Medication errors and adverse drug events are areas of high risk across the healthcare spectrum. 尽管多年来采取了多种干预措施, 与药物安全相关的问题仍然对医疗保健组织具有挑战性. 适用于家庭医疗保健组织和提供者, 由于许多原因，这些问题特别复杂, 包括护理环境和患者群体.

Unlike other healthcare settings, the home care setting is unregulated and often not well equipped or designed for the delivery of care.² For example, 药物储存区域可能很杂乱, lighting might be poor, 而且可能没有必要的补给. Additionally, the majority of people who receive home healthcare services are over the age of 65.³ 这一人群患合并症的风险增加, polypharmacy, cognitive impairment, 以及其他增加用药错误风险的问题.⁴ Individuals receiving home care also may have caregivers (family members or friends) who have cognitive impairment or other medical issues, who are overwhelmed or stressed, 和/或医疗保健培训有限的人.⁵

家庭保健中与药物管理有关的其他风险领域包括:

• 提供者(专家)之间缺乏沟通和信息共享, primary care providers, and home healthcare providers)
• 家庭保健人员缺乏能力，患者缺乏知识
• 急匆匆的护理过渡和混乱的出院说明
• 社会经济问题对患者坚持治疗造成障碍
• 支持药物管理的信息系统和技术不足
• 提供者责任与患者自主相关的问题^6\

因为在家庭环境中管理患者药物的固有风险, home healthcare organizations and providers should be vigilant about assessing risks and supporting long-lasting improvements that reduce errors and patient harm. 这将包括在组织内部工作, across healthcare settings, and with patients/caregivers.

Below are some examples of strategies that can help safeguard patients from medication errors and adverse events as well as reduce risks for organizations and providers.

• 评估家庭保健人员在药物知识方面的能力, safety processes, and best practices. Provide ongoing staff education, 并使用药物错误和药物不良事件的例子来说明潜在的风险, identify gaps, and highlight safety strategies.
• Implement protocols for transitions of care and changes in patients’ medication regimens to ensure that home healthcare providers are receiving adequate and appropriate information when patients begin or resume home care or when their treatment plans are changed. 彻底的药物调解应该是所有护理过渡的一部分, 任何药物差异或问题应在规定的时间内解决.
• Work with the home healthcare organization’s pharmacist or a consultant pharmacist to review patients’ medication regimens for potential red flags (e.g.，药物-药物相互作用，多药，和相似/相似的产品).
• Determine the most effective method for communicating patients’ medication information and any related concerns or considerations during transitions of care between home healthcare providers.
• Evaluate whether health information technology systems help facilitate or hinder the exchange of information and clear communication between providers. If the latter, work with organizational leaders, technology experts and vendors, and other involved individuals to devise long-term solutions (rather than temporary workarounds).
• 使用工具，比如医疗保险中心 & Medicaid Services’ 结果和评估信息集(OASIS), to help assess patients’ medication management capabilities and to identify patients who might be at increased risk for medication errors.
• Be cognizant of errors that might occur as a result of polypharmacy and multiple providers prescribing medications to an individual patient. Coordinate with the patient’s providers to determine whether deprescribing might be beneficial to the patient and reduce the risk of errors or adverse drug events.
• 教育患者/护理人员与药物相关的风险, 并建议他们保持最新的药物清单的重要性. 许多组织，如 保健改善研究所 and the 医疗保健研究和质量机构，为创建药物清单提供指导和可编辑的模板.
• Encourage patients to take their medication lists to every medical appointment and to have their providers document any medication changes on the list (to help the patient remember, 并使其他提供者/护理人员意识到).
• Develop visual aids, such as charts or diagrams, 帮助病人跟踪他们的药物治疗方案. 确保文字简单，足够大，便于阅读，并且使用患者喜欢的语言. 列出每种药物的通用名和品牌名, 病人应该何时服用每种药物, and the indication for use. 考虑附上每种药物的图片以供参考.
• Evaluate medication storage areas in patients’ homes to identify potential risks and to ensure that medications are being stored appropriately (e.g.(如有需要，存放于阴凉干燥处或冰箱内).
• Make sure patients who use pill boxes understand how they work and are capable of correctly filling them (or have caregivers who can correctly fill them). Advise patients to keep pill boxes in a separate location from medication bottles to avoid mix-ups and duplicate doses.
• Devise strategies and pathways for clear communication between prescribing providers and home healthcare providers to ensure that patients’ pill boxes are promptly updated when changes occur in medication regimens.
• 教育患者/护理人员不按时服药的风险, altering medication doses (e.g.(将药片切成两半)，或者在治疗方案结束前停止用药. 找出可能导致这些行为的障碍.g., transportation or financial issues), and seek community-based services that can assist patients (e.g.、送货或邮购处方、财务规划等.).
• 如果健忘是病人的问题, explore different types of reminders (visual and electronic) to help cue patients to take their medications at the appropriate times.⁷

In Summary

由于护理环境的原因，家庭医疗中的药物管理是复杂的, the patient population, and various other factors. Home healthcare organizations and providers can implement strategies to help reduce the risk of medication errors and patient harm in the home care setting. 战略应侧重于教育提供者和患者/护理人员, 加强沟通和信息共享, and identifying and addressing potential barriers or risks that could lead to medication errors.

Endnotes

¹ Mager, D. R. (2007). 药物错误和家庭护理病人. 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). Homecare safety and medication management: A scoping review of the quantitative and qualitative evidence. JBI系统审查和执行报告数据库，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). 预防药物错误的过渡护理:一个病人的情况下的做法. Pharmacy Today, 21(3), 79–90. doi: 10.1331/JAPhA.2015.15509

⁵ Godfrey, et al., Homecare safety and medication management: A scoping review of the quantitative and qualitative evidence.

⁶ Berland, A., & Bentsen, S. B. (2017). 家庭护理中的用药错误:一项定性焦点小组研究. Journal of Clinical Nursing, 26(21-22), 3734–3741; Mager, 药物错误和家庭护理病人; Godfrey, et al., Homecare safety and medication management: A scoping review of the quantitative and qualitative evidence.

⁷ Mager, 药物错误和家庭护理病人; Lindblad, M., Flink, M. & Ekstedt, M. (2017)，专业家庭医疗保健的安全用药管理——一项观察性研究. BMC Health Services Research, 17, 598. http://doi.org/10.1186/s12913-017-2556-x; USP Quality Matters. (2015, March 11). 在家庭健康环境中用药安全的5个提示. Retrieved from http://qualitymatters.usp.org/5-tips-medication-safety-home-health-environment

This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. 因为适用于你的情况的事实可能会有所不同, 或者您所在司法管辖区适用的法律可能不同, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions.

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