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

Aim: This modified Delphi study aimed to achieve expert agreement on quality indicators (QIs) suitable for application at the population level, to evaluate quality use of medications and pharmacist services in long-term care facilities (LTCFs). 

Methods: We conducted a two-round modified online Delphi study with a multidisciplinary panel of Australian subject matter experts (n = 25). Experts rated 58 QIs, identified in a recent systematic review, on three criteria (importance, feasibility and amenability to change by an on-site pharmacist) using a 9-point Likert scale. A QI was selected if it reached agreement between expert members (defined as a disagreement index of ≤1) with a high median score (≥7 on the Likert scale) across all three criteria. 

Results: Twenty-five experts completed the first Delphi round, and 24 completed the second round. Overall, high scores with agreement were obtained for 45 QIs (78%) for importance, 27 QIs (47%) for feasibility and 25 QIs (43%) for amenability to change. Seventeen of the 58 QIs received high scores in agreement across all three criteria and were selected, covering: multidisciplinary clinical care (n = 7 QIs), clinical governance (n = 5), medication-specific issues (n = 3) and end-of-life care (n = 2). 

Conclusion: The identified QIs provide a valuable foundation to capture and monitor the complexity of medication management, including on-site pharmacist services, in LTCFs. Subject to future testing and research, the expert-prioritized QIs could help optimize medication-related quality of care efforts and improve outcomes for residents in LTCFs.