药物错误和药物不良事件是整个医疗保健领域的高风险领域. Despite a diverse range of interventions over the years, issues related to medication safety still prove challenging for healthcare organizations. For home healthcare organizations and providers, these issues are particularly complex for numerous reasons, including the care setting and the patient population.

Unlike other healthcare settings, 家庭护理环境不受监管，而且往往没有很好的设备或设计来提供护理.² For example, medication storage areas might be cluttered, lighting might be poor, and necessary supplies might not be available. 此外，接受家庭保健服务的大多数人年龄在65岁以上.³ This population is at increased risk for comorbidities, polypharmacy, cognitive impairment, and other issues that increase the risk of medication errors.⁴ 接受家庭护理的个人也可能有有认知障碍或其他医疗问题的照顾者(家庭成员或朋友), who are overwhelmed or stressed, and/or who have limited healthcare training.⁵

Other areas of risk related to medication management in home healthcare include:

• Poor communication and lack of information sharing between providers (specialists, primary care providers, and home healthcare providers)
• Lack of competency among home healthcare staff and knowledge deficits among patients
• Rushed transitions of care and confusing discharge instructions
• Socioeconomic issues that create barriers to treatment adherence for patients
• Inadequate information systems and technology to support medication management
• Issues associated with provider responsibility versus patient autonomy^6\

Because of the risks inherent in managing patients’ medications in the home setting, 家庭医疗保健组织和提供者应该对评估风险保持警惕，并支持长期改进，以减少错误和对患者的伤害. This will involve working within the organization, across healthcare settings, and with patients/caregivers.

以下是一些策略的例子，可以帮助保护患者免受药物错误和不良事件的影响，并降低组织和提供者的风险.

• Assess the competency of home healthcare staff in relation to medication knowledge, safety processes, and best practices. Provide ongoing staff education, and use examples of medication errors and adverse drug events to illustrate potential risks, identify gaps, and highlight safety strategies.
• 实施护理过渡和患者用药方案变更的协议，以确保家庭保健提供者在患者开始或恢复家庭护理或其治疗计划发生变化时获得充分和适当的信息. Thorough medication reconciliation should be part of all transitions of care, and any medication discrepancies or problems should be resolved within a specified timeframe.
• 与家庭保健机构的药剂师或顾问药剂师一起审查患者的药物治疗方案，以发现潜在的危险信号.g., drug–drug interactions, polypharmacy, and look-alike/sound-alike products).
• 确定沟通患者药物信息的最有效方法，以及家庭医疗保健提供者之间护理过渡期间的任何相关问题或考虑因素.
• 评估卫生信息技术系统是否有助于促进或阻碍提供者之间的信息交流和明确沟通. If the latter, work with organizational leaders, technology experts and vendors, 和其他相关人员一起设计长期解决方案(而不是临时的权宜之计).
• Use a tool, such as the Centers for Medicare & Medicaid Services’ Outcome and Assessment Information Set (OASIS), 帮助评估患者的药物管理能力，并识别可能增加药物错误风险的患者.
• 认识到可能由于多种用药和多个提供者给单个患者开药而发生的错误. 与患者的医疗服务提供者协调，以确定处方解除是否可能对患者有益，并减少错误或药物不良事件的风险.
• Educate patients/caregivers about risks associated with medications, and advise them of the importance of keeping up-to-date medication lists. Numerous organizations, such as the Institute for Healthcare Improvement and the Agency for Healthcare Research and Quality, offer guidance and editable templates for creating medication lists.
• 鼓励患者在每次医疗预约时都带着他们的药物清单，并让他们的医生在清单上记录任何药物变化(以帮助患者记住), and to make other providers/caregivers aware).
• Develop visual aids, such as charts or diagrams, to help patients keep track of their medication regimens. Make sure text is simple, large enough to read, and in the patient’s preferred language. List the generic and brand names of each medication, when the patient should take each medication, and the indication for use. Consider including a picture of each medication for reference.
• 评估患者家中的药物储存区域，以识别潜在风险，并确保药物被妥善储存.g., in a cool dry space or in a refrigerator if necessary).
• 确保使用药盒的患者了解药盒的工作原理，并能够正确地填满药盒(或者有能够正确填满药盒的护理人员)。. 建议患者将药盒与药瓶分开存放，以避免混淆和重复剂量.
• 为处方提供者和家庭保健提供者之间的明确沟通制定策略和途径，以确保在药物治疗方案发生变化时及时更新患者的药盒.
• Educate patients/caregivers about the risks associated with skipping medication doses, altering medication doses (e.g., cutting pills in half), or stopping medications before the end of the treatment regimen. Identify barriers that might lead to these behaviors (e.g.(如交通或财务问题)，并寻求能够帮助患者的社区服务.g., delivery or mail-order prescriptions, financial planning, etc.).
• If forgetfulness is an issue with patients, 探索不同类型的提醒(视觉和电子)，以帮助提示患者在适当的时间服用药物.⁷

In Summary

Medication management in home healthcare is complex due to the environment of care, the patient population, and various other factors. 家庭医疗保健组织和提供者可以实施策略，以帮助减少家庭护理环境中药物错误和患者伤害的风险. Strategies should focus on educating both providers and patients/caregivers, improving communication and information sharing, 识别和解决可能导致用药错误的潜在障碍或风险.

Endnotes

¹ Mager, D. R. (2007). Medication errors and the home care patient. Home Healthcare Nurse, 25(3), 151–155. Retrieved from http://nursing.ceconnection.com/ovidfiles/00004045-200703000-00003.pdf

² Godfrey, C. M., Harrison, M. B., Lang, A., Macdonald, M., Leung, T., & Swab, M. (2013). 家庭护理安全和药物管理:定量和定性证据的范围审查. JBI Database of Systematic Reviews and Implementation Reports, 11(2), 357–371.

³ Michas, F. (2021, October 27). Home care in the U.S. — statistics & facts. Statista. Retrieved from www.statista.com/topics/4049/home-care-in-the-us/

⁴ Johnson, A., Guirguis, E., & Grace, Y. (2015). Preventing medication errors in transitions of care: A patient case approach. Pharmacy Today, 21(3), 79–90. doi: 10.1331/JAPhA.2015.15509

⁵ Godfrey, et al., 家庭护理安全和药物管理:定量和定性证据的范围审查.

⁶ Berland, A., & Bentsen, S. B. (2017). Medication errors in home care: A qualitative focus group study. Journal of Clinical Nursing, 26(21-22), 3734–3741; Mager, Medication errors and the home care patient; Godfrey, et al., 家庭护理安全和药物管理:定量和定性证据的范围审查.

⁷ Mager, Medication errors and the home care patient; Lindblad, M., Flink, M. & Ekstedt, M. (2017), Safe medication management in specialized home healthcare – an observational study. BMC Health Services Research, 17, 598. http://doi.org/10.1186/s12913-017-2556-x; USP Quality Matters. (2015, March 11). 5 tips for medication safety in the home health environment. Retrieved from http://qualitymatters.usp.org/5-tips-medication-safety-home-health-environment

本文件不构成法律或医疗建议，不应被解释为规则或建立护理标准. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, 如果您对您的法律或医疗义务或权利有任何疑问，请联系您的律师或其他专业顾问, state or federal laws, contract interpretation, or other legal questions.

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