Key performance indicators for hospital clinical pharmacy services: results of a global Delphi study

The contribution of clinical pharmacy services (CPS) to patient outcomes and system performance is still not consistently measured. Most key performance indicators (KPIs) have been suggested only by pharmacists, without formal piloting or validation, and without benchmarking reference values. KPIs are indicators used to quantify pharmacists' clinical activities and their association with improvements in patient safety, therapeutic outcomes, and healthcare costs. There is a need for a globally informed, multi-stakeholder consensus on a core set of KPIs for hospital clinical pharmacy services that are explicitly outcome-based and suitable for international use.

This study aimed to reach a consensus on a core set of KPIs for clinical pharmacy activities in hospital settings, achieved through a multi-stakeholder consensus process.

The 3-round Delphi technique was used to reach a consensus. Panellists were systematically selected from three groups of stakeholders: 'Clinical Pharmacy KPI Experts', 'Healthcare Systems Assessment Experts', and 'Patient Association Representatives'. The initial set of KPIs was based on themes identified in a previous review study. During the three rounds, the consensus thresholds increased from 60 to 70% and then to 80%. Panellists could suggest new KPIs and propose modifications to those already suggested.

Of the 480 potential experts initially identified, 342 valid email addresses were found, of which 49 (from 25 countries) committed to the Delphi study, including 22 clinical pharmacy experts, 21 patient representatives, and six healthcare systems assessment experts. A total of 43 panellists from 23 different countries completed the third round. Starting with 12 KPIs (plus one added in the first round), the panellists agreed on five KPIs, which were distributed as follows: Three clinical KPIs (adverse drug event rate, medication-related near miss event rate and medication goal achievement rate); one economic KPI (average optimised treatment cost difference); and one humanistic outcome KPI (patient satisfaction survey results). A manual containing the KPI information sheets was created.

A global panel of stakeholders, including pharmacists, other healthcare professionals, and patient representatives, agreed on a core set of KPIs for hospital-provided CPS. This set comprises five measures covering three types of outcomes: economic, clinical, and humanistic.