Development of a conceptual framework for medication safety measurement

Abstract

Many patients are harmed by medications intended to help them. Significant efforts have been directed toward the improvement of medication safety. Policymakers, clinicians, researchers and consumers are interested in knowing the progress of medication safety but it is unclear whether it is safer than before. Part of the challenge has been the achievement of a common understanding of what medication safety means to multi-stakeholders, and then developing a measurement framework. Existing approaches to measurement have been narrow and piecemeal, failing to encompass diverse stakeholder beliefs and preferences. A multistakeholder derived conceptual framework for medication safety measurement was required. The interview method was used to elicit and explore stakeholder views in-depth. Stakeholders were selected by purposive sampling on the basis of their job role or expertise in the area of medication safety in the New Zealand public hospital setting. Snowball sampling was also used and data collection was continued until data saturation which occurred after interviewing 30 people. Transcripts were thematically analysed and interpreted with the aid of NVivo and mind maps using a general inductive approach. The developed multi-stakeholder derived conceptual framework for medication safety measurement consists of seven key dimensions meaningful to multi-stakeholders in the New Zealand public hospital setting. These are: 1) Outcome goals of medication safety; 2) Financial costs and effectiveness; 3) Medications available for and their use; 4) Safety culture; 5) Technical components of the medication use system; 6) Factors affecting medication use by patients; and 7) Staff competency. The contribution to knowledge has been the development of a multi-stakeholder derived conceptual framework for medication safety measurement. As a consequence of this research, the measurement of medication safety should change from one which has been narrow and fragmented, to one which is multi-dimensional and holistic. The developed framework incorporates diverse multi-stakeholder views and preferences increasing its relevance in the local context and is important for engagement and buy-in. It draws together all meaningful dimensions and facets providing a necessary and robust single theoretical frame to measure medication safety. Understanding stakeholders’ priorities and beliefs for medication safety can also be used to facilitate improvement programmes.