CQI IN COMMUNITY PRACTICE

Hello and welcome to the module on continuous quality improvement in community pharmacy practice.

Learning objectives

By the end of this presentation, I would like to have enabled you:

To report, analyze, and share medication incident learning according to the continuous quality improvement, or CQI, process in community pharmacy practice;
To document CQI activities, such as incident analysis and action plans, using standardized CQI programs; and
To be aware of the Canadian jurisdictions that have implemented mandatory standardized CQI and medication safety programs, in an effort to populate a larger database for aggregate analysis and learning.

First, let’s look at the CQI process in community pharmacy practice.—Given the complexity of the pharmacy workflow, medication incidents are an inevitable part of practice. Reporting, analyzing, and sharing learning from medication incidents are key components of a CQI program that aims to reduce the risk of future recurrences. CQI involves an ongoing and systematic examination of an organization’s work processes, both proactively and retrospectively, to identify and address the factors contributing to safety and quality issues and implement corresponding changes.
CQI in pharmacy practices must be built in a culture of safety –defined by ISMP Canada as the underlying beliefs and values of an organization as they relate to safety as a priority. Therefore, for CQI to be successful, organizations and practitioners must foster a culture of shared learning dedicated to patient and medication safety in community pharmacy practice, where members of the team feel comfortable reporting and discussing medication errors, without fear of negative consequences.

CQI Process in Community Pharmacy Using CQI Tools

The CQI process in community pharmacy practice include 4 key actions –Report, Analyze, Share, and Document, and they’re not necessarily completed in this order every time. I’ll go into more detail for each, but at a high level, we’d want to have a reporting platform to receive medication incidents in a manner that users can search and retrieve them for subsequent discussion and analysis of potential contributing factors and solution development.
Currently, CPhIR and PharmaPod are two such platforms currently used in certain provinces, which we’ll demo today, and there are others available as well, including Sobey’s Patient Safety Company and Rexall’s in–house platform.

The analysis can then be shared externally in newsletters, safety bulletins, or other modalities to bridge the silos in health care and allow others to identify similar vulnerabilities and safety opportunities in their own systems before experiencing the incident and potential patient harm. And of course, internal documentation is an important step, which includes documentation of a proactive assessment such as the Medication Safety Self–Assessment, or MSSA; or a retrospective incident analysis and action plan; and of staff education to support CQI processes.

Luckily, CPhIR has a training site to allow for hands–on practice of the steps we’re about cover. Please ensure you go to the CPhIR.ca/training site, and not the usual cphir.ca login page, as the ‘testuser’ username and password will only work under the training site.

You can pause the presentation now and take a moment to follow that link and sign into the demo site.

Report

Report the near miss or medication incident into a reporting platform.—In CPhIR, you’ll see that the second tab is “Report an Incident”. It’s important to note that the incident is anonymously submitted to ISMP Canada, so there’s no way to identify the individual who reported it, as we’ve found that fear of repercussions can be a deterrent to incident reporting. Additionally, any aggregate shared learning from the database of CPhIR incidents is non–identifiable and only for the purpose of shared learning and quality improvement.—Once you click into the tab, you’llsee this list of data fields in the medication incident reporting form for CPhIR.The 7 mandatory fields are marked in red font.

Date Incident Occurred
Time Incident Occurred
Type of Incident
Incident Discovered By
Medication System Stages Involved in this Incident
Medications
Patient’s Gender
Patient’s Age
Degree of Harm to Patient due to Incident
Incident Description/How Incident was Discovered
Other Incident Information
Contributing Factors of this Incident
Actions at Store Level
Shared Learning for ISMP Canada to Disseminate

To facilitate efficient medication incident reporting, these fields are mostly check boxes, pull–down menu, and radio buttons; the only free–text field is for the ‘Incident Description’. By completing only the mandatory fields, the report should usually take less than 5 minutes to complete. It’s necessary for incident analysis that the incident date is recorded, that we know the type of medication incident, who discovered the incident, which stage or stages of the medication–use system were involved, which medication or medications were involved, and the degree of harm that the patient did or might have suffered. And of course, adescription of what happened. The other data points listed in black font are good to know and would be very helpful in subsequent analysis and development of quality improvement initiatives if the reporter has time to complete them, but these are not mandatory. Please take a moment to refresh your memory of these reporting functions in CPhIR.

