title: Quality indicators for safe medication preparation and administration: a systematic review.
abstract: BACKGROUND
  One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used.
  
  
  OBJECTIVE
  The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration.
  
  
  METHODS
  MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form.
  
  
  RESULTS
  The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights.
  
  
  CONCLUSIONS
  Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators.
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marian
authors.initials: M
authors.lastname: Smeulers
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Lotte
authors.initials: L
authors.lastname: Verweij
authors.affiliation: Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center and University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jolanda M
authors.initials: JM
authors.lastname: Maaskant
authors.affiliation: Department of Hospital Pharmacy, Amsterdam, Academic Medical Center, the Netherlands.
authors.forename: Monica
authors.initials: M
authors.lastname: de Boer
authors.affiliation: Department of Internal Medicine, Amsterdam, Academic Medical Center, the Netherlands.
authors.forename: C T Paul
authors.initials: CT
authors.lastname: Krediet
authors.affiliation: Department of Surgery, Amsterdam, Academic Medical Center, the Netherlands.
authors.forename: Els J M
authors.initials: EJ
authors.lastname: Nieveen van Dijkum
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, the Netherlands; Department of Surgery, Amsterdam, Academic Medical Center, the Netherlands; Department of Nursing, the Amsterdam School of Health Professions, Amsterdam, the Netherlands.
authors.forename: Hester
authors.initials: H
authors.lastname: Vermeulen
mesh_terms: D016208:Databases, Factual; D011307:Drug Prescriptions; D019317:Evidence-Based Medicine; D006801:Humans; D008508:Medication Errors; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D019984:Quality Indicators, Health Care
chemical_list: D004364:Pharmaceutical Preparations