Developing a National Accreditation Model for Medication Management in the Iranian Primary Health Care System
Abstract
Background: Medication management plays a critical role in the quality of delivered treatments and patient safety.
Objectives: The present study aimed to develop a national accreditation model for medication management within the Iranian primary health care (PHC) system.
Methods: The primary standards were developed by considering existing accreditation models worldwide, reviewing available medication management documentation in Iran’s PHC system, and obtaining expert opinions in this field. The developed standards and measures were incorporated into a Delphi Questionnaire and evaluated by experts based on two criteria: Importance and feasibility, using a 9-point scale. The Delphi panel consisted of 20 experts, and the technique was implemented over two rounds. Of the 20 experts, 18 completed the questionnaire, with response rates of 90% and 100% in the first and second rounds, respectively.
Results: The study was conducted in 2021 - 2022. In the first round of the Delphi process, 55 out of 65 primary measures reached a quorum and were accepted. The remaining ten measures were approved by experts in the second round. The model developed in this study comprises five main standards: “Provision of resources for activities in the field of medication management”, “development and consideration of the list of authorized medications for prescribing in the form of a pharmacopoeia”, “safety in prescription and medication use”, “ordering, storing, and dispensing systems of medications” and “educating the community about the correct use of medications”. The total mean scores for all measures in terms of importance and feasibility were 8.32 and 7.68, respectively.
Conclusions: Given the high consensus among experts on the importance and feasibility of the developed standards, there is optimism that utilizing this model can lead to continuous improvement in the quality and safety of medication management in the Iranian PHC system.
1. Sanghera IS, Franklin BD, Dhillon S. The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK Intensive care unit. Anaesthesia.2007;62(1):53-61. [PubMed ID:17156227]. https://doi.org/10.1111/j.1365-2044.2006.04858.x.
2. Choo J, Hutchinson A, Bucknall T. Nurses’ role in medication safety. J Nurs Manag. 2010;18(7):853-61. [PubMed ID:20946221]. https://doi.org/10.1111/j.1365-2834.2010.01164.x.
3. Kohestani H, baghcheghi N. Investigation medication errors of nursing students in Cardiac. Iran J Forensic Med. 2008;13(4):249-55.
4. Mansouri A, Ahmadvand A, Hadjibabaie M, Kargar M, Javadi M, Gholami K. Types and severity of medication errors in Iran; a review of the current literature. Daru. 2013;21(1):49. [PubMed ID:23787134]. [PubMed Central ID:PMC3694014]. https://doi.org/10.1186/2008-2231-21-49.
5. Gharekhani A, Kanani N, Khalili H, Dashti-Khavidaki S. Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran. Ren Fail. 2014;36(8):1268-72. [PubMed ID:24987790]. https://doi.org/10.3109/0886022X.2014.934650.
6. Alsulami Z, Conroy S, Choonara I. Medication errors in the Middle East countries: A systematic review of the literature. Eur J Clin Pharmacol. 2013;69(4):995-1008. [PubMed ID:23090705]. [PubMed Central ID:PMC3621991]. https://doi.org/10.1007/s00228-012-1435-y.
7. Joolaee S, Hajibabaee F, Peyrovi H, Haghani H, Bahrani N. The relationship between incidence and report of medication errors and working conditions. Int Nurs Rev. 2011;58(1):37-44. [PubMed ID:21281291]. https://doi.org/10.1111/j.1466-7657.2010.00872.x.
8. Kohn L, Corrigan J, Donaldson M. To Err is Human: Building a Safer Health System. Washington (DC): National Academic Press; 2000.
9. Stratton KM, Blegen MA, Pepper G, Vaughn T. Reporting of medication errors by pediatric nurses. J Pediatr Nurs. 2004;19(6):385-92. [PubMed ID:15637579]. https://doi.org/10.1016/j.pedn.2004.11.007.
10. Grissinger MC, Kelly K. Reducing the risk of medication errors in women. J Womens Health (Larchmt). 2005;14(1):61-7. [PubMed ID:15692279]. https://doi.org/10.1089/jwh.2005.14.61.
11. Ahmadizar F, Soleymani F, Abdollahi M. Study of drug-drug in-teractions in prescriptions of general practitioners and specialists in Iran 2007-2009. Iran J Pharm Res. 2011;10(4):921-31. [PubMed ID:24250431]. [PubMed Central ID:PMC3813067].
12. Mrayyan MT, Shishani K, Al-Faouri I. Rate, causes and reporting of medication errors in Jordan: Nurses’ perspectives. J Nurs Manag. 2007;15(6):659-70. [PubMed ID:17688572]. https://doi.org/10.1111/j.1365-2834.2007.00724.x.
