Patients and caregivers play an essential role in safe ambulatory care. This mixed-methods analysis of ambulatory safety reports identified three themes related to patient and caregivers factors contributing to events – (1) clinical advice conflicting with patient priorities, (2) breakdowns in communication and patient education contributing to medication adverse events, and (3) the fact that patients with disabilities are vulnerable to due to the external environment.  

Older adults taking potentially inappropriate medications (PIMs) are at increased risk of adverse events including falls. Patients and primary care providers described their knowledge and awareness of risk of falls related to PIMs, deprescribing experiences, and barriers and facilitators to deprescribing. Patients reported lack of understanding of the reason for deprescribing, and providers reported concerns over patient resistance, even among patients with falls. Clinician training strategies, patient education, and increased trust between providers and patients could increase deprescribing, thereby reducing risk of falls. 

Medication reconciliation can improve patient safety, but prior research has documented challenges with implementation. Researchers conducted a gap analysis to inform the development of standardized medication reconciliation framework for use across multiple healthcare settings to reduce harm, including during the COVID-19 pandemic. Five key components were identified: (1) pharmacy-led medication reconciliation team, (2) patient education and involvement, (3) complete and accurate medication history, (4) admission and discharge reconciliation, and (5) interprofessional communication.

Naloxone administration is used to mitigate the effects of opioid overdose. The FDA recommends health care professionals educate patients about naloxone when prescribing opioid medications. In this audit of community pharmacists, researchers found that naloxone counseling commonly often excluded concepts important to patient safety, such as assessment of opioid misuse or abuse, possible adverse effects, and naloxone storage.

The goal of medication reconciliation is to prevent adverse events by identifying unintended medication discrepancies during transitions of care. This retrospective cohort evaluated the impact of attending a pharmacist-clinician collaborative (PCC) visit after hospital discharge with their medication containers on risk of 30-day readmission. Among adult patients on at least 10 total medications, findings indicate no significant difference in 30-day hospital readmission risk between patients presenting to a PCC visit with their medication containers compared with patients who did not. However, when patients did present to their PCC visit with medication containers, pharmacists identified more medication discrepancies and resolved more medication-related issues.

Insulin is a high-risk medication that can lead to harm if administered incorrectly. This article describes four cases highlighting the importance of providing appropriate education on injectable antidiabetic medications, common diabetes-related medication errors in primary care, identifying patients who may be at high risk and ways to prevent these errors.    

This study analyzed the association between potentially inappropriate prescribing involving opioids prescribed by dentists and emergency department visits and hospitalizations among older patients. Results indicated that a significant proportion of older patients prescribed opioids by their dentist have contraindications (such as psychotropic medication use) which places them at increased risk for 30-day hospitalizations.

The patient safety evidence base has been growing exponentially for two decades with noted expansion into the non-acute care environment. This special issue highlights eight articles illustrating the range of practices examined in the AHRQ Making Healthcare Safer III report, including rapid response teams and failure to rescue, deprescribing practices and opioid stewardship.   

National guidelines published in 2016 recommend prescribing low-dose opioids for short durations when necessary, including in dentistry practices. This cross-sectional analysis of over 500,000 commercial dental patients over a five-year period (2011-2015) examined prescribing practices prior to the recommendations and found that 29% of prescribed opioids exceeded the recommended dose for management of acute pain and half (53%) exceeded the recommended days’ supply. The authors emphasize the importance of evidence-based interventions tailored to dentistry to curtail excessive opioid prescribing.

Prior studies have identified medication errors associated with oral chemotherapy. This article discusses the evidence establishing a foundation for standardizing oral chemotherapy safe-handling education for healthcare providers, patients and caregivers. The authors provide an overview of a safe-handling checklist they developed, which consists of 12 educational components that clinicians or homecare nurses can use to facilitate patient and caregiver education.

Cancer patients often rely on family members or paid caregivers to assist with care maintenance at home, such as taking medications and mobility support. This review highlights common safety gaps in home cancer care. The authors suggest that nurses can help assess caregiver knowledge and provide education to address safety issues.

Medication safety in the ambulatory setting is an ongoing challenge, partly driven by the workload and ineffective computer systems. This commentary explores how to enhance the safety of community pharmacy practice and recommends improvements in reimbursement, quality metrics, training, electronic information tools, and staffing to achieve safe medication use at the community level.