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Mirarchi FL, Cammarata C, Cooney TE, et al. J Patient Saf. 2021;17(6):458-466.
Prior research found significant confusion among physicians in understanding Physician Orders for Life-Sustaining Treatment (POLST) documents, which can lead to errors. This study found that emergency medical services (EMS) personnel did not exhibit adequate understanding of all POLST or living will documents either. The researchers propose that patient video messaging can increase clarity about treatment, and preserve patient safety and autonomy.
Lopez-Pineda A, Gonzalez de Dios J, Guilabert Mora M, et al. Expert Opin Drug Saf. 2021:1-11.
Medication administration errors made by parent or caregivers can result in medication errors at home. This systematic review found that 30% to 80% of pediatric patients experience a medication error at home, and that the risk increases based on characteristics of the caregiver and if a prescription contains more than two drugs.
Stokke R, Melby L, Isaksen J, et al. BMC Health Serv Res. 2021;21(1):553.
This article explored the interface of technology and patients in home care. Researchers identified three work processes that contribute to patient safety: aligning people with technologies, being alert and staying calm, and coordinating activities based on people and technology. Topics for future research should include the division of labor on home care shifts, the need for new routines and education in telecare for care workers, and how decisions are made regarding home technology.
Carman E-M, Fray M, Waterson P. Appl Ergon. 2021;93:103339.
This study analyzed incident reports, discharge planning meetings, and focus groups with hospital and community healthcare staff to identify barriers and facilitators to safe transitions from hospital to community. Barriers included discharge tasks not being complete, missing or inaccurate information, and limited staff capacity. Facilitators include  improved staff capacity and good communication between hospital staff, community healthcare staff, and family members. The authors recommend that hospital and community healthcare staff perspectives be taken into account when designing safe discharge policies.
Aldila F, Walpola RL. Res Social Adm Pharm. 2021;Epub Apr 4.
Older adults are at increased risk of medicine self-administration errors (MSEs) due to polypharmacy, cognitive decline, and decline in physical abilities. In this review, incorrect dosing was the most common MSE; the most common factor influencing the errors is complex medication regimens due to the need for multiple medications. Additional research is needed into how community pharmacists can assist older adults at risk of MSE.

The Patient Safe-D(ischarge) program used standardized tools to educate patients about their discharge needs, test understanding of those needs, and improve medication reconciliation at admission and discharge. A quasi-randomized controlled trial of the program found that it significantly increased patients' understanding and knowledge of their diagnoses, treatment, and required follow-up care. Based on the success of this test, Patient Safe-D was incorporated as part of the Society of Hospital Medicine's Project BOOST (Better Outcomes for Older Adults through Safe Transitions) initiative which uses medication reconciliation, teach back and the Discharge Patient Education Tool (DPET) to help reduce medication-related errors. BOOST provides a full implementation toolkit to help institutions implement this and other programs to improve discharge education.

A 4-year-old (former 33-week premature) boy with a complex medical history including gastroschisis and subsequent volvulus in infancy resulting in short bowel syndrome, central venous catheter placement, and home parenteral nutrition (PN) dependence was admitted with hyponatremia. A pharmacist from the home infusion pharmacy notified the physician that an error in home PN mixing had been identified; a new file had been created for this chronic PN patient by the home infusion pharmacy and the PN formula in this file was transcribed erroneously without sodium acetate.

José A, Morfín, MD, FASN, is a health sciences clinical professor at the University of California Davis School of Medicine. In his professional role, he serves as the Medical Director for Satellite Health Care and as a member of the Medical Advisory Board for Nx Stage Medical. We discussed with him home dialysis and patient safety considerations.

Carvalho IV, Sousa VM de, Visacri MB, et al. Pediatr Emerg Care. 2021;37(4):e152-e158.
This study sought to determine the rate of pediatric emergency department (ED) visits due to adverse drug events (ADE). Of 1,708 pediatric patients, 12.3% were admitted to the ED due to ADEs, with the highest rates of admission due to neurological, dermatological, and respiratory medications. The authors recommend the involvement of clinical pharmacists to prevent and identify ADEs in the pediatric population, particularly through education of children’s caregivers and health professionals.

The Hospital at Homesm program provides hospital-level care (including daily physician and nurse visits, diagnostic testing, treatment, and other support) in a patient's home as a full substitute for acute hospital care for selected conditions that are common among seniors. Studies have shown that the Hospital at Home program results in lower length of stay, costs, readmission rates, and complications than does traditional inpatient care, whereas surveys indicate higher levels of patient and family member satisfaction than with traditional care.

Macías-Colorado ME, Rodríguez-Pérez M, Rojas-Ocaña MJ, et al. Healthcare (Basel). 2021;9(2):205.
Clear communication between patients, family caregivers, and nurses is crucial to improve patient safety in the home. This qualitative study identified four key concepts around communication of safe family caregiving: communication-related aspects, professional skills of nurse case managers, communication on safety, and the caregiving role. The authors suggest five areas for research to improve patient safety in the home.   

Care management staff (such as nurses, community health workers, health coaches, social workers, or other clinical staff) use software-based protocols to screen older clients' medications and collaborate with pharmacists and physicians to reduce the risk of medication errors and adverse effects. The HomeMeds Medication Safety Program identified and addressed targeted medication problems, leading to fewer cases of therapeutic duplication and more appropriate medication use for cardiovascular medications, NSAIDS, psychotropics and overall medication use.

ten Haken I, Ben Allouch S, van Harten WH. Nurse Educ Today. 2021;100:104813.
Adverse events are common among patients receiving home care, particularly among those requiring complex medication dosing or use of infusion devices. Results from a survey administered to home care nurses in the Netherlands reveal that nurses may not receive practical training or be tested in required skills for the use of advanced medical technologies, such as infusion therapy, parenteral nutrition, or morphine pumps.
Emonds EE, Pietruszka BL, Hawley CE, et al. J Am Pharm Assoc (2003). 2021;Epub Feb 9.
The “Hospital at Home’ program provides inpatient medical treatment (such as intravenous medications, daily laboratory monitoring, and basic imaging) to patients in their home under close clinician supervision. The authors found that integration of a pharmacist into the program enabled detection and resolution of medication discrepancies, which contributed to cost savings from medication dispensing and avoided early hospital discharge.
Gurwitz JH, Kapoor A, Garber L, et al. JAMA Intern Med. 2021;181(5):610-618.
High-risk medications have the potential to cause serious patient harm if not administered correctly. In this randomized trial, a pharmacist-directed intervention (including in-home assessment by a clinical pharmacist, communication with the primary care team, and telephone follow-up) did not result in a lower rate of adverse drug events or medication errors involving high-risk drug classes during the posthospitalization period.
Mitchell G, Porter S, Manias E. J Adv Nurs. 2021;77(2):899-909.
Oral chemotherapy regimens are complex and may lead to severe adverse drug events. Through ethnographic research, the authors found that the two most important factors in ensuring optimal management of oral chemotherapy are (1) early recognition and appropriate response to side effects and (2) maintenance of safe and effective medication communication.

Morris S, O’Hara J. Pharmacuetical Journal. February 26, 2021.

It is a challenge to track medical errors that take place in the home environment, yet it is understood they happen and can cause harm. This article discusses errors that parents make in providing medications to their children. The authors advocate for engaging parents as partners to improve care safety in the home.