Diseño de un set de indicadores de calidad para la gestión de los medicamentos en las unidades de hospitalización

Resumen

Abstract Objectives Main objective To elaborate a set of quality indicators for management of medication in the hospital units based on the found evidences and the opinion of experts. Specific objectives To collect and select quality recommendations for medication management in hospital units. To develop quality indicators based on the quality recommendations. To prioritize indicators by means of consensus techniques. Methods To obtain quality recommendations on medication management in hospital units, a bibliographic searches were carried out in the Web of Science, ProQuest experts, SCIELO, PUBMED, EMBASE, CINAHL and Google Scholar databases. Other sources of gray literature such as Google and Internet resources such as the Joint Commission International, the National Quality Forum, the Spanish Ministry of Health and the Spanish Office of the Institute of Safe Medicines Practices have been consulted. The indexation in databases of the collected references was analyzed through the innovative use of ecological indexes which evaluate the degree of similarity as product of nesting and turnover. The collected recommendations were prioritized, using the nominal group technique, by a panel of 6 experts. Based on the selected prioritized recommendations, quality indicators and have been developed. The extensive list of indicators has been prioritized, using the consensus method Delphi, by a panel of 26 experts (37 initial guests) from several health centers of the Region of Murcia. Results 6,255 possible scientific references were checked and 46 of them, specifically related to the management of drugs in hospitalization units, were selected. 2 references more were found with Google Scholar and 22 references from the gray literature, to reach a total of 70 references. Of these, 62 quality recommendations were extracted wich were included in variable frequency in the 70 selected references. The indexation of selected references in databases was studied and the turnover is greater than nesting. This means that, although there are repeated sets between various sources, there is another very exclusive part. Then, if the search had been done in a few databases, a significant portion of the information, regarding the study objective, would have been ignored. The recommendations were prioritized using the nominal group technique, addressing three dimensions of quality: adequacy, relevance and feasibility. The first 50 ones, corresponding to 80% of the total, were selected. Based on the selected recommendations, 61 quality indicators were developed and many of the recommendations were split into structure and process indicators. Measurement for them were proposed. The indicators were prioritized using the Delphi method and 2 rounds were required to reach the appropriate consensus level. Only 2 indicators did not obtain the consensus but the stability study indicated that there were no significant changes of score between rounds. According to the medians of the scores, the indicators were ordered and those that with scores 10 and 9.5 were selected, whose set of scores constituted a significantly homogeneous group, were selected. In the health research, the Delphi method is very much used but, in many cases, adequate steps are not followed in its process. Especially in the assessment/measurement of consensus, which should be the criterion for deciding the number of rounds to perform. Several reviews on the Delphi method in the health field have pointed out several recommendations for the process and presentation of its results. The present study fulfills the most of them. Finally, the relationship between the Delphi experts' score and their professional profile a was explored by means of a multivariate analysis, but no consistent patterns were found.