Quality standards for safe medication in nursing homes: development through a multistep approach including a Delphi consensus study

Abstract

ObjectivesThe aim of the study was to develop quality standards reflecting minimal requirements for safe medication processes in nursing homes.DesignIn a first step, relevant key topics for safe medication processes were deducted from a systematic search for similar guidelines, prior work and discussions with experts. In a second step, the essential requirements for each key topic were specified and substantiated with a literature-based rationale. Subsequently, the requirements were evaluated with a piloted, two-round Delphi study.SettingNursing homes in Switzerland.ParticipantsInterprofessional panel of 25 experts from science and practice.Primary and secondary outcome measuresEach requirement was rated for its relevance for a safer and resident-oriented medication on a 9-point Likert-Scale based on the RAND/UCLA method. The requirements were considered relevant if, in the second round, the median relevance rating was ≥7 and the proportion of ratings ≥7 was ≥80%.ResultsFive key topics with a total of 87 requirements were elaborated and rated in the Delphi study. After the second round (response rate in both rounds 100%), 85 requirements fulfilled the predefined criteria and were therefore included in the final set of quality standards. The five key topics are: (I) ‘The medication is reviewed regularly and in defined situations’, (II) ‘The medication is reviewed in a structured manner’, (III) ‘The medication is monitored in a structured manner’, (IV) ‘All healthcare professionals are committed to an optimal interprofessional collaboration’ and (V) ‘Residents are actively involved in medication process’.ConclusionsWe developed normative quality standards for a safer and resident-oriented medication in Swiss nursing homes. Altogether, 85 requirements define the medication processes and the behaviour of healthcare professionals. A rigorous implementation may support nursing homes in taking a step towards safer and resident-oriented medication.

Exploring medication safety structures and processes in nursing homes: a cross-sectional study

“…Such systems are often managed by pharmacists. In NHs, medication use processes are often complex, consisting of different part processes, involving multiple professions, as well as residents and even informal caregivers [ 19 ]. It encompasses not only prescribing—a key factor of appropriate polypharmacy—but also logistical concerns (i.e., ordering, delivery, storage, redistribution of medications) [ 20 ].…”

“…Having on-site physicians impacts NHs’ collaboration with pharmacies and other primary care physicians (e.g., regarding medications administration) [ 23 ]. Not all Swiss NHs have a legal obligation to work with pharmacists; however, when they do, the pharmacist is legally responsible for all of their medication use and supply processes (except prescription and administration of medication, which are physicians’ responsibilities) as well as to maintain the medication supply [ 19 ].…”