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Consensus-based development and practice testing of a generic quality indicator set for parenteral medication
Jedidja Lok-Visser1,2, Roald Hunneman3,4, Cecile H J Bekkers5,6
1Center for Healthcare Operations Improvement & Research, University of Twente, Enschede, The Netherlands j.lok-visser@utwente.nl.
BMJ Open
|July 1, 2025
Summary
A new quality set for parenteral medication administration at home (PMAaH) was developed to improve patient safety and healthcare worker conditions. This framework helps hospitals benchmark and redesign PMAaH pathways for high-quality care.
Area of Science:
- Healthcare Management
- Patient Safety
- Medication Administration
Background:
- Increasing demand for home healthcare and nursing shortages necessitate optimized parenteral medication administration at home (PMAaH) pathways.
- Existing PMAaH care pathways exhibit complexity and variability, highlighting the need for a standardized quality framework.
- A lack of generic quality indicators (QIs) hinders the consistent monitoring and improvement of PMAaH services.
Purpose of the Study:
- To develop a comprehensive, generic set of quality indicators (QIs) for parenteral medication administration at home (PMAaH).
- To provide a framework for benchmarking and redesigning PMAaH care pathways to ensure high-quality patient care.
- To address the need for standardized quality assessment in the growing field of home-based parenteral therapies.
Main Methods:
- A systematic RAND appropriateness method was employed, including a scoping review to identify potential QIs.
- Expert panel ratings via online questionnaires and meetings were conducted to assess indicator appropriateness.
- Retrospective practice testing in multiple hospitals evaluated the feasibility, clarity, and measurability of the proposed QIs.
Main Results:
- A final set of 32 generic QIs (15 structure, 17 process) was established for parenteral medication administration at home (PMAaH).
- The developed QIs primarily focus on patient safety and healthcare worker conditions.
- Practice testing indicated that 17.6% of QIs are fully implemented, with operational QIs showing higher implementation rates than systemic ones.
Conclusions:
- The study successfully developed and validated a generic quality set for parenteral medication administration at home (PMAaH).
- This quality set provides a valuable tool for hospitals to benchmark and redesign their PMAaH care pathways.
- The practice testing confirmed the necessity and utility of this structured quality set for improving home healthcare services.
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