Development of indicators to assess medication safety – An experience from a resource limited healthcare setting

Background Evidence based safety indicators could be used to assess and compare the status of medication safety in a country and facilitate benchmarking, making judgments, setting priorities, and supporting accountability, regulation, and accreditation. Currently there are no established indicators available to assess medication safety in resource limited healthcare settings. Aim To develop indicators to measure medication safety in different stages of handling medications including regulations, procurement, storage, distribution of medicines, and during the medication use process i.e prescribing, transcribing, dispensing, administration, and monitoring. Methodology From a systematic review and brainstorming sessions, 126 medication safety indicators were developed with defined numerators and denominators. The modified Research And Development / University of California Los Angeles (RAND/UCLA) appropriateness method was used with two panels of experts to finalize the indicators. During the two rating rounds, each indicator was rated on six parameters; appropriateness, relevance, measurability and feasibility, clarity, usefulness, and comparability, using a 1–9 Likert scale, where nine was considered as highly appropriate. Indicators were accepted if all the parameters were rated with a panel median of ≥ 7 without disagreement. The final consensus of the panel was obtained at a meeting. Results The panel I rated 36 indicators (16 for regulation, 6 for procurement, and 14 for storage and distribution), and the panel II rated 68 indicators (18 for prescribing, 03 for transcribing, 17 for dispensing, 17 for administration and 13 for monitoring), as necessary for assessing medication safety. Of them, 80 were categorized as core, and 24 as supplementary indicators. Among the selected indicators, 17 covered structure or organizational issues, 65 addressed the processes, and 22 focused on outcomes. Conclusions The study identified 104 indicators which could be used to assess the medication safety in resource limited healthcare settings.