Safety in Homecare: A focus on medication management

Patient safety is a current national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. Medication safety requires the integrity of a complex series of interrelated steps, such that failure to adequately assess, prescribe, dispense, and monitor them can potentially lead to adverse events and harm. Human beings are fallible as they receive, transmit and act upon information related to medication in the home care environment. Understanding what factors contribute to, and/or reduce the risk of, adverse drug events in this setting will enable the identification and promotion of safer medication administration practices (whether client or caregiver administered). Compromised safety in medication management can be extremely costly to patients, healthcare professionals, and the healthcare system. Our perspective on the research to date is that the unique nature of private homes and communities as well as the multiple inter-relationships among clients, family members, unpaid caregivers, and home care staff constitute a complex socio-ecological phenomenon in terms of medication safety management. Providers can engage clients and families in conversations and collaborate with them to mitigate risks; but the nature of the home setting requires clients, family members, and caregivers to regularly exercise autonomous decisions about medications in the context of minimal professional as well as frequently strained or absent home and community supports. The proposed study will: 1) help to illustrate the breadth and depth of risks that seniors, their family members/caregivers, and providers currently encounter in terms of medication management; and 2) illuminate the strategies that seniors and their caregivers presently use to mitigate those risks.