Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 325

Perhaps the most vulnerable elderly population are those who reside in care homes; here, patient safety issues are likely to be similar to those encountered in hospitals in terms of geriatric syndromes, risks associated with immobility and functional decline, and adverse drug events. There are, however, crucial differences that are likely to affect patient safety in care homes compared with hospitals: in this environment, things move at a different pace, the majority of patients are frail, responsibilities and expertise amongst staff are different, and problems with the management and diagnosis of acute problems also differ.

Falls‐prevention trials in care homes have focused on a variety of interventions. Dyer, et al. trialled a multicomponent falls‐prevention programme that showed some benefit in falls prevention but did not reach statistical significance.⁷² Although feasibility trials looked promising, a recent Cochrane meta‐analysis concluded that the evidence was uncertain regarding the effect of exercise, medication review, or multifactorial interventions on fall rates.⁷³ Care home residents are also at risk of medication‐related side effects due to multimorbidities and polypharmacy. A recent clinical trial showed that multi‐professional medication reviews improved medication appropriateness in care home residents but failed to improve clinical outcomes and were costly.⁷⁴ Embedding quality improvements by providing training and intensive facilitator support to care homes showed trends toward reducing adverse events in the Safer Provision and Caring Excellence (SPACE) programme in England.⁷⁵ Harnessing quality‐improvement techniques and allowing flexibility of interventions by empowered staff may pave the way to effective interventions.

Although large amounts of patient‐related data are created in primary care, this information is not used effectively to measure adverse events.⁷⁶ Standardised definitions of adverse events are lacking in home‐care settings, and intervention studies are sparse. This is especially true for people with dementia. A range of issues have been identified, including inter‐professional communications, medications errors, carer stress, and unclear service pathways.⁷⁷ Professionals and caregivers have different attitudes about balancing safety with autonomy and who is responsible for safety. Further research is needed in measuring patient adverse events in primary care and interventions to reduce them.