# Development and Psychometric Validation of the Hospital Medication System Safety Assessment Questionnaire

## TL;DR

This study created and validated a questionnaire to assess hospital medication system safety in Portugal, showing it is reliable and could help improve patient safety.

## Contribution

The study introduces a new validated questionnaire for evaluating hospital medication system safety in a Portuguese context.

## Key findings

- The HMSSA-Q has five domains covering key aspects of medication safety.
- The questionnaire demonstrated excellent internal consistency with a Cronbach’s alpha of 0.97.
- Factor analysis supported the internal structure of each domain in the questionnaire.

## Abstract

Background/Objectives: Medication incidents remain a significant concern in hospital settings. Integrated medication systems, regarding organized processes, policies, technologies and professional practices are designed to enhance patient safety; however, their safety performance is still suboptimal. The use of valid and reliable instruments to assess hospital medication system safety can be a valuable resource for health care management. The aim of this study was to describe the development and psychometric validation of the Hospital Medication System Safety Assessment Questionnaire (HMSSA-Q) for assessing the safety of hospital medication systems and its processes in Portugal. Methods: The HMSSA-Q was developed through a literature review and two rounds of expert panel consultation. Following consensus, a pilot methodological study was conducted in 95 Portuguese hospitals. Construct validity was assessed using principal component factor analysis, and reliability was evaluated through internal consistency (Cronbach’s alpha). Results: The instrument is theoretically structured into five predefined domains/subscales: Organizational Environment, Safe Medication Prescribing, Safe Medication in Hospital Pharmacy, Safe Medication Preparation and Administration, and Information and Patient Education. Principal component analyses performed separately for each domain supported their internal structure. The overall scale showed excellent internal consistency (Cronbach’s α = 0.97), with Cronbach’s alpha values for the domains ranging from 0.86 to 0.94. Conclusions: The HMSSA-Q is a valid and reliable instrument for assessing the safety of hospital medication systems and has the potential to serve as an innovative management tool for improving patient safety.