13. Ferner RE, Aronson JK. Clarification of terminology in medication errors: Definitions and classification. Drug Saf. 2006;29(11):1011-
22. [PubMed ID:17061907]. https://doi.org/10.2165/00002018-200629110-00001.
14. Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S. Drug-related problems in hospitals: A review of the recent literature. Drug Saf. 2007;30(5):379-407. [PubMed ID:17472418]. https://doi.org/10.2165/00002018-200730050-00003.
15. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-5. [PubMed ID:9555760]. https://doi.org/10.1001/jama.279.15.1200.
16. Ernst FR, Grizzle AJ. Drug-Related Morbidity and Mortality: Updating the Cost-of-Illness Model. J Am Pharmaceut Assoc.2001;41(2):192-9. https://doi.org/10.1016/s1086-5802(16)31229-3.
17. Seki Y, Yamazaki Y. Effects of working conditions on intravenous medication errors in a Japanese hospital. J Nurs Manag.2006;14(2):128-39. [PubMed ID:16487424]. https://doi.org/10.1111/j.1365-2934.2006.00597.x.
18. 18.Bahadori M, Ravangard R, Aghili A, Sadeghifar J, Gharsi Manshadi M, Smaeilnejad J. The Factors Affecting the Refusal of Reporting on Medication Errors from the Nurses’ Viewpoints: A Case Study in a Hospital in Iran. ISRN Nurs. 2013;2013:1-5. https://doi.org/10.1155/2013/876563.
19. Evans SM, Berry JG, Smith BJ, Esterman A, Selim P, O’Shaughnessy J, et al. Attitudes and barriers to incident reporting: A collaborative hospital study. Qual Saf Health Care. 2006;15(1):39-43.[PubMed ID:16456208]. [PubMed Central ID:PMC2563993].https://doi.org/10.1136/qshc.2004.012559.
20. Harding L, Petrick T. Nursing student medication errors: A retrospective review. J Nurs Educ. 2008;47(1):43-7. [PubMed ID:18232615]. https://doi.org/10.3928/01484834-20080101-05.
21. Williams DJP. Medication errors. J Royal College Physic Edinburgh. 2007;37(4):343-6. https://doi.org/10.1177/1478271520073704028.
22. Hemmati H, Ghorbani R, Hossein-Zadeh B, Ebrahim-Zadeh H, Shakeri S. [The Effect of Single Dose of Dexamethasone on Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy]. J Babol Uni Med Sci. 2014;16(11):15-21. Persian. https://doi.org/10.18869/acadpub.jbums.16.11.15.
23. Carlton G, Blegen MA. Medication-related errors: A literature review of incidence and antecedents. Annu Rev Nurs Res. 2006;24:19-38. [PubMed ID:17078409].
24. Gorgich EA, Barfroshan S, Ghoreishi G, Yaghoobi M. Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint. Glob J Health Sci. 2016;8(8):54448. [PubMed ID:27045413]. [PubMed Central ID:PMC5016359]. https://doi.org/10.5539/gjhs.v8n8p220.
25. Ghasemi F, Valizadeh F, Nasab MM. [Analyzing the knowledge and attitude of nurses regarding medication error and its prophylactic ways in educational and therapeutic hospitals of Khorramabad]. Yafteh. 2009;10(2):55-63. Persian.
26. Robabi H, Arbabisarjou A. Computer Literacy Among Students of Zahedan University of Medical Sciences. Global J Health Sci. 2015;7(4). https://doi.org/10.5539/gjhs.v7n4p136.
27. Mansouri A, Ahmadvand A, Hadjibabaie M, Javadi M, Khoee SH, Dastan F, et al. A review of medication errors in iran: sources, underreporting reasons and preventive measures. Iran J Pharm Res. 2014;13(1):3-17. [PubMed ID:24734052]. [PubMed Central ID:PMC3985240].
28. Hinchcliff R, Greenfield D, Moldovan M, Westbrook JI, Pawsey M, Mumford V, et al. Narrative synthesis of health service accreditation literature. BMJ Qual Saf. 2012;21(12):979-91. [PubMed ID:23038406]. https://doi.org/10.1136/bmjqs-2012-000852.
29. Lee E. Safety climate and attitude toward medication error reporting after hospital accreditation in South Korea. Int J Qual Health Care. 2016;28(4):508-14. [PubMed ID:27283441]. https://doi.org/10.1093/intqhc/mzw058.
30. Fortune T, O’Connor E, Donaldson B. Guidance on designing healthcare external evaluation programmes including accreditation. Dublin, Ireland: International Society for Quality in Healthcare (ISQua). 2015.
