Development of a High-Risk Medication List for Australian Residential Aged Care: A Modified Delphi Study

Abstract

Introduction: High-risk medications are medications associated with significant patient harm or death if misused or used in error. This study aimed to develop a national consensus high-risk medication list for use in Australian residential aged care. Methods: A 3-round modified Delphi study involving Australian healthcare professionals was conducted. In Round 1, participants indicated their level of agreement, on a 9-point Likert scale, whether 60 medications/medication classes were considered high-risk and should be included in a high-risk medication list for Australian residential aged care. Round 2 included medications/medication classes that did not reach consensus and new medications identified by participants. Consensus was defined as 70% or more of participants responding at 7 or higher on the Likert scale. In Round 3, participants were asked to prioritise medications/medication classes that reached consensus in Round 1 or 2. Results: In total, 42 participants completed Round 1, and 35 (83%) completed all three rounds. Participants included pharmacists (n = 21), prescribers (n = 15), nurses (n = 5) and a paramedic (n = 1), with representation from all Australian states and mainland territories. Overall, 26 medications reached consensus (21 in Round 1, five in Round 2) and were categorised into 15 medications/medication classes for prioritisation in Round 3. The final prioritisation list was opioids, insulin, benzodiazepines, anticoagulants, z-drugs, antipsychotics, lithium, sulfonylureas with high risk of hypoglycaemia, chemotherapeutic agents, methotrexate, digoxin, narrow therapeutic range antiepileptics, tricyclic antidepressants, immunosuppressants for transplant and sedating antihistamines. Discussion: This is the first, national consensus list of high-risk medications developed specifically for Australian residential aged care. It can be used to implement targeted strategies to minimise medication-related harm.