Benefits and Limitations of Reporting

Benefits

As medication incident reporting programs continue to accumulate data over time, particularly from multiple pharmacies, and ideally, multiple jurisdictions, any trends and changes in medication incident patterns can be identified.
Medication incident analysis can provide guidance to reporting community pharmacies, and on a larger scale, can help identify new areas of focus to enhance medication safety in pharmacy practice throughout the country.

Limitations

Of course, there are limitations and potential barriers to reporting as well. Since it’s mostly done on a voluntary basis, there is under–reporting and we cannot know the denominator –how many medication incidents are actually happening – only those that are reported.
As I mentioned, CPhIR has made an effort to minimize the time barrier by incorporating as many pull–down menus and check boxes as possible, but it is still time out of a user’s busy day.
And lastly, some jurisdictions and even individual pharmacies may have different thresholds for reporting –some may say that all incidents, including near misses that didn’t reach the patient, need to be reported, while others may recommend that only incidents that reached the patient, or those causing harm, should be reported. This variation in the reporting threshold may limit certain reports.

Analyze

Analyze the reported medication incident to determine potential contributing factors and develop solutions to prevent recurrence.—You’ve seen this summary before, from the Canadian Incident Analysis Framework. With medication incident data, we can do quantitative analysis and qualitative analysis. And within the qualitative analysis, an individual incident can be analyzed in detail, or a number of incidents can be analyzed together in an aggregate, multi–incident analysis. Quantitative analyses summarize medication incident data using descriptive statistics such as graphs and tables, while qualitative analyses focus on the medication incident narratives.
Quantitative analysis can be used to address the “what” question –it provides an overview of the data and monitoring of trends, and can quickly identify areas for improvement. A key limitation of quantitative analysis, however, is that case–specific contributing factors cannot be identified; additionally, with voluntary reporting, we cannot ensure the reliability of the results.
Qualitative analysis can be used to address the “why” question –it provides an in–depth analysis of the incident narrative to identify detailed, case–specific contributing factors. This in–depth analysis can be time–consuming, however, and incident rates cannot be determined.—We’ll take a look atan example of quantitative analysis in CPhIR.

Quantitative Analysis – Stats

The CPhIR program features a statistical analysis tool, the tab labelled ‘Stats’, that is used by community pharmacies for CQI, where pharmacy staff can compare their pharmacy’s quality improvement performance against the aggregate performance of all other pharmacies that are using the CPhIR program. Once you click on the ‘Stats’ tab, you can see the many ways that the medication incidents can be sorted so that pharmacy staff can consider targeting their CQI efforts to an area with frequent incidents.

Medication incidents can be sorted by:

No. of Incidents by Day of the Week
No. of Incidents by Month
No. of Incidents by Year
No. of Incidents by Type
No. of Incidents by Discoverer
No. of Incidents by Medication System Stages
No. of Incidents by Degree of Harm to Patient
No. of Incidents by Contributing Factors
Top 10 DINs
Top 10 Active Ingredients

The incidents can be sorted temporally by day of the week, by month, or even by year. They can also be sorted by the type of incident if users needed to know whether incorrect medication errors were more frequent than incorrect patient errors, for example, when considering a dispensing software update. Staff can sort the incidents by medication–use system stages to determine if workflow changes are needed in the dispensing stage, or software changes in the order entry stage, for example.

A common selection is by patient harm, because staff would definitely want to discuss, analyze, and develop solutions for an incident that caused patient harm. Even though contributing factors is an optional field in the medication incident report, if completed, it can help with sorting incidents to target a key area for improvement –for example, if look–alike labelling and packaging was a frequently identified factor, strategies might include saving up for a bar code scanner and implementing warning labels on stock shelves in the interim. And then to target a specific medication or product, users can sort by the top 10 DINs or top 10 active ingredients.

Once the sorting criteria is selected, stats are presented in data tables and graphs. As you can see here, the incidents by day of the week are displayed for the pharmacy’s data in red and the aggregate data from all pharmacies in CPhIR in green. From a CQI perspective, a pharmacy manager might note that they have more incidents on weekends than the average community pharmacy; if staffing during weekends is about 50% of a weekday, with only one pharmacist and one pharmacy assistant, perhaps there should be some discussion with weekend staff to determine if staffing and workload contribute to that increase in incidents over the weekend. A possible solution could then be to add a pharmacy technician or another pharmacy assistant, depending on which tasks are overloaded on the weekend, and see if there’s an improvement. That’s just a simple example of how the quantitative analysis can help guide users to ask qualitative questions about how and why certain incidents may be happening; they could then target the CQI activities accordingly.

