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

• Published in: BMJ open 2021-10, Vol.11 (10), p.e054364
• Main Authors: Brühwiler, Lea Domenica, Niederhauser, Andrea, Fischer, Simone, Schwappach, David L B
• Format: Article
• Language: English
• Subjects: Consensus; Delphi method; Delphi Technique; Geriatric Medicine; health & safety; Health Personnel; Humans; Nursing Homes; Patient safety; Pharmacists; Physicians; Polypharmacy; quality in health care; Search strategies; Switzerland
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-054364

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.