Assist Ontario hospitals, long term care facilities and community pharmacies to implement strategies and safeguards for the prevention of patient injury from medication use.
The program is aligned with the Excellent Care for All Act and government priorities to improve patient care. Medication safety is a key component of quality improvement and patient safety.
The Medication Safety Support Service (MSSS) is a joint initiative of the Ontario Ministry of Health and Long-Term Care and the
Institute for Safe Medication Practices Canada established to promote medication safety.
Guiding this service is an Advisory Group with membership from:
- Ontario Ministry of Health and Long-Term Care
- Ontario Hospital Association
- College of Physicians and Surgeons of Ontario
- Ontario Medical Association
- Canadian Society of Hospital Pharmacists - Ontario Branch
- Ontario College of Pharmacists
- Institute for Safe Medication Practices Canada
- Registered Nurses Association of Ontario
- Registered Practical Nurses of Ontario
- College of Nurses of Ontario
- Ontario Pharmacists' Association
- Quality Healthcare Network
As of January 1, 2012, Ontario hospitals became "institutions" under the Freedom of Information and Protection of Privacy Act (FIPPA.) FIPPA governs institutions with regard to collection, use and disclosure of "personal information" and provides rights of access to information within the custody or control of the institution. The updated ISMP Canada's Guidance for Sharing Medication Incident Data in the Era of Ontario's PHIPA, QCIPA and FIPPA includes ISMP Canada's review of rules that relate to disclosure of information under FIPPA, considers some of the impacts on hospitals that report medication incident information to ISMP Canada and shows that reporters can continue to share incident information that consists of non-identifying facts about the incident.
Medication Safety Support Service Achievements
2009 - 2012
ISMP Canada provides subject matter expertise to support a collaborative process and coordinated system for selecting medication safety indicators in Ontario. This work supports provincial directions towards increased public reporting and sharing of information with the public, and recognizes the interest in developing indicators related to medication safety.
Development of Medication Safety Indicators for Public Reporting. Project to identify three medication safety indicators that are feasible and suitable for public reporting in Ontario. These included venous thromboembolism prevention, acute myocardial infarction discharge medications, medication reconciliation.
Identification of Medication Safety Indicators in Acute Care Settings for Public Reporting in Ontario - September 2010
From more than 300 potential medication safety indicators two analysts at ISMP Canada worked independently to narrow the focus to 49, and subsequently to 12 candidate indicators. The selection criteria for evaluation of the indicators focused on data that: a) aligned with current patient safety initiatives in Ontario and/or Canada, b) are feasible or readily available, c) have acceptable validity and quality, d) are actionable, e) are understandable by the target audience, and f) are evidence-based. Stakeholder consensus suggested medication reconciliation for potential indicator development in Ontario
- Potential Medication Reconciliation Indicators for Public Reporting in Ontario - April 2012
ISMP Canada was asked to support the direction of MOHLTC towards public reporting of safety indicators by facilitating the determination of a suitable medication reconciliation (MedRec) indicator. Based on available data on the current state of MedRec implementation, it was decided that an indicator specific to admission MedRec would be the most appropriate as this interface of care has the highest implementation rates and frontline experience associated with it.
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2006 - 2012
Medication safety is integral to overall patient safety in the OR setting. The OR is a unique
environment where high-alert medications are frequently used and most procedures take place in a
sterile field, requiring medications to be removed from their original packaging. Furthermore,
medications may be prescribed, selected, prepared and administered by only one practitioner. In
addition, medications may be administered in response to verbal orders, which can be error-prone.
The OR is also a point of continuous patient transfer (i.e., the OR team assumes the care of a
patient for short time period), with frequent hand-offs between the OR team and others, and
transfer points are considered a time where there is increased risk for medication incidents
(i.e., errors) to occur.
