Risk-free hospital at home: Strengthening safety in the patient's environment through hospital pharmacy

Hospital at home has become an established care model capable of delivering high-complexity treatment in the patient's own environment; however, it shifts part of the medication circuit to a less controlled setting, introducing variability that may compromise pharmacotherapeutic safety. A descriptive quality-improvement study was conducted to evaluate the implementation of a multidimensional medication-safety programme in the Hospital at Home unit of a tertiary-care hospital. The programme was structured according to the Joint Commission International standards for home care and led by the Hospital Pharmacy Service. Between October 2023 and December 2024, seven strategies were implemented: high-alert medication management, restriction of concentrated electrolytes, standardization of a home emergency medication kit, introduction of a domiciliary pharmaceutical-suitability checklist, protocol updating, staff training, and development of educational resources for patients and caregivers. The initial evaluation, conducted in January and February 2025, included a before-and-after comparison of concentrated-electrolyte dispensing, two post-implementation audits of high-alert medication labelling and emergency-kit adequacy, and a descriptive analysis of the remaining process indicators. Correct labelling of high-alert medications increased from 91% to 98%, concentrated-electrolyte dispensing decreased by 100%, and emergency-kit adequacy improved from 75% to 100%. The domiciliary checklist was completed for 100% of the evaluated cases; deficiencies were identified in 28%, all of which were corrected during the first visit, with no cases of ineligibility due to medication-safety concerns. Attendance at the training sessions was 100% among physicians and 89% among nursing staff, with an overall satisfaction score of 9.45 out of 10. The findings show that a programme based on international standards and led by the Hospital Pharmacy Service can be implemented and evaluated in the home setting. Its application in other centers would require adaptation to their structure and resources, together with periodic monitoring of the indicators.