Table 4 Minimum indicator set for evaluating medication-related quality of care in Australian residential aged care

1. Medication appropriateness in the most prevalent diseases

1.1 Use of beta blocker post myocardial infarction/ischaemic heart disease (National Committee for Quality Assurance & USA: www.ncqa.org Accessed [September 2013; Australian Institute of Health and Welfare 2009; Wegner et al. 2007; Primary Care & Social Care Information Centre 2013; NSW Therapeutic Assessment Group 2007; National Prescribing Service 2006; Basger et al. 2008)

1.2 Use of statin post myocardial infarction/ischaemic heart disease (Australian Institute of Health and Welfare 2009; Wegner et al. 2007; Primary Care & Social Care Information Centre 2013; NSW Therapeutic Assessment Group 2007; National Prescribing Service 2006; O'Mahony et al. 2010)

1.3 Angiotensin converting enzyme inhibitor/angiotensin receptor blocker use in hypertension/congestive heart failure (Wegner et al. 2007; Primary Care & Social Care Information Centre 2013; NSW Therapeutic Assessment Group 2007; National Prescribing Service 2006; Mackinnon & Hepler 2002; Basger et al. 2008; O'Mahony et al. 2010)

1.4 Antiplatelet therapy post myocardial infarction/ischaemic heart disease (e.g. aspirin/clopidogrel not ticlopidine) (National Committee for Quality Assurance & USA: www.ncqa.org Accessed [September 2013; Australian Institute of Health and Welfare 2009; Wegner et al. 2007; Primary Care & Social Care Information Centre 2013; NSW Therapeutic Assessment Group 2007; National Prescribing Service 2006; Basger et al. 2008)

1.5 Antiplatelet therapy post stroke/transient ischaemic attacks (e.g. aspirin/clopidogrel not ticlopidine) (Wegner et al. 2007; Primary Care & Social Care Information Centre 2013; NSW Therapeutic Assessment Group 2007; Basger et al. 2008; O'Mahony et al. 2010)

1.6 Medicines to avoid in patients with cardiovascular disease (e.g. NSAIDs/COX 2 inhibitors, calcium channel blockers and select anti-arrhythmics) (Wegner et al. 2007; Mackinnon & Hepler 2002; Basger et al. 2008; The American Geriatrics Society 2012; O'Mahony et al. 2010; Winit-Watjana et al. 2008; Naugler et al. 2000)

1.7 Medicines to avoid in patients with dementia (e.g. medications with clinically significant anticholinergic properties) (Wegner et al. 2007; Basger et al. 2008; The American Geriatrics Society 2012; O'Mahony et al. 2010; Laroche et al. 2007; Onder et al. 2013)

2. Medication appropriateness in limited life expectancy

Did not meet inclusion criteria

3. General medication appropriateness

3.1 Medicines to avoid in patients at risk of falling or with a history of falls ( e.g. medications with clinically significant anticholinergic properties, sedating antihistamines, tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, benzodiazepines and antipsychotics) (Wegner et al. 2007; Mackinnon & Hepler 2002; Basger et al. 2008; The American Geriatrics Society 2012; Rognstad et al. 2009; O'Mahony et al. 2010)

3.2 Avoid use of benzodiazepines (short and long acting) (Wegner et al. 2007; National Prescribing Service 2006; Basger et al. 2008; Holt et al. 2010; The American Geriatrics Society 2012; Rognstad et al. 2009; O'Mahony et al. 2010; Winit-Watjana et al. 2008; Laroche et al. 2007; Rancourt et al. 2004; Naugler et al. 2000)

3.3 Avoid use of medicines with clinically significant anticholinergic properties (Wegner et al. 2007; Basger et al. 2008; Holt et al. 2010; The American Geriatrics Society 2012; Rognstad et al. 2009; O'Mahony et al. 2010; Winit-Watjana et al. 2008; Laroche et al. 2007; Naugler et al. 2000)

3.4 Anti-arrhythmic medicines to avoid (e.g. disopyramide and see 1.6) (The American Geriatrics Society 2012; Rognstad et al. 2009; Laroche et al. 2007; Naugler et al. 2000)

3.5 Digoxin > 0.125mcg/day (The American Geriatrics Society 2012; O'Mahony et al. 2010; Winit-Watjana et al. 2008; Laroche et al. 2007; Rancourt et al. 2004; Naugler et al. 2000)

3.6 Antidepressants to avoid (e.g. tricyclic antidepressants (see 3.1 and 3.3) and monoamine oxidase inhibitors (see 3.1) (Wegner et al. 2007; Holt et al. 2010; The American Geriatrics Society 2012; Rognstad et al. 2009; O'Mahony et al. 2010; Winit-Watjana et al. 2008; Rancourt et al. 2004; Naugler et al. 2000)

