Defining quality indicators, pharmaceutical care bundles and outcomes of clinical pharmacy service delivery using a Delphi consensus approach

Abstract

Abstract Background Clinical pharmacists perform patient-centred activities to optimise medicines use and prevent harm. Clinical pharmacy quality indicators (CPQI) are often non-uniform and measure individual activities and are not linked to outcomes. Aim To define a consensus agreed pharmaceutical care bundle (PCB) and patient outcome measures across an entire State jurisdiction. Methods A four-round modified-Delphi approach with State Directors of Pharmacy (DOPS) was performed (n = 25). DOPS were asked to rate on a 5-point LIKERT scale the relevance and measurability of 32 inpatient CPQI as well as outcome measures. They also ranked clinical pharmacy activities in order from perceived most to least beneficial. Based upon this ranking, groups of indicators were proposed as PCB, and relevance and measurability assessed. Results Response rate ranged from 40–60% between rounds. Twenty-six individual CPQI reached consensus. The top ranked CPQI was the proportion of patients where a pharmacist documents an accurate list of medicines during admission. There were nine PCB formed consisting between 3 and 7 activities. Only one PCB reached consensus: medication history, adverse drug reaction/allergy documentation, admission and discharge medication reconciliation, medication review, provision of medicines education and provision of a medication list on discharge. Sixteen outcome measures reached consensus. The top ranked were hospital acquired complications, readmission due to medication misadventure and unplanned readmission within 10 days. Conclusion Consensus has been reached on one PCB and sixteen outcomes to monitor clinical pharmacy service delivery. The next step is to measure the extent of PCB delivery and the link to patient outcomes.