Meyer-Massetti Carla, Lettieri-Amstutz Stefanie, Rölli Daniela, Meier Christoph R
Clinical Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland.
Nurs Rep. 2025 May 1;15(5):158. doi: 10.3390/nursrep15050158.
Medication-related problems (MRPs) are common among home-care patients urgently needing improvement. Due to limited resources, patients with the greatest risk of MRPs should be prioritised for interventions. We sought to develop a collaborative assessment tool for nurses and pharmacists to identify home-care patients at high risk of developing MRPs. Using Pubmed for a first scoping literature review, we sought existing tools identifying patients at risk of MRPs or prioritising patients for clinical pharmacy services. Extracted items were prioritised in a first interprofessional Delphi round. Results from the first Delphi round were complemented by individual risk factors identified in a second scoping literature review and again submitted to the expert panel in a second Delphi round. Each item was rated for its relevance to identify home-care patients at risk of MRPs. The highest scoring factors were combined into an interprofessional assessment tool. Literature review one yielded 19 risk tools and six lists containing potentially inappropriate medications. The 78 resulting risk factors were submitted to experts (five pharmacists, five physicians, five nurses) in Delphi round one. Since the identified tools did not fit the scope (interprofessional assessment in home care) entirely, the results of Delphi round one were complemented with individual risk factors identified in a second literature review, leading to 82 potential risk factors for Delphi round two. Experts decided on a 15-item tool for future pilot testing-the doMESTIC RISK tool. It incorporated diverse factors potentially influencing medication safety: demographic information, social context, diagnosis, specific medication and health care resources use. With expert feedback from a Delphi process, we developed a 15-item tool to help nurses and pharmacists jointly identify home-care patients at a high risk of MRPs. Validation of the doMESTIC RISK tool will be imperative to verify its value in clinical practice.
与用药相关的问题（MRPs）在急需改善的居家护理患者中很常见。由于资源有限，应优先对MRPs风险最高的患者进行干预。我们试图开发一种供护士和药剂师使用的协作评估工具，以识别有发生MRPs高风险的居家护理患者。通过在PubMed上进行首次范围界定文献综述，我们寻找现有的识别有MRPs风险患者或对临床药学服务患者进行优先排序的工具。在第一轮跨专业德尔菲法中对提取的项目进行优先排序。第一轮德尔菲法的结果由第二轮范围界定文献综述中确定的个体风险因素补充，并在第二轮德尔菲法中再次提交给专家小组。对每个项目与识别有MRPs风险的居家护理患者的相关性进行评分。得分最高的因素被整合到一个跨专业评估工具中。文献综述一产生了19种风险工具和6份包含潜在不适当药物的清单。由此产生的78个风险因素在第一轮德尔菲法中提交给了专家（5名药剂师、5名医生、5名护士）。由于所识别的工具并不完全符合范围（居家护理中的跨专业评估），第一轮德尔菲法的结果由第二轮文献综述中确定的个体风险因素补充，从而为第二轮德尔菲法产生了82个潜在风险因素。专家们确定了一个用于未来试点测试的15项工具——居家风险工具（doMESTIC RISK tool）。它纳入了可能影响用药安全的多种因素：人口统计学信息、社会背景、诊断、特定药物和医疗资源使用情况。通过德尔菲法的专家反馈，我们开发了一个15项工具，以帮助护士和药剂师共同识别有MRPs高风险的居家护理患者。对居家风险工具（doMESTIC RISK tool）进行验证对于核实其在临床实践中的价值至关重要。