The OR Medication Safety Checklist was developed by an expert panel and in collaboration with
the Canadian Anesthesiologists' Society and the Operating Room Nurses Association of Canada to
help guide individual organization to assess system-based medication issues such as storage and
use of medications in the OR setting. The pilot version of this checklist was reviewed and tested
by 18 Ontario hospitals (4 of these hospitals were multi-site organizations). A post-pilot survey evaluation
was completed by 9 of the participating hospitals. The survey results showed:
44% have implemented changes in
their OR medication system as a result of the pilot
67% are planning or are in the process of implementing changes
89% indicated a plan for inclusion of the
OR Medication Checklist as part of their quality improvement program
Version 2 of the OR Medication Safety Checklist includes learning from a recent Canadian event
involving the inadvertent injection of concentrated epinephrine 1 mg per mL intended for topical
In an effort to combine OR safety initiatives in Ontario, ISMP Canada in collaboration with the
OHA is providing the OR Medication Safety Checklist as part of the Surgical Safety Checklist
Implementation toolkit distributed by the OHA to Ontario hospitals. The OR Medication Safety
Checklist complements the Surgical Safety Checklist. Additionally, ISMP Canada staff presented
to each LHIN to support medication safety in conjunction with roll out of the OHA
Surgical Safety Checklist Implementation toolkit to Ontario hospitals. Presentations highlight for
participants the key findings from reported events and literature regarding the inadvertent
injection of concentrated epinephrine intended for topical administration.
Operating Room Medication Safety Checklist©
Medication Errors : What You Cannot Afford to Ignore in the Perioperative Setting Presentation
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2006 - 2012
Medication reconciliation has long been identified as a system solution to enhance medication information communication for patients as they move from one health care setting to another. ISMP Canada supports Medication Reconciliation provincially, nationally and internationally. ISMP Canada created Getting Started Kits for Medication Reconciliation in Acute Care, Long Term Care, Home Care for the Canadian Safer Healthcare Now! campaign and for the World Health Organization High 5s initiative and provides ongoing support to teams around the world.
Medication reconciliation at discharge - Provincial Pilot Project 2011/2012
Tools for discharge medication reconciliation
Jump into MedRec: Improving BPMH Quality across the Continuum of Care, Best Possible Medication History (BPMH) Training
Optimizing Communication about Medications at Transitions of Care Provincial Roundtable - September 2010
Linking MedsCheck to MedRec - Provincial 2009
This project is also supported by the Ontario College of Pharmacists and complements the Ministry
Read more about Medication Reconciliation national and internationally.
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2004 - 2012
The Ontario Medication Incident Database (OMID), supported by the Ontario Ministry of Health and Long-Term Care, has been capturing medication incident reports submitted by Ontario health service organizations since 2004. The OMID is a component of the Ontario Medication Safety Support Service (MSSS) and ISMP Canada's Medication Incident and Near Miss Reporting Program. Learning from analysis of medication incidents collected helps identify priority areas for intervention, and will ultimately lower the rate of preventable hard from mediation use.
Ontario has achieved a high level of stakeholder participation in and commitment to medication incident reporting and learning. From January 1st 2010 to September 30th, 2011, the OMID received 9,715 medication incident reports submitted voluntarily by Ontario health service organizations and by individual practitioners.
As of October 2011, all hospitals in Ontario are required to begin reporting medication and IV fluids critical incidents through the National System of Incident Reporting (NSIR). ISMP Canada, in collaboration with the Canadian Institute for Health Information (CIHI), the Ontario Hospital Association (OHA) and Health Quality Ontario (HQO) provides support for the new provincial requirement and the Excellent Care for All Act.
ISMP Canada is encouraging Ontario hospitals to report medication incidents to the CIHI National System for Incident Reporting (NSIR) and will continue to provide support for analysis and communication of learning.
Sincere appreciation is expressed to the many healthcare professionals who have demonstrated
support for a culture of safety, exemplified by their willingness to share information about
medication incidents and related findings.
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2002 - 2012
The Medication Safety Self-Assessment® (MSSA) was developed for Hospitals, Long-Term Care,
Community Pharmacy and Complex Continuing Care/Rehabilitation Facilities. The MSSA is a
comprehensive tool that can help organizations evaluate the strengths and weaknesses of their
medication use processes and identify opportunities for improvement. Most importantly, this tool
facilitates the development of a plan to improve medication safety within an organization. This
proactive approach permits the identification of actions required to ensure the safety of
115 Ontario hospitals have completed the MSSA, and 103 hospitals have completed it more than
once. Hospitals repeating the assessment demonstrate higher scores on the repeat assessment,
indicating that system improvements have been implemented. For some hospitals, the MSSA has
become part of the facility's quality improvement program.1 Ontario results have been consistently
about 5% above the Canadian aggregate.
