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BACKGROUND: In order to cognitively and physically activate people with dementia (MMD) in institutional settings, there are numerous touch-based multimedia applications specifically designed for this target group that are actually being used in practice. In contrast, the use of similar applications in domestic settings has been relatively limited. AIM AND METHOD: This study is based on 11 expert interviews guided by questions and examines design options and requirements for application content as well as requirements for study designs to provide evidence of the effectiveness of touch-based multimedia applications for MMD and their caregiving relatives (PA). RESULTS: There is a high degree of consensus regarding the criteria for requirements for touch-based multimedia applications. Acceptance is highly dependent on user competence, usage practices, experiences and incentive structures; however, there are diverse opinions about their structural and content-related design. The quality of life is mentioned as an essential evaluation parameter for multimedia applications. DISCUSSION: The highly variable individual life circumstances of MMD and their PAs, along with limited access options and a lack of suitability of the multimedia applications, may be causal factors for their relatively limited use, especially in domestic settings. Daily performance capabilities and individual disease progression pose special requirements for the scientific evaluation and the demonstration of the effectiveness of touch-based multimedia applications.

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OBJECTIVE: The aim of the study is to validate and adapt the "Knowledge Attitute and Behaviour in the administration of medication in the home care setting questionnaire" in the home care setting in Cordoba, Spain, through a cross-validation process. DESIGN: Cross-sectional study SAMPLE: 106 community nurses provide home care in Cordoba, and are involved in the management of the medication process in the patient's home. MEASUREMENTS: Community nurses' knowledge, attitudes, and behaviors toward medication error prevention strategies in-home care. RESULTS: For the evaluation of psychometric properties, Cronbach's α was calculated, which returned a value of 0.639, showing good internal consistency. Most participants agreed that the home care setting increases the risk of medication errors. CONCLUSION: The study, underscores the importance of analyzing the phenomenon of medication errors in the home care setting. The characteristics and peculiarities of a home care setting are different from a hospital setting, which means that factors such as the environment, the figures involved in the care process (caregivers and/or family members), and the way in which they communicate with the rest of the multi-professional team can influence both the type of errors and the likelihood of their occurrence.

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BACKGROUND: Several preventive medications and supplements become inappropriate in the last phase of life due to increased risk of adverse events caused by changed pharmacokinetics, drug-drug interactions, and changed care goals. Information on these preventive medication and supplements use in patients with a life-limiting illness in the home-care setting is limited. The primary aim of this study was to assess the use of four different groups of preventive drugs and supplements, which are inappropriate in adult patients with a life-limiting illness, living at home in the last year of life. The secondary aims were to assess reasons for discontinuing these drugs as documented in the general practitioners' patient file and whether these reasons affected the time between medication discontinuation and death. METHODS: We performed a retrospective cohort study using the routine primary care database of the Julius General Practitioners' Network of the University Medical Centre Utrecht, a database consisting of routine care data from GPs from the city of Utrecht and its vicinity. Patients in the homecare setting with a life-limiting illness, diagnosed at least one year before death, were included. Descriptive analyses were used to describe the study population and the frequency of starting, using, and discontinuing medication and supplements in the last year of life. RESULTS: A total of 458 of 666 included patients (69%) used at least one preventive drug in the last year of life. Vitamins were used by 36% of the patients, followed with 35% using cholesterol-lowering medication, 24% using calcium supplements and 9% using bisphosphonates. Bisphosphonates were discontinued by 70% of the users, calcium supplements by 61%, vitamins by 56% and cholesterol-lowering medication by 48% of the users, with a median interval between day of discontinuation and death of 119, 60, 110 and, 65 days, respectively. The median time between medication or supplement discontinuation and death was longest in patients with side effects and who had medication reviews. CONCLUSION: Many patients in their last phase of life in the home-care setting use inappropriate medication and supplements. Timely medication review may contribute to optimise medication use in the last year of life.

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BACKGROUND: Inappropriate management of medications is a major threat to homebound patients with chronic conditions. Despite many efforts in improving medication reconciliation in ambulatory and inpatient settings, little research has focused on home care settings. In 2016, Taiwan initiated the Integrated Home Health Care programme, which was intended to reduce potentially inappropriate medication management and risks of uncontrolled polypharmacy through the integration of different medication sources for chronic conditions among homebound patients. This study investigated factors associated with having home care physicians as an integrated source of medications for chronic conditions among homebound patients. METHOD: This retrospective cohort study enrolled 3142 community-dwelling homebound patients from Taipei City Hospital. Homebound patients' adherence to using home care physicians as an integrated source of chronic condition medications was defined as having all prescriptions for their chronic conditions prescribed by a single home care physician for at least 6 months. Both patient and home care physician characteristics were analysed. Multivariable logistic regression was applied. RESULTS: Of the 3142 patients with chronic conditions, 1002 (31.9%) had consistently obtained all medications for their chronic illnesses from their home care physicians for 6 months and 2140 (68.1%) had not. The most common chronic diseases among homebound patients were hypertension, diabetes mellitus, dementia, cerebrovascular disease and constipation. Oldest-old patients with poor functional status, fewer daily medications, no co-payment exemption and no recent inpatient experience were more likely to adhere to this medication integration system. In addition, patients whose outpatient physicians were also their home care physicians were more likely to adhere to the system. CONCLUSIONS: The finding suggests that building trust and enhancing communication among homebound patients, caregivers and home care physicians are critical. Patient and provider variations highlight the need for further improvement and policy modification for medication reconciliation and management in home care settings. The improvement in medication management and care integration in home care settings may reduce misuse and polypharmacy and improve homebound patients' safety.