31. Tabrizi JS, Gharibi F, Pirahary S. Developing of National Accreditation Model for Rural Health Centers in Iran Health System. Iran J Public Health. 2013;42(12):1438-45. [PubMed ID:26060646]. [PubMed Central ID:PMC4441941].
32. Tabrizi JS, Gharibi F, Wilson AJ. Advantages and Disadvantages of Health Care Accreditation Mod-els. Health Promot Perspect. 2011;1(1):1-31. [PubMed ID:24688896]. [PubMed Central ID:PMC3963612]. https://doi.org/10.5681/hpp.2011.001.
33. Sadeq Tabrizi J, Gharibi F. [Developing a national accreditation model via Delphi Technique]. Hospital. 2012;11(2):9 18. Persian.
34. Directorate General of Health Services Ministry of Health and Family Welfare. Standards for Primary Healthcare Units/Centers. India: Directorate General of Health Services Ministry of Health & Family Welfare; 2012. Available from: https://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2012/primayhealth-centres.pdf.
35. Health Care Accreditation Council. HCAC Primary Health Care Accreditation Standards. Amman: Health Care Accreditation Council; 2025. Available from: https://hcac.jo/en-us/Accreditation/Primary-Care-Accreditation-Standards.
36. Ministry of Health. Primary Healthcare Standards. Saudi Arabia: Ministry Of Health; 2025. Available from: http://www.moh.gov.sa/depts/Pharmacy/Documents.pdf.
37. Lawshe CH. A Quantitative Approach to Content Validity1. Personnel Psychol. 2006;28(4):563-75. https://doi.
org/10.1111/j.1744-6570.1975.tb01393.x.
38. Kim YS, Han SH, Hwang JH, Park JM, Lee J, Choi J, et al. Development of the Korean framework for senior-friendly hospitals: a Delphi study. BMC Health Serv Res. 2017;17(1):528. [PubMed ID:28778159]. [PubMed Central ID:PMC5545032]. https://doi.org/10.1186/s12913-017-2480-0.
39. Lee PP, Sultan MB, Grunden JW, Cioffi GA, IOP Consensus Panel. Assessing the Importance of IOP Variables in Glaucoma Using a Modified Delphi Process. J Glaucoma. 2010;19(5):281-7. [PubMed ID:19855301]. https://doi.org/10.1097/IJG.0b013e3181b4ca8d.
40. Culley JM. Use of a computer-mediated Delphi process to validate a mass casualty conceptual model. Comput Inform Nurs. 2011;29(5):272-9. [PubMed ID:21076283]. [PubMed Central ID:PMC4322391]. https://doi.org/10.1097/NCN.0b013e3181fc3e59.
41. Tabrizi JS, Gharibi F. Primary healthcare accreditation standards: a systematic review. Int J Health Care Qual Assur. 2019;32(2):310-20. [PubMed ID:31017069]. https://doi.org/10.1108/IJHCQA-02-2018-0052.
2. Choo J, Hutchinson A, Bucknall T. Nurses’ role in medication safety. J Nurs Manag. 2010;18(7):853-61. [PubMed ID:20946221]. https://doi.org/10.1111/j.1365-2834.2010.01164.x.
3. Kohestani H, baghcheghi N. Investigation medication errors of nursing students in Cardiac. Iran J Forensic Med. 2008;13(4):249-55.
4. Mansouri A, Ahmadvand A, Hadjibabaie M, Kargar M, Javadi M, Gholami K. Types and severity of medication errors in Iran; a review of the current literature. Daru. 2013;21(1):49. [PubMed ID:23787134]. [PubMed Central ID:PMC3694014]. https://doi.org/10.1186/2008-2231-21-49.
5. Gharekhani A, Kanani N, Khalili H, Dashti-Khavidaki S. Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran. Ren Fail. 2014;36(8):1268-72. [PubMed ID:24987790]. https://doi.org/10.3109/0886022X.2014.934650.
6. Alsulami Z, Conroy S, Choonara I. Medication errors in the Middle East countries: A systematic review of the literature. Eur J Clin Pharmacol. 2013;69(4):995-1008. [PubMed ID:23090705]. [PubMed Central ID:PMC3621991]. https://doi.org/10.1007/s00228-012-1435-y.
7. Joolaee S, Hajibabaee F, Peyrovi H, Haghani H, Bahrani N. The relationship between incidence and report of medication errors and working conditions. Int Nurs Rev. 2011;58(1):37-44. [PubMed ID:21281291]. https://doi.org/10.1111/j.1466-7657.2010.00872.x.