3.7 Avoid typical (see 3.3) and atypical antipsychotics (e.g. olanzapine and clozapine) (Holt et al. 2010; The American Geriatrics Society 2012; Rognstad et al. 2009; O'Mahony et al. 2010; Winit-Watjana et al. 2008; Rancourt et al. 2004)

3.8 Antispasmodics and muscle relaxants to avoid ( smooth muscle relaxants alverine and mebeverine and see 3.3) (McLeod et al. 1997; Moher et al. 2009; National Aged Care Alliance 2014; National Committe for Quality Assurance. (Desirable attributes of HEDIS). USA: www.ncqa.org/tabid/415/Default.aspx Accessed [March 2012; National Committee for Quality Assurance & USA: www.ncqa.org Accessed [September 2013; National Institute for Health and Care Excellence 2014a; Onder et al. 2013)

3.9 Avoid duplication of drug class (e.g. >2 NSAIDs) (Mackinnon & Hepler 2002; O'Mahony et al. 2010; Winit-Watjana et al. 2008; Laroche et al. 2007; Rancourt et al. 2004)

3.10 Avoid alpha blockers (e.g. prazosin and doxazosin) (Holt et al. 2010; The American Geriatrics Society 2012; O'Mahony et al. 2010; Winit-Watjana et al. 2008)

3.11 Avoid centrally acting alpha agonists (e.g. clonidine and methyldopa) (Holt et al. 2010; The American Geriatrics Society 2012; Laroche et al. 2007; Rancourt et al. 2004; Naugler et al. 2000)

3.12 Calcium channel blockers to avoid (e.g. short acting nifedipine) (Holt et al. 2010; The American Geriatrics Society 2012; Winit-Watjana et al. 2008; Laroche et al. 2007; Naugler et al. 2000)

3.13 Avoid combination of warfarin and aspirin (+/− gastric protection) (Rognstad et al. 2009; O'Mahony et al. 2010; Winit-Watjana et al. 2008; Rancourt et al. 2004)

3.14 Avoid ‘Triple Whammy’ combination of angiotensin converting enzyme inhibitor/angiotensin two receptor antagonist plus diuretic plus non-steroidal anti-inflammatory (excluding low dose aspirin) (National Prescribing Service 2006; Basger et al. 2008; Rognstad et al. 2009)

3.15 Influenza vaccination rates (National Committee for Quality Assurance & USA: www.ncqa.org Accessed [September 2013; Australian Institute of Health and Welfare 2009; Centres for Medicare and Medicaid Services & USA: www.cms.gov Accessed [February 2014; Wegner et al. 2007; Primary Care & Social Care Information Centre 2013; Basger et al. 2008)

3.16 Pneumococcal vaccinations rates (National Committee for Quality Assurance & USA: www.ncqa.org Accessed [September 2013; Australian Institute of Health and Welfare 2009; Centres for Medicare and Medicaid Services & USA: www.cms.gov Accessed [February 2014; Wegner et al. 2007; Basger et al. 2008)

4. Detection and monitoring of adverse events

4.1 Fall rates (+/− associated with medication use) (Australian Institute of Health and Welfare 2009; Campbell Research and Consulting (CR&C) 2006; Nay et al. 2004; Courtney et al. 2007; Centres for Medicare and Medicaid Services & USA: www.cms.gov Accessed [February 2014; Wegner et al. 2007; Mackinnon & Hepler 2002; Onder et al. 2013)

5. Access to services

5.1 Annual cycle of care for people with chronic disease (e.g. diabetes) (National Committee for Quality Assurance & USA: www.ncqa.org Accessed [September 2013; Australian Institute of Health and Welfare 2009; Wegner et al. 2007; Primary Care & Social Care Information Centre 2013)

5.2 Medication review (National Committee for Quality Assurance & USA: www.ncqa.org Accessed [September 2013; Australian Institute of Health and Welfare 2009; Department of Health 2012; Courtney et al. 2007; Wegner et al. 2007; Primary Care & Social Care Information Centre 2013; National Prescribing Service 2006)

6. Policy/Procedure

6.1 Access to up to date medicines information for providers, carers and residents (Department of Health 2012; Wegner et al. 2007; National Prescribing Service 2006)

6.2 Policy of regular medication review including over the counter and complementary medicines (Department of Health 2012; Wegner et al. 2007; Primary Care & Social Care Information Centre 2013; National Prescribing Service 2006)