Supplemental Standard of Practice: Mandatory Standardized Medication Safety Program in Ontario Pharmacies

Feedback deadline was: Aug. 6, 2018


This consultation is now closed.

The College is now consulting on a supplemental Standard of Practice (sSOP), in accordance with our consultation framework. Pharmacy professionals, stakeholders, members of the public and others are invited to comment on whether the sSOP provide clear guidance on the expectations of pharmacists and pharmacy technicians in regards to the Medication Safety Program.

Following the consultation, the final sSOP will be brought forward for approval by Council in September 2018.

The Ontario College of Pharmacists has launched a province-wide Medication Safety Program with the goal of identifying medication incident trends and supporting continuous quality improvement in pharmacy practice. The components of the program were confirmed in spring of 2017, after a formal consultation process. Since then, the expectations for pharmacy professionals have been outlined in a sSOP which was considered by Council in June 2018.

The sSOP is an adjustment to the NAPRA Model Standards of Practice (pharmacists and pharmacy technicians) related to safety and quality, to provide additional detail on what is expected of Ontario pharmacy professionals under the Medication Safety Program. The sSOP will also be reinforced in the pharmacy through the Operational Standards for Pharmacy in Ontario, which are also currently posted for consultation.

Review the supplemental Standard of Practice prior to submitting your feedback.

Question to Guide Your Feedback

Does the supplemental Standard of Practice provide clear guidance on the College’s expectations of pharmacy professionals in regards to the Medication Safety Program?

Frequently Asked Questions

What are the responsibilities of pharmacy professionals in meeting the sSOP?

Pharmacy professionals must practice in accordance with all of the requirements of the Medication Safety Program.

Under the supplemental Standard of Practice, all pharmacists and pharmacy technicians have the responsibility and obligation to manage medication incidents and address unsafe practices. This includes documenting and communicating all medication incidents and near misses with the entire pharmacy staff, and as appropriate to the patient and other health care providers (e.g. if the incident reaches the patient).

There is an expectation that pharmacy professionals will record medication incidents and near misses, and engage in continuous quality improvement planning and initiatives to improve system vulnerabilities.

What are the responsibilities of Pharmacy Owners and Designated Managers (DMs) in Meeting the sSOP?

Pharmacy owners and DMs must enable a culture that supports learning and accountability rather than blame and punishment, and encourages individuals to discuss medication incidents without fear of punitive outcomes. It is an expectation that all pharmacy operations are conducted in a manner that supports the aim of the Medication Safety Program (as outlined in the introduction), the Standards of Operation, and the requirements outlined in the sSOP. This includes ensuring that pharmacy staff are able to anonymously record medication incidents, and implementing processes to continually document, identify, and apply learnings from medication incidents to improve workflow within the pharmacy.

Why is the Medication Safety Program important?

Patient safety and protecting patients from harm associated with medication incidents is a priority we all share. By identifying and sharing sources of risk and system vulnerabilities, prevention strategies can be put in place across the system that will better protect patients.

Moving forward with a formal Medication Safety Program will lead to standardized, accurate and complete tracking of information on medication incidents across the province and help provide a better understanding of how they occurred and how they can be prevented. Through aggregate data obtained by reporting, the College will be able to identify areas of risk and provide appropriate guidance to pharmacy professionals. Additionally, the program will support ongoing continuous quality improvement within and among pharmacies. Not only will the program help encourage and promote a positive safety and learning culture in individual pharmacies and help reduce the risk of medication errors, it will help contribute to a safer health system as learnings from incidents will be shared among all pharmacies and health care system partners, not just in Ontario but also throughout the country.

When will this program be implemented?

All components of the Medication Safety Program will be in place by December 2018. It is the College’s expectation that pharmacies are currently preparing for implementation of the program by familiarizing themselves with the program requirements and educating staff about the program, including how it will help to improve patient safety and outcomes. Pharmacies will be onboarded to the reporting platform, managed by the College’s third party vendor Pharmapod, in phases throughout early 2019. You will be contacted by Pharmapod when it is time for you to receive access.

How will the sSOP work in hospital pharmacies?

Although the Medication Safety Program is currently being implemented in community pharmacies, the sSOP reinforce the important role hospital pharmacy professionals play in medication safety. Hospital pharmacy professionals also have the responsibility and obligation to manage medication incidents and address unsafe practice and will be expected to practice in accordance with the requirements of the program. The sSOP will support pharmacy professionals practicing in hospital to actively participate in medication safety while following the hospital’s procedure for incident documentation. This will facilitate incident review and analysis to drive continuous quality improvement and enhance patient safety in hospitals. The College will expand reporting mechanisms in hospital practice, to enhance current reporting practices, following implementation in community pharmacies.

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