There are currently media stories circulating relating to some extremely unfortunate circumstances resulting from medication errors involving pharmacy professionals. One of the stories involves a patient in Saskatchewan and the other a young boy in Mississauga who tragically died. Prior to the Ontario case being reported in the media, the College had been made of aware of the incident, and we are currently investigating. While we can confirm the fact that we are aware of this situation and have initiated an investigation, the details remain confidential as per privacy and confidentiality guidelines.
The broad focus of these media stories has been on the monitoring and reporting of medication errors. Minister Hoskins has provided media with the following statement:
“This is a tragic situation and my heart goes out to this family as they come to terms with their terrible loss.” “Our government is committed to working with our partners to improve safety for patients… We will continue to work with the Ontario College of Pharmacists and patient groups to improve the monitoring and reporting of medication incidents, as well as working with all of our colleges to increase transparency for the public.”
Although the College does not currently mandate the reporting of medication errors to an external body [such as the Institute for Safe Medication Practices (ISMP)], it has always been a recommended best practice and part of our ongoing dialogue with pharmacists and pharmacy technicians. Whether through broad communications (e.g., articles or practice tools) or as part of our discussions during regular pharmacy practice assessments, the College is continuously reminding practitioners of their responsibility to appropriately manage medication incidents in their practice. The focus is on ensuring that practitioners learn from these incidents and review and enhance their policies and procedures to minimize the risk of them ever happening again.
As an organization committed to continuous quality improvement and transparency, the College is open to ongoing discussions with all interested stakeholders, including the Ministry of Health and Long-Term Care, regarding opportunities to enhance the safe, effective and ethical delivery of pharmacy services in Ontario.