Aligning regional medication optimization practices and documentation with the national patient information documentation guideline in Finland: a Delphi study

Background The World Health Organization has identified inconsistent medication information and documentation practices among major risk factors jeopardizing medication safety. To tackle this challenge, medication risk management and optimization practices, including documentation, need to be harmonized nationally and regionally. This study aimed at aligning medication reconciliation, prescription review (PR) and medication review (MR) practices and documentation in a regional electronic health record (EHR) system with the national patient information documentation guideline in Finland. Methods The study was conducted in one of the 21 wellbeing services counties established in connection with a major social and health systems reform in Finland in 2023 (county coverage 210 000 residents). The Delphi consensus method was used with two interprofessional expert panel rounds in 2024. The regional expert panel ( n = 20) consisting of practicing physicians ( n = 5), nurses ( n = 5), and pharmacists ( n = 10) defined the contents of medication reconciliation, PR and MR practices and related patient information that should be documented in the regional EHR system. The preset consensus rate was 80%. The first-round survey was based on the national patient information documentation guideline and an inventory of national and international practices. Results Consensus was reached on a total of 147 predetermined and expert panelist suggested items. Of them, 39 items related to the contents and documentation of medication reconciliations, 32 items to PRs, and 76 items to MRs. The consensus and response rates (90%) remained high throughout the study. Greater variation was observed when defining the patient groups to whom the medication optimization interventions should be targeted. Conclusions A strong consensus was reached on the contents and documentation of medication reconciliations, PRs, and MRs within the regional EHR system. The results were consistent with the national documentation guideline, as well as international recommendations and previous research. The Delphi method proved to be a feasible approach for supporting regional implementation of the national documentation guideline and may be useful in similar healthcare system development initiatives. Further research will be needed to evaluate the actual implementation process and impact of the harmonized practices on medication safety and effectiveness.