Developing a medication-safety self-assessment tool for rural primary care units - a case from Finnish Lapland

In rural areas, primary care faces several challenges, and medication therapy is one of the most complex processes in primary care. With a specific, proactive, medication-safety self-assessment tool designed for rural primary care units, healthcare professionals could identify development needs in their medication processes.

The Delphi consensus method with two Delphi rounds was used to create a medication-safety self-assessment tool for rural primary care units in Finnish Lapland. A preliminary tool was designed based on three national and international risk management tools. Statements of the preliminary tool were evaluated with a two-round Delphi panel by 12 experts in primary care and patient safety. Evaluated aspects were suitability for primary care settings, medication safety relevance, and the necessity of the statements to be included in the developed rural, primary care, medication-safety self-assessment tool.

In the first Delphi round, a consensus of ≥ 85% on being "sufficiently important and essential" was reached on 39% of the statements (n = 118/304), of which 86% (n = 101/118) were included, and 14% (n = 17/118) were excluded from the final primary care medication- safety self-assessment tool. In the second round, 84% of the statements (n = 141/167) reached a consensus, of which 70% (n = 98/141) were excluded and 30% (n = 43/141) included in the final tool. The included 144 statements were divided into 12 thematic sub-groups: (1) Patient information, (2) Drug information, (3) Communication of drug orders and other drug information; (4) Drug labeling, packaging and nomenclature; (5) Drug storage and distribution, (6) Medication device acquisition and use, (7) Environmental factors, workflow and staffing patterns; (8) Staff competency and education, (9) Patient education, (10) Preventive risk management, 11. Learning from medication safety incidents, and 12. Electronic health record.

The developed medication-safety self-assessment tool is targeted for proactive medication risk management in rural primary care settings. While experts reached a consensus for the Primary care Medication Safety Self Assessment tool contents, adopting the tool to suit the rural primary care environments in different countries should be further investigated.