Lead author Certina Ho, lecturer at the Leslie Dan Faculty of Pharmacy and project lead with ISMP Canada

Community pharmacies in Canada provide valuable services to patients, dispensing over 600 million prescriptions each year; however, there is little research exploring the safety of this process. A new study led by researchers from University of Toronto’s Leslie Dan Faculty of Pharmacy, the SafetyNET-Rx Research Team and the Institute for Safe Medication Practices Canada (ISMP Canada) found that less than one per cent of errors reported by community pharmacies in Nova Scotia resulted in patient harm.

The study, published in CMAJOpen, examines nearly seven years of error-reporting data collected from 301 community pharmacies in Nova Scotia from 2010 to 2017. It provides insight into these types of events, where they occurred in the dispensing process, and the degree of resulting harm to the patient.

“This scale of analysis provides important information that can be used to guide quality improvement and strengthen medication safety in community pharmacies across Canada,” says lead author Certina Ho, lecturer at the Leslie Dan Faculty of Pharmacy and project lead with ISMP Canada. “To our knowledge, no studies have been conducted to quantitatively examine reported errors from community pharmacies in North America and so this work is a first step toward filling that gap.”

The research team tracked what is known as quality related-events (QREs), which includes errors that reach the patient as well as errors that are intercepted prior to dispensing. A total of 98,097 QREs were reported of which 82 per cent did not reach the patient and 0.95 per cent were associated with patient harm. The most frequent type of QRE reported was incorrect dose or frequency of medication (25.6 per cent) followed by incorrect quantity (20 per cent).

“The majority of QREs were discovered by pharmacist or pharmacy technician safety checks during their workflow processes and did not reach the patient,” says Adrian Boucher, research analyst at the Leslie Dan Faculty of Pharmacy, University of Toronto, and medication safety analyst with ISMP Canada. “Examining the contributing factors of these events is important to continue to improve the safety of the process and the quality of care provided to patients.”

The researchers chose to investigate QREs in Nova Scotia because it was the first province in Canada to require reporting and therefore offered a strong database from which early insight can be gleaned to help inform safety practices in other provinces and jurisdictions. In Nova Scotia, all members of the pharmacy team can anonymously report a QRE through ISMP Canada’s online Community Pharmacy Incident Reporting system (CPhIR).

“It’s important that healthcare professionals are not afraid to report errors and other quality related events,” says Beverley Zwicker, Registrar of the Nova Scotia College of Pharmacists. “Accurately reporting and then learning from these events is a crucial aspect of patient safety. Seeing the number of reports increasing over time shows that many pharmacists in Nova Scotia are embracing a culture of reporting errors and see the value in it.”

A number of QREs that caused harm were related to allergic reactions to medication, possibly indicating that information about a patient’s allergies was not available during the pharmacist’s   consideration of the prescribed medication – a crucial part of the dispensing process. “Analysis of the data can help us target our quality improvement efforts so that we can look at ways to address specific issues,” says Zwicker.

“Our colleagues in Nova Scotia have led the way in establishing processes to strengthen medication safety in community pharmacies,” says Carolyn Hoffman, CEO and President, ISMP Canada. “We’re pleased to partner in this work locally and to share the learning nationally as other provinces launch similar initiatives.”

The Ontario College of Pharmacists (OCP) stated in a recent press release that it has moved forward with a province-wide implementation of a medication safety and quality assurance program to over 4,300 community pharmacies. The Assurance and Improvement in Medication Safety (AIMS) Program is a mandatory medication safety program for Ontario pharmacies and is expected to be fully implemented by mid-2019.

The study authors note that future research in this area should focus on the types of medications involved and deeper qualitative analysis of event descriptions to better understand contributing factors associated with QREs in community pharmacy practice.


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