Stepwise development of a quality assessment instrument for the medicines' pathway in nursing homes.

Quality of care in nursing homes (NHs), and especially the quality of the medicines' pathway, remains a concern. To develop a quality assessment instrument to support NHs to evaluate the quality of their medicines' pathway, and to formulate recommendations for its implementation. A stepwise approach was used. First, a performance questionnaire for coordinating physicians, pharmacists and head nurses was developed, alongside a set of quality indicators (QIs). Next, a feasibility study regarding the QIs was performed in 4 NHs, followed by two pilot studies to optimize the instrument (in 14 and 9 NHs, respectively). Focus groups were held to formulate recommendations for instrument implementation. The QI feasibility and first pilot study showed that the clarity and feasibility of QIs was insufficient. All QIs were therefore integrated in the performance questionnaire. The first pilot study also showed low response rates for certain questions in the performance questionnaire and resulted in a revision of questions with the aim to target the right type of healthcare professional, including quality coordinators and general practitioners. The final instrument targets all involved healthcare professionals (i.e. coordinating physicians, pharmacists, head nurses, general practitioners, and quality coordinators), and applies a sequential approach: a quick scan to set priorities, followed by a detailed scan to detect specific working points. The second pilot study showed appreciation for this approach. Last, five recommendations were made to promote the instrument's implementation. A series of feasibility and pilot studies allowed the stepwise optimization of a quality assessment instrument for the medicines' pathway in NHs and resulted in modifications to improve its clarity and feasibility. Participants' recommendations will promote the successful implementation of the quality assessment instrument