8. Kohn L, Corrigan J, Donaldson M. To Err is Human: Building a Safer Health System. Washington (DC): National Academic Press; 2000.
9. Stratton KM, Blegen MA, Pepper G, Vaughn T. Reporting of medication errors by pediatric nurses. J Pediatr Nurs. 2004;19(6):385-92. [PubMed ID:15637579]. https://doi.org/10.1016/j.pedn.2004.11.007.
10. Grissinger MC, Kelly K. Reducing the risk of medication errors in women. J Womens Health (Larchmt). 2005;14(1):61-7. [PubMed ID:15692279]. https://doi.org/10.1089/jwh.2005.14.61.
11. Ahmadizar F, Soleymani F, Abdollahi M. Study of drug-drug in-teractions in prescriptions of general practitioners and specialists in Iran 2007-2009. Iran J Pharm Res. 2011;10(4):921-31. [PubMed ID:24250431]. [PubMed Central ID:PMC3813067].
12. Mrayyan MT, Shishani K, Al-Faouri I. Rate, causes and reporting of medication errors in Jordan: Nurses’ perspectives. J Nurs Manag. 2007;15(6):659-70. [PubMed ID:17688572]. https://doi.org/10.1111/j.1365-2834.2007.00724.x.
13. Ferner RE, Aronson JK. Clarification of terminology in medication errors: Definitions and classification. Drug Saf. 2006;29(11):1011-
22. [PubMed ID:17061907]. https://doi.org/10.2165/00002018-200629110-00001.
14. Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S. Drug-related problems in hospitals: A review of the recent literature. Drug Saf. 2007;30(5):379-407. [PubMed ID:17472418]. https://doi.org/10.2165/00002018-200730050-00003.
15. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-5. [PubMed ID:9555760]. https://doi.org/10.1001/jama.279.15.1200.
16. Ernst FR, Grizzle AJ. Drug-Related Morbidity and Mortality: Updating the Cost-of-Illness Model. J Am Pharmaceut Assoc.2001;41(2):192-9. https://doi.org/10.1016/s1086-5802(16)31229-3.
17. Seki Y, Yamazaki Y. Effects of working conditions on intravenous medication errors in a Japanese hospital. J Nurs Manag.2006;14(2):128-39. [PubMed ID:16487424]. https://doi.org/10.1111/j.1365-2934.2006.00597.x.
18. 18.Bahadori M, Ravangard R, Aghili A, Sadeghifar J, Gharsi Manshadi M, Smaeilnejad J. The Factors Affecting the Refusal of Reporting on Medication Errors from the Nurses’ Viewpoints: A Case Study in a Hospital in Iran. ISRN Nurs. 2013;2013:1-5. https://doi.org/10.1155/2013/876563.
19. Evans SM, Berry JG, Smith BJ, Esterman A, Selim P, O’Shaughnessy J, et al. Attitudes and barriers to incident reporting: A collaborative hospital study. Qual Saf Health Care. 2006;15(1):39-43.[PubMed ID:16456208]. [PubMed Central ID:PMC2563993].https://doi.org/10.1136/qshc.2004.012559.
20. Harding L, Petrick T. Nursing student medication errors: A retrospective review. J Nurs Educ. 2008;47(1):43-7. [PubMed ID:18232615]. https://doi.org/10.3928/01484834-20080101-05.
21. Williams DJP. Medication errors. J Royal College Physic Edinburgh. 2007;37(4):343-6. https://doi.org/10.1177/1478271520073704028.
22. Hemmati H, Ghorbani R, Hossein-Zadeh B, Ebrahim-Zadeh H, Shakeri S. [The Effect of Single Dose of Dexamethasone on Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy]. J Babol Uni Med Sci. 2014;16(11):15-21. Persian. https://doi.org/10.18869/acadpub.jbums.16.11.15.
23. Carlton G, Blegen MA. Medication-related errors: A literature review of incidence and antecedents. Annu Rev Nurs Res. 2006;24:19-38. [PubMed ID:17078409].
24. Gorgich EA, Barfroshan S, Ghoreishi G, Yaghoobi M. Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint. Glob J Health Sci. 2016;8(8):54448. [PubMed ID:27045413]. [PubMed Central ID:PMC5016359]. https://doi.org/10.5539/gjhs.v8n8p220.
25. Ghasemi F, Valizadeh F, Nasab MM. [Analyzing the knowledge and attitude of nurses regarding medication error and its prophylactic ways in educational and therapeutic hospitals of Khorramabad]. Yafteh. 2009;10(2):55-63. Persian.
