European Journal of Clinical Pharmacology

, Volume 70, Issue 8, pp 991–1002

Content validation of a tool for assessing risks for drug-related problems to be used by practical nurses caring for home-dwelling clients aged ≥65 years: a Delphi survey

  • Maarit S. Dimitrow
  • Sanna I. Mykkänen
  • Saija N. S. Leikola
  • Sirkka-Liisa Kivelä
  • Alan Lyles
  • Marja S. A. Airaksinen
Pharmacoepidemiology and Prescription



Home care services are becoming a critically important part of health care delivery as populations are aging. Those using home care services are increasingly older, more frail than previously, and use multiple medications, making them vulnerable to drug-related problems (DRPs). Practical nurses (PN) visit home-dwelling aged clients frequently and, thus, are ideally situated to identify potential DRPs and, if needed, to communicate them to physicians for resolution. This study developed and validated the content of a tool to be used by PNs for assessing DRP risks for their home-dwelling clients aged ≥65 years.


The first draft of the tool was based on two systematic literature reviews and clinical experience of our research group. Content validity of the tool was determined by a three-round Delphi survey with a panel of 18 experts in geriatric care and pharmacotherapy. An agreement by ≥80 % of the panel on an item was required.


The final tool consists of 18 items that assess risks for DRPs in home-dwelling aged clients. It is divided into four sections: (1) Basic Client Data, (2) Potential Risks for DRPs in Medication Use, (3) Characteristics of the Client’s Care and Adherence, and (4) Recommendations for Actions to Resolve DRPs.


The Delphi process resulted in a structured DRP Risk Assessment Tool that is focused on the highest priority DRPs that should be identified and resolved. The tool also assists the PNs to identify solutions to these problems, which is a unique feature compared to similarly purposed prior tools.


Geriatric pharmacotherapy Adverse drug reactions Drug-related problems Risk management Patient safety Primary care 

Supplementary material

228_2014_1699_MOESM1_ESM.doc (100 kb)
ESM 1(DOC 99 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Maarit S. Dimitrow
    • 1
  • Sanna I. Mykkänen
    • 1
  • Saija N. S. Leikola
    • 1
  • Sirkka-Liisa Kivelä
    • 1
    • 2
    • 3
    • 4
  • Alan Lyles
    • 1
    • 5
  • Marja S. A. Airaksinen
    • 1
  1. 1.Clinical Pharmacy Group, Faculty of PharmacyUniversity of HelsinkiHelsinkiFinland
  2. 2.Department of Family Medicine, Institute of Clinical MedicineUniversity of TurkuTurkuFinland
  3. 3.Unit of Family MedicineTurku University HospitalTurkuFinland
  4. 4.Satakunta Hospital DistrictPoriFinland
  5. 5.School of Health and Human ServicesUniversity of BaltimoreBaltimoreUSA

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