686 Ontario long term care homes have completed medication safety self-assessments and 184 of those assessments were completed in 2011-2012. A total of 408 homes have completed at least one assessment and 278 of those homes have completed the assessment more than once.
In Ontario, 10 of 20 complex continuing care/rehabilitation facilities and 40 community pharmacies have completed the self-assessment. Additionally, 360 (with
39 repeating the process) LTC homes have completed the MSSA.
51 community pharmacies in Ontario have completed the MSSA program for Community Pharmacist/Ambulatory Care and 1 pharmacy has repeated the program to measure improvement. The medication safety self-assessment for community pharmacist/ambulatory care fulfills Standard 6: Safe Medication Practices for the Standards of Practice for Pharmacy Managers in Ontario.
Analysis of MSSA results assists in providing direction for future provincial safety
initiatives. Of interest, approximately 80 safe practice characteristics from the hospital MSSA
have been adapted for inclusion in the Accreditation Canada required organizational practices.
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2005 - 2009
The optimal management of hospital use of thromboprophylaxis has been well-documented and
published. The project goal was to increase compliance with the use of evidence-based clinical
practice guidelines in thromboprophylaxis (deemed the #1 priority for patient safety intervention
by AHRQ in the US). A comprehensive, national web-based survey on anticoagulants to which 99
Ontario hospitals responded, identified the degree of adherence to best practice
guidelines. A subsequent chart audit in 8 Ontario hospitals to establish baseline performance of
thromboprophylaxis practices reinforced the need for a system improvement intervention. An
average of 86% of patients having hip fracture surgery received prophylaxis; 51% of general
surgery and only 31% of general medicine patients received appropriate prophylaxis. According to
the practice guidelines for these groups of patients, the target was 100% compliance for all
groups. Post-intervention results included:
Safer distribution and storage of high potency heparin products was the second anticoagulant
system improvement intervention. Unfractionated heparin ranks within the top 10 drugs reported as
causing harm in medication incident databases worldwide. Findings from the baseline survey showed
that 57.7% of responding hospitals had no specific safeguards to prevent the misuse of high-dose
heparin (having the potential for substitution errors); only about 19% of hospitals did not stock
high-dose heparin products (10,000 units/mL or greater) in patient care areas. Intervention
strategies were successfully tested in 4 hospitals with full implementation of the
recommendations. The heparin resource kit Getting Started with Storage Safeguards to Minimize the
Risk of Harm with Unfractionated Heparin was downloaded 179 times by 98 participating Ontario
- 13% increased rate of compliance for General Surgery patients
- 25% increased rate of compliance for General Medicine patients
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2004 - 2005
This high alert drug category was selected based on a number of critical incidents reported to
ISMP Canada that resulted in patient harm, as well as on feedback from Ontario hospitals at an
Ontario medication safety conference held in July 2003. Twelve months after the interventions were
introduced to Ontario hospitals, a follow-up survey identified successful implementation or action
in 94% of responding hospitals. These safeguards included removal of high potency opioids from
patient care areas, standardization of doses and solutions, and implementation of independent
double-checks for patient controlled analgesia and epidurals.
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2002 - 2003
In response to a number of patient deaths in Ontario (and other parts of Canada and the USA)
due to unintended intravenous administration of potassium chloride (KCl) concentrate, ISMP Canada
provided solutions and support to hospitals to prevent further mishaps. ISMP Canada's follow-up
survey demonstrated significant achievements among Ontario hospitals, with a decrease in
availability of concentrated KCl in patient care areas from 62% to 26%. An independent national
survey conducted in 2004 reported that 96% of Ontario hospital respondents had removed KCl
concentrate from patient care areas, citing Ontario as the most successful province in this safety
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1 Hofman L, Greenall J, McBride J, Jelincic V. Assessment of Risk in Medication-Use
Systems: Learning from the Medication Safety Self-Assessment. Can J Hosp Pharm 2007; 60(1) 49-52
2 McKerrow R, Johnson N, Hall KW, Roberts N, Salsman B, Bussieres JF, Macgregor P,
Lefebvre P, Harding J. (Eds.). 2004. "2003/2004 Annual Report, Hospital Pharmacy in Canada:
Medication Safety" [15th Hospital Pharmacy in Canada Survey]. Eli Lilly Canada. P;. 55-57.
Retrieved March 9, 2007. http://www.lillyhospitalsurvey.ca/hpc2/content/rep_2004_toc.asp.