26. Robabi H, Arbabisarjou A. Computer Literacy Among Students of Zahedan University of Medical Sciences. Global J Health Sci. 2015;7(4). https://doi.org/10.5539/gjhs.v7n4p136.
27. Mansouri A, Ahmadvand A, Hadjibabaie M, Javadi M, Khoee SH, Dastan F, et al. A review of medication errors in iran: sources, underreporting reasons and preventive measures. Iran J Pharm Res. 2014;13(1):3-17. [PubMed ID:24734052]. [PubMed Central ID:PMC3985240].
28. Hinchcliff R, Greenfield D, Moldovan M, Westbrook JI, Pawsey M, Mumford V, et al. Narrative synthesis of health service accreditation literature. BMJ Qual Saf. 2012;21(12):979-91. [PubMed ID:23038406]. https://doi.org/10.1136/bmjqs-2012-000852.
29. Lee E. Safety climate and attitude toward medication error reporting after hospital accreditation in South Korea. Int J Qual Health Care. 2016;28(4):508-14. [PubMed ID:27283441]. https://doi.org/10.1093/intqhc/mzw058.
30. Fortune T, O’Connor E, Donaldson B. Guidance on designing healthcare external evaluation programmes including accreditation. Dublin, Ireland: International Society for Quality in Healthcare (ISQua). 2015.
31. Tabrizi JS, Gharibi F, Pirahary S. Developing of National Accreditation Model for Rural Health Centers in Iran Health System. Iran J Public Health. 2013;42(12):1438-45. [PubMed ID:26060646]. [PubMed Central ID:PMC4441941].
32. Tabrizi JS, Gharibi F, Wilson AJ. Advantages and Disadvantages of Health Care Accreditation Mod-els. Health Promot Perspect. 2011;1(1):1-31. [PubMed ID:24688896]. [PubMed Central ID:PMC3963612]. https://doi.org/10.5681/hpp.2011.001.
33. Sadeq Tabrizi J, Gharibi F. [Developing a national accreditation model via Delphi Technique]. Hospital. 2012;11(2):9 18. Persian.
34. Directorate General of Health Services Ministry of Health and Family Welfare. Standards for Primary Healthcare Units/Centers. India: Directorate General of Health Services Ministry of Health & Family Welfare; 2012. Available from: https://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2012/primayhealth-centres.pdf.
35. Health Care Accreditation Council. HCAC Primary Health Care Accreditation Standards. Amman: Health Care Accreditation Council; 2025. Available from: https://hcac.jo/en-us/Accreditation/Primary-Care-Accreditation-Standards.
36. Ministry of Health. Primary Healthcare Standards. Saudi Arabia: Ministry Of Health; 2025. Available from: http://www.moh.gov.sa/depts/Pharmacy/Documents.pdf.
37. Lawshe CH. A Quantitative Approach to Content Validity1. Personnel Psychol. 2006;28(4):563-75. https://doi.
org/10.1111/j.1744-6570.1975.tb01393.x.
38. Kim YS, Han SH, Hwang JH, Park JM, Lee J, Choi J, et al. Development of the Korean framework for senior-friendly hospitals: a Delphi study. BMC Health Serv Res. 2017;17(1):528. [PubMed ID:28778159]. [PubMed Central ID:PMC5545032]. https://doi.org/10.1186/s12913-017-2480-0.
39. Lee PP, Sultan MB, Grunden JW, Cioffi GA, IOP Consensus Panel. Assessing the Importance of IOP Variables in Glaucoma Using a Modified Delphi Process. J Glaucoma. 2010;19(5):281-7. [PubMed ID:19855301]. https://doi.org/10.1097/IJG.0b013e3181b4ca8d.
40. Culley JM. Use of a computer-mediated Delphi process to validate a mass casualty conceptual model. Comput Inform Nurs. 2011;29(5):272-9. [PubMed ID:21076283]. [PubMed Central ID:PMC4322391]. https://doi.org/10.1097/NCN.0b013e3181fc3e59.
41. Tabrizi JS, Gharibi F. Primary healthcare accreditation standards: a systematic review. Int J Health Care Qual Assur. 2019;32(2):310-20. [PubMed ID:31017069]. https://doi.org/10.1108/IJHCQA-02-2018-0052.
| Files | ||
| Issue | Vol 9 No 2 (2025) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v9i2.18716 | |
| Keywords | ||
| Accreditation Model Primary Health Care Medication Management | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Moshiri E, Ebrahimi Tavani M, Gharibi F. Developing a National Accreditation Model for Medication Management in the Iranian Primary Health Care System. Health Tech Ass Act. 2025;9(2).
