Developing a medication safety self-assessment tool for high-alert medications in community pharmacies.

Background: High-alert medications are recognised as those carrying heightened risk of causing significant patient harm when used erroneously. Objective: To develop a high-alert medications self-assessment tool for Finnish community pharmacies. Methods: The tool was developed using a three-phase Delphi method and is based on the Institute for Safe Medication Practices´ Medication Safety Self Assessment® for High-Alert Medications, which comprises 380 items. A pre-Delphi round was first conducted to assess tool's applicability for Finnish pharmacies, followed by two Delphi rounds with a multidisciplinary expert panel evaluating the applicability and desirability of each item. A consensus rate of 70 % was defined. Following the Delphi rounds, the tool was finalized through refinement, removal of duplicates, and reorganization. Results: Consensus was reached on 114 items, resulting in a finalized self-assessment tool organized into eight sections covering medicine groups such as insulin and oral diabetes medicines, anticoagulants, opioids, immunosuppressants, methotrexate, and over-the-counter high-alert medications. After the first Delphi round, 33 items were accepted without changes and 97 were revised. After the second Delphi round, 77 items were transferred to the final tool as such, 35 were modified and 21 were removed. Conclusion: The developed high-alert self-assessment tool offers a structured method for evaluating existing practices and implementing targeted safety measures, addressing a specific need in community pharmacies, where such resources are limited. While further validation and implementation research are needed, the tool represents a practical step toward enhancing medication safety and promoting continuous improvement in pharmacy practice.