Content validation of drug problem-oriented clinical record

Area of Science:

• Clinical Pharmacy
• Patient Safety
• Health Informatics

Background:

• Hospitals face challenges in managing drug-related problems, posing risks to patient safety.
• Effective tools are needed to support the diagnosis, management, and resolution of medication-related issues.

Purpose of the Study:

• To develop a novel clinical record system specifically designed for drug-related problems.
• To validate the content of this new drug-oriented clinical record.

Main Methods:

• A drug-oriented clinical record was developed by experienced researchers.
• Content validation was performed using the nominal group technique with an expert panel (physician, nurses, pharmacists).
• The instrument was assessed for objectivity, simplicity, clarity, and relevance.

Main Results:

• Expert feedback led to modifications in item order, additions, and clarifications.
• The final instrument, the DAM Clinical Record, contains 45 items across six sections.
• Sections include Patient Identification, Anamnesis, Clinical Diagnosis, Adverse Clinical Findings, Medicines, and Pharmaceutical Evaluation.

Conclusions:

• The DAM Clinical Record was successfully developed and content-validated to aid healthcare professionals.
• This tool guides the identification and resolution of drug-related problems in hospital settings.
• It facilitates the systematic storage of relevant patient information for drug problem management.