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Many studies analyze the medication errors in the hospital setting, but the literature involving the home care setting seems scarce. The aim of this study is to identify the main risk factors that affect the genesis of medication errors and the possible solutions to reduce the phenomenon in the home care setting. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The critical analysis of the literature shows that medication errors in home care occur mainly during transitional care. The main risk factors related to transitional care are poor interprofessional communication, lack of a standardized process for medication reconciliation, the widespread use of computerized tools, and the inadequate integration of the pharmacist into the care team. The strategies to reduce the risk of errors from therapy at home are the implementation of the pharmacist in the health team to ensure accurate medication reconciliation and the use of computerized tools to improve communication between professionals and to reduce the dispersion of information.

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OBJECTIVE: Medication errors are a concern in overall the world. Although there are studies that investigate what may be the main causes that lead to the genesis of the medication error in the home care setting, there is no tool that correlates knowledge, attitudes, and behavior to medication errors in the context of home care. This study aimed to psychometrically test to the questionnaire on knowledge, attitudes, and behaviors in the administration of medication in the new setting: home care setting. DESIGN: This observational study was reported according to the STROBE checklist. SAMPLE: Sixty two nurses working in home care setting responded to the online survey. MEASUREMENT: The face and content validity of the items generated was assessed. An Exploratory Factorial Analysis descriptive statistical analysis was conducted. The final questionnaire is composed of 20 items. RESULTS: The results of the statistical analyses allowed to validate the questionnaire, ensuring good internal consistency and reliability. Most of the sample pointed out that the use of electronic health record, medication reconciliation and the pharmacist's figure are all useful strategies for reducing the risk of medication errors. CONCLUSION: The questionnaire is reliable to measure knowledge, attitude, and behavior about medication errors prevention in home care settings.

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Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients' homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients' higher care-need levels affected the higher number of adverse events in home-care nursing agencies.

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BACKGROUND: Process evaluation addresses the implementation, mechanisms of impact, and context of participants in complex interventions. The STADPLAN study assesses the effects of conversations on advance care planning (ACP) led by trained nurse facilitators. The complex intervention consists of several components that may lead to various changes in attitude and behavior regarding personal ACP activities. With the process evaluation, we aim to assess how changes were achieved in the STADPLAN intervention. METHODS: The planned process evaluation study will be conducted alongside a cluster-randomized controlled trial on ACP in home care services (HCS). Trained nurse facilitators will deliver the ACP intervention consisting of an information brochure and two ACP conversations. A logic model depicts the assumed change processes of the intervention: the educational program enables nurses to conduct ACP conversations with patients and their caregivers. Patients gain knowledge and reflect upon and engage in their own ACP. Caregivers better understand patients' wishes and feel reassured in their role as surrogates. Designation of a surrogate and communication on ACP are facilitated. We will assess the effects of the educational program with questionnaires and a focus group including all participating nurses. We will measure ACP engagement, and prevalence of advance directives in patients, and ask for their experiences with the intervention. We will conduct semi-structured interviews with caregivers about their expectations and experiences regarding ACP in general and the intervention. We will address context factors, e.g., basic characteristics of the HCS (such as ownership, number of clients, staff and qualification). Analysis will be based upon the logic model, integrating qualitative and quantitative data. DISCUSSION: The comprehensive process evaluation will provide essential information on the feasibility of implementation strategies and the clinical relevance of a nurse-led ACP intervention in home care recipients and its generalizability and transferability to other settings. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00016886 . Registered retrospectively on June 4, 2019, first participant included on May 29, 2019.

