Tools for Assessing Medication Safety Processes in Nursing Homes: A Systematic Review

Objective: This systematic review aimed to identify tools for measuring the quality of medication safety-related processes in nursing homes. Methods: We systematically searched Medline, Embase, and CINAHL databases to identify studies describing tools for measuring medication safety-related processes or systems supporting medication safety in nursing homes. Databases were searched from their inception to June 2022. For each tool, the individual items included in the tool were mapped to the 9 steps and 3 background processes of the medication management pathway and the methodological quality was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) Instrument. Results: Four tools for assessing medication safety-related processes or systems in the nursing home setting were identified. The tools varied substantially in terms of development, content (number of key elements and items), focus and quality. Only one tool, the Canadian Medication Safety Self-Assessment for Long-Term Care (MSSA-LTC), addressed all 9 steps and 3 background processes of the medication management pathway and had a high overall quality rating as per the AIRE instrument. Conclusions: While the Canadian MSSA-LTC tool had the widest focus and highest quality of the 4 tools identified, the choice of a tool by an individual nursing home or care organization will depend on the purpose of the assessment and processes of interest as well as the validity of the tool in the jurisdiction in which it is being used. Awareness of the differences and limitations of each tool in the relevant context should facilitate this endeavour.