Qualitative Analysis – Quality Improvement

We see that CPhIR offers a place for this in the ‘Quality Improvement’ tab. This is an online environment for community pharmacies to document staff meetings and discussion in response to medication incidents and incident analysis, as well as action plans to improve medication safety in the community setting; this helps make the environment safer for practitioners and patients. —Community pharmacies can use the CPhIR Quality Improvement module to conduct a system–based analysis of an individual incident, which is a 7–step process, to identify potential contributing factors and develop an action plan to implement a chosen solution.

Share – CE and Education

Once you’ve analyzed reported incidents, whether quantitatively, qualitatively, or both, sharing the learning can help others benefit from that work without having to first experience the incident and potential patient harm themselves.—Because as you’ve seen before, “the most detrimental error is failing to learn from error. ”We know that errors are happening –people can never be perfect, and systems aren’t perfect either, but with CQI we can continuously improve those systems and make them as robust as we can against identified gaps and vulnerabilities and educate people to help them make good and safe decisions.

The CPhIR program’s ‘Home’ page has a middle bar with a mix of shared learning, both CPhIR–specific resources, such as CPhIR Newsletters and Medication Safety Agendas, and general ISMP Canada resources, such as ISMP Canada Safety Bulletins and SafeMedicationUse.ca Newsletters for consumers. —And these are samples of some of the shared learning from ISMP Canada’s analysis of the medication incidents and safety concerns reported to us. I encourage you to check out the latter 3 at least, as these are available for free on the ISMP Canada website –there are a variety of topics covered in each modality, and you may find opportunities for system and practice improvements in your own setting before an incident or harm occurs.—And of course, you want to document everything that’s been discussed, analyzed, and implemented.

Documentation of CQI activities.

Documentation of CQI discussions is a form of internal communication, as it keeps the staff apprised of what incidents were reported and analyzed, and what actions may be put in place to prevent recurrence.

Internal Documentation

Community pharmacies can document staff meetingsin response to

a) medication incidents and analysis, which is retrospective;

b) proactive MSSAs that generate improvement initiatives; and

c) staff education and action plans to improve medication systems.

We’ll go into each of these in a little more detail, with a focus on the retrospective medication incident analysis.

Recall the medication incident you reported into CPhIR earlier in the term. Mr. Smith dropped off a prescription at the pharmacy for a 30–day supply of bisoprolol 5 mg, to be taken once daily. The prescription was erroneously entered as Apo–Bisacodyl 5 mg with the directions of 1 tablet once daily for 30 days. The prescription was filled with 30 tablets of Apo–Bisacodyl 5 mg, and the pharmacist caught the error when checking the prescription. Remembering that incident, we’re going to go through the process of analyzing and documenting the action plan in CPhIR, using the ‘Quality Improvement’ module. This is a highly effective and easy to follow documentation procedure that will assist in incident analysis and provide you with a common place for all record–keeping required for your CQI program. I encourage you to pause this recording intermittently to get some hands–on documentation practice in the demo site before viewing the answers. Once you click on the ‘Quality Improvement’ tab, you can select a ‘New Meeting’ to create a new entry for today. The first documentation we’ll look at in the CQI tool is the medication incident discussion. The incident summary, outlined in purple on the top right, displays incidents, by month of occurrence or severity of harm, since the last CQI meeting. The ‘Import’ function in green allows users to populate data fields from selected incidents for discussion at the meeting.

a) Medication Incident Discussion

You can complete multiple logistical details for the meeting outlined in red in the left column, including the date, the attendees, and the personnel responsible for reporting. The ‘Medication Incident Discussion’,outlined in yellow, gives users the opportunity to update a previous unresolved incident discussion or add a new incident discussion. The new incident discussion is outlined in light blue in the lower right side. Once clicked, a pop–up window like the one following the first blue arrow will prompt the user to import a CPhIR incident or add a new CPhIR incident. If import is selected, a search window will appear, and you can search by date and type of incident, etc. Then the second blue window with the incidents that match the criteria will be listed, and you click on the check box next to the incident you want to import for discussion.