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BACKGROUND: In Germany, advance care planning (ACP) was first introduced by law in 2015. However, ACP is still uncommon in Germany and only few people have advance directive forms. This study aims to evaluate an ACP program in care dependent community-dwelling persons, compared to optimised usual care. METHODS: A cluster-randomised controlled trial of 12 months duration will be conducted in 3 German study sites comparing the pretested ACP-counselling offered by trained nurses with a control group receiving optimised usual care. Using external concealed randomisation, 16 home care services each will be included in the intervention and the control group (30 participants per cluster; n = 960). Eligibility criteria for patients are: ≥60 years, somehow care dependent, adequate German language skills, assumed life-expectancy of ≥4 weeks, and cognitive ability for participation. ACP will be delivered by trained nurse facilitators of the respective home care services and communication will include proxy decision-makers. The primary endpoint will be patient activation, assessed by the Patient Activation Measure (PAM-13). Secondary endpoints include ACP-engagement, proportion of prepared advance directives, number and duration of hospitalisations, quality of life as well as depression and anxiety. Further, comprehensive economic and process evaluations will be conducted. DISCUSSION: STADPLAN is the first study in Germany that assesses an adapted ACP intervention with trained nurses in home care services and the first international study focusing on cost effectiveness of ACP in community-dwelling older persons. The results will help to improve the understanding and communicating of patients' preferences regarding medical treatment and care and thereby contribute to patients' autonomy. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00016886 (Date of registration: 04.06.2019).

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Intraosseous (IO) access is normally reserved for emergencies and critical care conditions when venous cannulation is not possible. Nonetheless, we present a case of IO insertion to a 56-year-old man, tetraplegic for many years due to progressive spinal muscular atrophy and with refractory suffering. The IO access was used for palliative sedation with propofol in a home care setting. The patient died after 11 days of palliative care, of which the last 4 days were with palliative sedation using an IO cannula as a vascular access. No complications were noted from this route of administration. We advocate the use of IO access in the palliative care of terminal ill patients when a venous cannulation is not possible.

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BACKGROUND: Although several previous studies have examined the prevalence and risk factors associated with inappropriate prescribing (IP) among elderly patients, as identified by the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria, no research has been conducted among elderly home care patients. OBJECTIVE: This study aimed to explore the prevalence of IP and its risk factors as identified by the STOPP/START criteria among elderly home care patients in Japan. STUDY DESIGN: Cross-sectional study. SETTING: Home care settings in Japan. PARTICIPANTS: Eighty-nine patients aged 65 years or older who received regular home visiting services from Yamato Clinic between May 2013 and June 2013. MAIN OUTCOME MEASURE: The prevalence of IP and its risk factors as identified by the STOPP/START criteria. RESULTS: Of the study population, 40.4% had at least one potentially inappropriate medication and 60.7% had at least one incidence of underprescribing. Risk factors for potentially inappropriate medications were hypertension, constipation, and polypharmacy, while those for underprescription were osteoporosis and polypharmacy. CONCLUSION: The prevalence of IP among elderly home care patients is high, with risk factors that include not only polypharmacy but also several specific underlying medical conditions.

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AIMS: This study aimed to prospectively clarify the accuracy of the Palliative Prognostic Index (PPI) for advanced cancer patients in home care settings. METHOD: The study included 66 advanced cancer patients who received home visiting services between April 2010 and June 2012, and who died at home or in the hospital. Using medical records from initial home visits, we prospectively calculated PPI scores along with sensitivity and specificity. RESULTS: For 3- and 6-week survival, prognostic prediction showed respective sensitivities of 60% and 70.6%, and specificities of 87.0% and 71.9%. CONCLUSION: The sensitivity of the PPI for advanced cancer patients in home care settings was lower than that reported for patients in palliative care units. Development of prognostic tools suitable for home care settings is needed.

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<b>Purpose: </b>This study explored risk factors, risk diseases and specific prescriptions related to inappropriate prescribing (IP) as identified by the criteria of the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) among elderly home care patients in Japan.<br><b>Methods: </b>This cross-sectional study enrolled all patients aged 65 years or older who received regular home visiting services.<br><b>Results: </b>This study included 430 patients (276 females). Of the study population, 34.0% had at least one potentially inappropriate medications (PIMs) and 60.0% had at least one incidence of potential prescribing omissions (PPOs). Risk factors or risk diseases for receiving PIMs were hypertension (Regression Coefficient 0.89, P < 0.001, 95%CI 0.53–1.25), constipation (0.95, <0.001, 0.58–1.31), osteoarthritis (1.02, <0.001, 0.56–1.48), recent history of fall (0.90, <0.001, 0.46–1.33) and number of drug (0.11, <0.001, 0.07–0.15), while those for PPOs were osteoporosis (0.66, <0.001, 0.47–0.85), atrial fibrillation (0.23, 0.047, 0.00–0.45), diabetes mellitus (0.78, <0.001, 0.60–0.97), peripheral artery occlusive disease (0.41, 0.002, 0.15–0.68), cerebral infarction/transient ischemic attack (0.76, <0.001, 0.58–0.94), chronic obstructive pulmonary disease (0.61, <0.001, 0.32–0.90), heart failure (0.44, 0.004, 0.14–0.73), bronchial asthma (0.52, <0.046, 0.01–1.04) and coronary artery disease (1.21, <0.001, 1.03–1.40).<br><b>Conclusion: </b>Risk factors or risk diseases for IP included polypharmacy and several underlying medical conditions. Specific prescriptions associated with PIMs and PPOs were identified.