diagnose or treat 24 (3) 40 (2) 13 (3) 77 (2) 9 (12) 28 (19) 9 (31) 46 (18) Chiropractic 13 (2) 68 (3) 0 (0) 81 (2) 0 (0) 5 (3) 0 (0) 5 (2) Other 31 (3) 128 (5) 8 (2) 167 (4) 3 (4) 5 (3) 1 (3.5) 9 (3) - Table 2
Medications in Primary Care Causing Injury and Serious and Sentinel Injury in the Elderly (Aged ≥65 Years), Adults (Aged 0–64 Years), and the Young (Aged <18 Years)
Medication All Medication Injuries Serious and Sentinel Medication Injuries ≥65 y n = 294 18–64 y n = 928 <18 y n = 201 Total N = 1,423 ≥65 y n = 56 18–64 y n = 88 <18 y n = 7 Total N = 151 Antibiotic 150 (51) 531 (57) 164 (82) 845 (59) 22 (39) 21 (24) 2 (29) 45 (30) NSAID 27 (9) 108 (12) 6 (3) 141 (10) 3 (5) 15 (17) 0 18 (12) ACE inhibitor 24 (9) 22 (2) 0 46 (3) 1 (2) 1 (1) 0 2 (1) Warfarin 11 (4) 4 (1) 0 15 (1) 8 (14) 2 (2) 0 10 (7) Steroid 10 (3) 18 (2) 3 (2) 31 (2) 4 (7) 8 (9) 3 (42) 15 (10) Opiates 8 (3) 12 (1) 2 (1) 22 (1) 3 (5) 1 (1) 0 4 (2) Allopurinol 7 (2) 4 (1) 0 11 (0) 3 (5) 1 (1) 0 4 (2) Statin 4 (1) 9 (1) 0 13 (0) 2 (4) 3 (3) 0 5 (3) Diuretic 4 (1) 3 (0) 0 7 (0) 1 (2) 1 (1) 0 2 (1) Aspirin 3 (1) 3 (0) 1 (0) 77 (5) 1 (2) 0 0 1 (1) Terbinafine 3 (1) 11 (1) 1 (0) 15 (1) 2 (4) 4 (5) 0 6 (4) Proton pump inhibitor 2 (1) 10 (1) 2 (1) 14 (1) 1 (2) 1 (1) 0 2 (1) Anticonvulsant 2 (1) 9 (1) 3 (2) 14 (1) 0 5 (6) 2 (29) 7 (5) Hormonal contraceptive 0 12 (1) 2 (1) 14 (1) 0 6 (7) 0 6 (4) Antidepressant, antipsychotic 0 25 (3) 2 (1) 27 (1) 0 4 (5) 0 4 (3) Other 39 (13) 147 (16) 15 (7) 201 (14) 5 (9) 15 (17) 0 20 (14) ACE = angiotensin-converting enzyme; NSAID = nonsteroidal anti-inflammatory drug.
Additional Files
The Article in Brief
Learning From No-Fault Treatment Injury Claims to Improve the Safety of Older Patients
Katharine A. Wallis
Background Patient safety is an urgent issue, particularly in the aging population and vulnerable elderly. Claims data from New Zealand's no-fault accident insurance program presents novel opportunities for learning from all types of patient safety incidents.
What This Study Found The greatest threat to older patients' safety in primary care is the risk posed by treatment itself, not error. Examination of four years of primary care treatment injury claims data showed that antibiotics were the biggest threat to safety and thus a key target for injury prevention initiatives. Most medication injuries were allergic and idiosyncratic reactions, for which there was no suggestion of error.
Implications
- The author concludes that to improve patients' safety, we need to look beyond reducing error to reducing patients? exposure to treatment risk where appropriate ? in particular the risk posed by medication, especially antibiotics.
