Medication Logistics in Professional Homecare Organisations: An Assessment of the Practical Implementation of Regulations and Recommendations.

Abstract

Background/Objectives: Patients receiving professional homecare often require support in managing their medication. In Switzerland's legislative system, medication logistics (ordering, delivery, pickup, storage) are regulated differently by each canton, making it challenging for professional homecare organisations to comply with provisions efficiently. The present study aimed to analyse the current international literature, Switzerland's regulations about medication logistics for professional homecare, and the current practices. Methods: We conducted a systematic literature review of the PubMed, Embase and CINAHL databases to identify existing international research on medication logistics by professional homecare organisations published until February 2024. The results of a structured online survey on medication logistics by professional homecare organisations in Switzerland's German-speaking regions were compared against the medication regulations currently in place. Results: Ten studies were included in the review. The medication logistics processes of homecare organisations have rarely been researched, especially short-term and long-term storage. Few regulations cover medication logistics in Switzerland's legislation, and they are often formulated non-specifically and focus on inpatient facilities. Some cantons allow centralised medication storage, others prohibit it. Only one canton explicitly permits short-term medication storage under simplified requirements. We evaluated the answers of 105 homecare organisations responding to our survey; 73.7% (73/99) of them nevertheless stored medications in the short term before bringing them to patients' homes. Switzerland's professional homecare organisations generally fulfil their legal requirements well. There is potential to improve the formulation of standard operating procedures for each step of the homecare medication use process, especially for cleaning medication storage sites (12/31, 38.7%) and short-term storage processes (29/56, 51.8%). Conclusions: There are few studies or guidelines on professional homecare organisations' medication logistics, and they generally fail to address medication storage. Short-term medication storage is common despite most cantonal requirements being strict or prohibiting it, or not regulating it all. There is an urgent need for unambiguous, practice-oriented recommendations specific to homecare, especially for short-term medication storage.