title: 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.
  
  
  RESULTS
  22 items were included in the review. 11 types of patient safety risks associated with telecare use in homecare services emerged. These are in the main related to the nature of homecare tasks and practices, and person-centred characteristics and capabilities, and to a lesser extent, problems with the technology and devices, organisational issues, and environmental factors. Training initiatives related to safe telecare use are not described in the literature.
  
  
  CONCLUSIONS
  There is a need to better identify and describe patient safety risks related to telecare services to improve understandings of how to avoid and minimize potential harm to patients. This process can be aided by reframing known telecare implementation challenges and user experiences of telecare with the help of a human factors systems approach to patient safety.
authors.affiliation: Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway. veslemoy.guise@uis.no.
authors.forename: Veslemøy
authors.initials: V
authors.lastname: Guise
authors.affiliation: Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway. janet.anderson@kcl.ac.uk.|Florence Nightingale School of Nursing and Midwifery, Kings College London, London, UK. janet.anderson@kcl.ac.uk.
authors.forename: Janet
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway. siri.wiig@uis.no.
authors.forename: Siri
authors.initials: S
authors.lastname: Wiig
mesh_terms: D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D033262:Narration; D061214:Patient Safety / Q000706:statistics & numerical data*; D012307:Risk Factors; D017216:Telemedicine / Q000706:statistics & numerical data*