Quality indicators for safe and effective use of medications in long-term care settings: A systematic review

People accessing aged care services are increasingly older and often experience multimorbidity and polypharmacy, which puts them at risk of medication-related harm. Quality indicators (QIs) can assist with monitoring, benchmarking and informing initiatives to reduce medication-related harm. This systematic review aimed to identify and summarize QIs that assess the safe and effective use of medications in long-term care services. Bibliographic databases and grey literature were searched to identify relevant QIs. Eligible publications were in English and described the development, application and/or validation of QIs in long-term care facilities or in-home aged care services. QI information, including their development and settings, were extracted. All QIs were classified according to 3 validated classification systems and grouped by themes constructed from the review. From the 62 academic articles and 16 grey literature documents included, 53 QI sets were extracted, which comprised 442 individual QIs and 18 potentially inappropriate medication lists were identified. Most (80%, n = 354) QIs were process indicators. About 1/4 (26%, n = 115) were medication-specific QIs focusing mainly on prevalence of use and dosing, with similar numbers for infection prevention and control (25%, n = 112). A smaller proportion (7%, n = 32) of QIs encompassed person-centred measures such as resident involvement in medication-related decisions. This comprehensive overview of contemporary QIs to monitor medication safety and effectiveness across long-term care services can help clinicians, aged care providers and policy makers to identify important measures to employ in aged care settings to monitor and influence care improvements.