Quality indicators for safe and effective medication use in long-term care facilities: A modified Delphi study

Area of Science:

• Gerontology
• Health Services Research
• Pharmaceutical Sciences

Background:

• Medication management in long-term care facilities (LTCFs) is complex and impacts resident outcomes.
• Evaluating the quality of medication use and pharmacist services in LTCFs requires robust indicators.
• Previous research identified 58 potential quality indicators (QIs) for medication management in LTCFs.

Purpose of the Study:

• To achieve expert consensus on quality indicators (QIs) for evaluating medication use and pharmacist services at a population level in LTCFs.
• To identify QIs suitable for application in the long-term care setting, focusing on importance, feasibility, and amenability to change by pharmacists.

Main Methods:

• A two-round modified online Delphi study was conducted with 25 Australian multidisciplinary subject matter experts.
• Experts rated 58 identified QIs on a 9-point Likert scale across importance, feasibility, and amenability to change.
• QI selection required expert agreement (disagreement index ≤1) and a high median score (≥7) for all three criteria.

Main Results:

• Seventeen of 58 QIs (29%) achieved expert agreement across all three criteria.
• The selected QIs cover multidisciplinary clinical care (7), clinical governance (5), medication-specific issues (3), and end-of-life care (2).
• High agreement was reached for importance (78%), but lower for feasibility (47%) and amenability to change (43%).

Conclusions:

• The 17 expert-prioritized QIs provide a foundation for monitoring medication management quality in LTCFs.
• These QIs can help optimize medication-related quality of care and improve resident outcomes.
• Further testing and research are needed to validate and implement these QIs in practice.