Validation of quality indicators for medication handling in residents under municipality care

To improve medication handling in municipal care facilities, a large-scale project was launched in Denmark providing education on the topic. One of the components of the project was the development of quality indicators concerning instructions on how to handle medications, the residents' medication lists, medication dispensing, and medication administration to the residents. This study aimed to analyze the validity of the developed indicators focusing on their feasibility, improvement potential, discriminatory capacity, and sensitivity to change.

Scoring of the indicators was carried out in a total of 20 municipalities by 21 community pharmacies from November 2022 to April 2023. Each indicator was scored by a pharmacy representative before and after the education as either complied or not. Subsequently, aggregated indicators were generated by calculating individuals with all measured indicators complied or other. Feasibility, improvement potential, and discriminatory capacity were calculated using pre-education data; sensitivity to change assessed the difference between pre- and post-education measurement, where the same residents were not necessarily evaluated at both points. The SQUIRE check list was used to guide the reporting.

For the Instruction group, nearly all individual indicators (N = 11) showed excellent feasibility and improvement potential, and both aggregated indicators were sensitive to change; the discriminatory capacity of all indicators was limited. For the Medication list group, almost 40% of the individual indicators (N = 16) showed low feasibility; the aggregated indicator demonstrated the strongest measurement properties. In the Dispensing group, all individual indicators (N = 17) had excellent feasibility, and almost 30% of them had good validity across all measured properties. For the Administration group indicators (N = 2), one demonstrated good validity in all measured aspects.

The developed quality indicators can be improved and used to support preparation and assessment of education or other pharmacy services for municipal staff about working safely when handling medications.