Quality Standards for Safe Medication in Nursing Homes: Development Through a Multistep Approach Including a Delphi Consensus Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 Oct 12

PMID 34635533

Citations 1

Authors

Lea Domenica Bruhwiler

Andrea Niederhauser

Simone Fischer

David L B Schwappach

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of the study was to develop quality standards reflecting minimal requirements for safe medication processes in nursing homes.

Design: In 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.

Setting: Nursing homes in Switzerland.

Participants: Interprofessional panel of 25 experts from science and practice.

Primary And Secondary Outcome Measures: Each 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%.

Results: Five 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'.

Conclusions: We 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.

Citing Articles

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

Favez L, Zuniga F, Meyer-Massetti C Int J Clin Pharm. 2023; 45(6):1464-1471.

PMID: 37561370 PMC: 10682270. DOI: 10.1007/s11096-023-01625-6.

References

Hill-Taylor B, Walsh K, Stewart S, Hayden J, Byrne S, Sketris I . Effectiveness of the STOPP/START (Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther. 2016; 41(2):158-69. DOI: 10.1111/jcpt.12372. View

Gurwitz J, Field T, Judge J, Rochon P, Harrold L, Cadoret C . The incidence of adverse drug events in two large academic long-term care facilities. Am J Med. 2005; 118(3):251-8. DOI: 10.1016/j.amjmed.2004.09.018. View

Zuniga F, Blatter C, Wicki R, Simon M . [National quality indicators in Swiss nursing homes : Questionnaire survey on data reliability and users' view on the usefulness]. Z Gerontol Geriatr. 2019; 52(8):730-736. DOI: 10.1007/s00391-019-01583-7. View

Cateau D, Ballabeni P, Niquille A . Effects of an interprofessional Quality Circle-Deprescribing Module (QC-DeMo) in Swiss nursing homes: a randomised controlled trial. BMC Geriatr. 2021; 21(1):289. PMC: 8088558. DOI: 10.1186/s12877-021-02220-y. View

Niederhauser A, Bruhwiler L, Fishman L, Schwappach D . [Selected safety-relevant medication processes in Swiss nursing homes: Current state of affairs and optimization potentials]. Z Evid Fortbild Qual Gesundhwes. 2019; 146:7-14. DOI: 10.1016/j.zefq.2019.06.005. View

Al-Jumaili A, Doucette W . Comprehensive Literature Review of Factors Influencing Medication Safety in Nursing Homes: Using a Systems Model. J Am Med Dir Assoc. 2017; 18(6):470-488. DOI: 10.1016/j.jamda.2016.12.069. View

Schneider R, Reinau D, Schur N, Blozik E, Fruh M, Signorell A . Drug prescription patterns, polypharmacy and potentially inappropriate medication in Swiss nursing homes: a descriptive analysis based on claims data. Swiss Med Wkly. 2019; 149:w20126. DOI: 10.4414/smw.2019.20126. View

Nazir A, Unroe K, Tegeler M, Khan B, Azar J, Boustani M . Systematic review of interdisciplinary interventions in nursing homes. J Am Med Dir Assoc. 2013; 14(7):471-8. DOI: 10.1016/j.jamda.2013.02.005. View

Mahlknecht A, Krisch L, Nestler N, Bauer U, Letz N, Zenz D . Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT. BMC Geriatr. 2019; 19(1):257. PMC: 6749664. DOI: 10.1186/s12877-019-1263-3. View

10.

Strauven G, Anrys P, Vandael E, Henrard S, De Lepeleire J, Spinewine A . Cluster-Controlled Trial of an Intervention to Improve Prescribing in Nursing Homes Study. J Am Med Dir Assoc. 2019; 20(11):1404-1411. DOI: 10.1016/j.jamda.2019.06.006. View

11.

Xing X, Zhu C, Liang H, Wang K, Chu Y, Zhao L . Associations Between Potentially Inappropriate Medications and Adverse Health Outcomes in the Elderly: A Systematic Review and Meta-analysis. Ann Pharmacother. 2019; 53(10):1005-1019. DOI: 10.1177/1060028019853069. View

12.

Reich O, Rosemann T, Rapold R, Blozik E, Senn O . Potentially inappropriate medication use in older patients in Swiss managed care plans: prevalence, determinants and association with hospitalization. PLoS One. 2014; 9(8):e105425. PMC: 4138178. DOI: 10.1371/journal.pone.0105425. View

13.

Junger S, Payne S, Brine J, Radbruch L, Brearley S . Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review. Palliat Med. 2017; 31(8):684-706. DOI: 10.1177/0269216317690685. View

14.

Neeman M, Dobrinas M, Maurer S, Tagan D, Sautebin A, Blanc A . Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward. Eur J Intern Med. 2016; 38:30-37. DOI: 10.1016/j.ejim.2016.11.004. View

15.

Abolhassani N, Vollenweider P, Waeber G, Marques-Vidal P . Ten-Year Trend in Polypharmacy in the Lausanne Population. J Patient Saf. 2020; 17(4):e269-e273. DOI: 10.1097/PTS.0000000000000651. View

16.

Viktil K, Blix H, Moger T, Reikvam A . Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2006; 63(2):187-95. PMC: 2000563. DOI: 10.1111/j.1365-2125.2006.02744.x. View

17.

Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M . Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2017; 6:CD000072. PMC: 6481564. DOI: 10.1002/14651858.CD000072.pub3. View

18.

Fishman L, Bruhwiler L, Schwappach D . [Medication safety in Switzerland: Where are we today?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018; 61(9):1152-1158. DOI: 10.1007/s00103-018-2794-z. View

19.

Forsetlund L, Eike M, Gjerberg E, Vist G . Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials. BMC Geriatr. 2011; 11:16. PMC: 3108292. DOI: 10.1186/1471-2318-11-16. View

20.

Jordan S, Gabe-Walters M, Watkins A, Humphreys I, Newson L, Snelgrove S . Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. PLoS One. 2015; 10(10):e0140203. PMC: 4603896. DOI: 10.1371/journal.pone.0140203. View