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Background, aim and objectives: Evaluating quality of care is essential when redesigning or improving practice. Medicines reconciliation (MR) on hospital admission is now policy in the UK. It is the process of obtaining an up-to-date and accurate medication list and documenting any discrepancies. The overall aim of this work was to develop quality indicators to evaluate MR on admission to hospital; the specific objectives include developing MR quality indicators, achieving consensus on their appropriateness and testing their feasibility by applying them in a hospital setting. Design: The study was designed in three parts, each consisting of three steps. In part I, ideas about potential indicators were obtained from two sources: a literature search and the nominal group technique. These ideas were converted to potential indicators using criteria for good indicators and then reviewed by nine reviewers. Part II was designed to achieve consensus on the appropriateness of the indicators to evaluate MR. It involved pre-piloting, piloting and conducting the main two-round online Delphi study. Several methods were used to approach predefined experts. Part III involved applying in hospital settings those MR indicators that had achieved consensus. It included developing operational definitions and directly observing the MR process as conducted by pharmacy staff in two hospitals. The indicators were further tested by collecting data about the MR process for all patients seen by pharmacy staff on one weekday in the two hospitals. Results: A systematic approach was followed to develop MR indicators. The idea generation step produced over 90 ideas about potential indicators, which were converted to 85 MR indicators. The assessment by the nine practicing hospital pharmacists discarded 29 of them and the remaining 56 MR indicators were carried forward to the Delphi study, during which 41 indicators achieved consensus as appropriate for evaluating MR on admission to hospital. In the feasibility study, 5 MR indicators were found not to be feasible and three not adequately assessed, while 33 indicators were considered feasible to be used in a hospital setting. Conclusions: This work provided a novel list of 33 indicators that achieved consensus and were found to be feasible to evaluate the MR process on admission to hospital. Further research should explore the use of these indicators, among others, to assess and improve the overall quality of care provided to patients on admission and throughout the hospitalization journey. |
