Hospital Medication Safety Self-Assessment™
(Canadian Version)

Frequently Asked Questions:

How was the Medication Safety Self-Assessment™ (MSSA) developed?

The Medication Safety Self Assessment (MSSA) was developed by the Institute for Safe Medication Practices (ISMP) in the United States. It is based on approximately 20 years of information regarding medication errors and root cause analyses in hospitals. Its value in reducing errors is grounded in scientific research and expert analysis of medication errors and their causes. The MSSA distributed by ISMP Canada is an adaptation of the original version.

The self-assessment offers you a systematic approach to reviewing your facility to help you identify areas where improvements can be made. You will begin to see the value of conducting the exercise once your facility begins to assess its level of compliance with the characteristics, even before you enter on-line data and make comparisons.

Do the MSSA characteristics represent standards of practice?

As ISMP (US/Canada) is not a standard setting organization, there are no requirements nor specific targets for you to reach. The purpose of the self-assessment is to provide a method for evaluating areas where improvement and changes might be considered within your own facility.

The Canadian Council on Health Facilities Accreditation (CCHSA) has recognized the value of the MSSA and plans to endorse it in their updated standards as a suggested tool to assess medication system safety. Use of the MSSA will be not be compulsory.

MSSA findings are intended for internal use and become even more useful as repeat assessments are performed to see where you have improved over time. Furthermore, some of the characteristics describe functionality or technology which is not readily used in various hospitals, but represents a potential safety goal.

How can I access the MSSA for my facility?

Some provinces have an agreement with ISMP Canada for conducting the MSSA. If you have questions about the status of the agreement in your province, or require information about your provincial contact, please contact ISMP Canada (e-mail mssa@ismp-canada.org). If your province does not have an agreement with ISMP Canada, you can request a copy of the MSSA and obtain a password for on-line entry of your findings. The fee is CDN$250.00 + GST for one password annually.

My facility has a number of sites. Do I need a password for each one?

If your facility is homogeneous or is managed as a single entity, then it may be appropriate to conduct a single MSSA across the entire institution. However, if your sites are relatively autonomous and have different procedures and levels of technology, then separate MSSAs are probably in order.

Are there situations where the MSSA is not appropriate for a facility?

The MSSA version that ISMP Canada uses was intended for acute care hospitals. As such, it may not be applicable for use in a long-term care facility or one with a large outpatient component.

How secure is my on-line data?

The use of passwords provides the first level of anonymity and security with the on-line MSSA.

In addition, only two ISMP Canada individuals have access to assigned MSSA password data. The data is transmitted over a portal to a remote server, which has its own firewall and security levels.

When requesting data comparison, facilities within the aggregate are not identified (i.e., no password or other details are evident); you will only see the total number of facilities as the "n", which will include you. There will not be comparator information available if the number of facilities falling within the selected parameters is too low. This further protects identifying information.

What kind of information can I get from the on-line MSSA?

You can compare your assessment data to previous assessments as a measure of change over time. You can also compare your data to aggregate data to identify areas of relative strength and weakness.

Below are graphs illustrating the types of comparisons you will be able to make. (Please note that the sample graphs are a compilation of different test passwords - they do not represent any specific facilities. They were generated at different times, therefore the total number of facilities represented may be different for each.)

The first figure shows the screen from which you will select your comparison parameters. You can compare from various levels of the self-assessment: by key elements, characteristics, or individual questions.

If you have not completed entering your assessments for every characteristic, you will not be able to generate graphs, nor see aggregate data. While your data entry is incomplete (identified by unchecked tabs), you have the opportunity to "Update" your responses. The date of the file will be the date on which you began data entry, not the date of completion.

Once all your entries are completed, you will not be able to change them.

If you have completed more than one assessment, only your most recent assessment is included in the total aggregate.

You can compare your most recent assessment with the aggregate any number of times and print your graphed results.

The benefit of comparing your facility to others is to help you assess which areas you might prioritize for taking action. It will also help you to see that, despite what might appear to be a low score, you may actually be at the same level as other hospitals for specific elements. These comparisons may help you decide where to focus your resources and actions.

Sample graphs are shown below.

Compare Type = Key Elements; Compare With = Total Aggregate (n = 153 facilities in the aggregate):

Compare Type = Key Elements; Compare With = Province = Ontario (n = 63 facilities in the aggregate):

Compare Type = Specify Questions (6 20 30 54 99); Compare With = Total Aggregate (n = 160 facilities in the aggregate):

It is also possible to compare your own results over time, if you have completed more than one assessment. This will show you how you are progressing in terms of system changes to promote medication safety.

May I enter more than one assessment for my facility?

Each registered facility is given a single access for their password. If a provincial program requests repeated self-assessments to conduct comparisons over time, ISMP Canada will allocate additional "credits" to each password.

Re-assessments are probably best conducted with at least one year's interval between them. This allows sufficient time to take action and stabilize the implemented medication system changes.

How is the scoring for individual characteristics done?

Each characteristic has a specific weighting. If the characteristic is fully implemented, then the maximum score is achieved, i.e., 100% of the maximum score. (This is often not realistic.)

The scoring is not the same for all characteristics, as some identify situations representing a higher safety risk than others. The scores may range this way:

0,1,2,3,4 or
0,2,4,6,8 or
0,3,6,9,12 or
0,4,8,12,16

Some questions may be more clear cut, then they'll be scored in this way:

0,0,0,0,8
0,0,0,0,12 etc.

The use of the "absolute" scores is useful when comparing repeated self-assessments or for a specific group analysis; otherwise, the general findings as represented on the graphs are sufficient.

How do I contact ISMP Canada regarding specific questions I may have about the (MSSA)?

The easiest and most direct way of contacting ISMP Canada about the MSSA is to e-mail mssa@ismp-canada.org.