Patient Safety in Home Care Research, Education, and Assessing Care for Home Care Safety (REACHomeS) Final rept. (Sept. 30, 2001-Sept. 29, 2004)

摘要

The aim was to establish a center to study medication errors in home health care. We developed educational programs on the medication errors and conducted three pilot studies. We developed a cd on medication errors in home care. We conducted home care RN focus groups and a drug utilization review (DUR) study about RN assessment and monitoring of harmful drug duplication and interactions using an automated alert system. We also analyzed MEPS home care data. The retrospective cohort design drug study with random selection of 300 discharged patients with diabetes or hypertension included a review of 300 records, followed by RN chart abstraction of 65 records and expert review by a nurse practitioner and pharmacist. In focus groups RNs identified (1) poly-pharmacy, (2) lack of patient knowledge, (3) multiple physicians, (4) cost of medications, (5) patient's lack of trust for health care provider, (6) lack of communication, and (7) mail order drugs as medication problems. For drug study the alert system generated many not very serious alerts. However, expert reviewers judged that 41% of high-risk diabetes patients and 54% of high-risk hypertension patients did generate alerts that required nurse follow-up. Furthermore, a sizable proportion did not receive it, and 8-11% evidenced potentially medication-related symptoms.