With the CPhIR Incident Number, outlined in red in the top left of the image, the program will auto–populate data fields of the selected incident prior to discussion. This CQI tool then guides the team through a 7–step process for a system–based approach to medication incident analysis. We’ll go through each step together, and again, I encourage you to pause the recording intermittently to try this out for yourself in the demo site before viewing the sample answers provided.

Step 1 is to describe the medication incident. If you import the incident, that information will already be at the top of the form.
Step 2 is to gather all relevant information –consider the 10 Key Elements in the MSSA to get you thinking about what additional information may be useful. For example, in terms of patient and drug information, you will likely want to pull up the patient profile in the pharmacy system. In terms of labelling and packagingand drug storage, you should identify the two products and note their placement on the shelves.
Step 3 is to identify all possible contributing factors –the MSSA items can help with this process as they uncover potential safety gaps in the system.
Step 4 is to develop a causal statement based on identified possible contributing factors. Here’s an example with the structure highlighted for clarity. The look–alike/sound–alike drug names of bisoprolol and bisacodyl increased the likelihood that the incorrect drug would be selected and entered, leading to an incorrect drug being prepared and filled.
Step 5 is to discuss and identify possible solutions to mitigate the contributing factors. Consider the hierarchy of effectiveness and aim for higher leverage strategies, where feasible.
- One option is a medium leverage independent double check strategy. Engage in dialogue with the patient and/or caregiver as a way to detect potential errors. For example, as an additional check before entering a prescription, ask the patient to state the reason why the medication was prescribed.
- Another option is a low leverage education strategy. Educate pharmacy staff on look–alike/sound–alike drug names and products.
- Yet another option could be a high leverage, longer–term strategy. Incorporate a bar code scanner in the dispensing process to minimize the risk of selection errors reaching the patient. Of the solutions discussed in the CQI meeting, rate the relative effectiveness and feasibility of each to determine which one should be implemented.
Step 6 is to consider the solution ratings according to effectiveness and feasibility and rank them according to the needs of your pharmacy.
Step 7 is to develop a SMART action plan for implementation of the selected solution, ensuring that it’s specific, measurable, attainable, relevant, and time–based.

Once the discussion and decisions for those 7 analytical steps are complete, you can decide to finalize the submission, or leave it open to complete during another meeting. Either way, be sure to ‘Save’ your team’s CQI work. CQI staff meetings need not only be used to discuss new medication incidents but also to update a previously unresolved medication incident. This brings us to our second documentation topic in CQI meetings –the MSSA improvement initiative.

b) MSSA Improvement Initiative

Pharmacists can use the MSSA tool to assess the safety of medication practices in their pharmacy, identify opportunities for improvement, and monitor progress in making those improvements via the online interface. We encourage pharmacy staff members to implement this self–assessment program as part of the pharmacy’s CQI process as it can help evaluate the pharmacy’s uptake of various medication safety strategies over time.Within the ‘Quality Improvement’ tab, users can document and update a previous MSSA improvement initiative or add a new one.

c) Staff education

And the third documentation topic for the CQI meeting is staff education. Continuous professional development initiatives educate staff to enable them to embrace and support a culture of medication safety in the pharmacy. This is an important part of the CQI process because

Pharmacy staff are the ones that must report medication incidents and gaps in the system, as well as implement solutions to make the system more robust –thus, they need to be motivated and feel supported in doing so.Within the CQI tool, users can document and update a previous staff education event or add a new one.—CPhIR (and likely other reporting programs) enables community pharmacies to document CQI staff meetings, where several items may be discussed.Medication incident discussions involve a retrospective medication incident analysis and CQI action plan to prevent recurrence. MSSA improvement initiative reflects a proactive assessment and opportunity to make care safer.Staff education is an important adjunct to action plans and improvement initiatives, as staff should receive continuous professional development to support their role in safe medication practices.

Mandatory CQI programs in Canada.

A CQI program requires community pharmacies to conduct proactive reviews of existing work processes to identify areas of risk and retrospective reviews of medication incidents to help preventrecurrences in order to enhance medication safety. The incident reports generated not only help individual pharmacies to develop quality improvement initiatives, but also allow aggregate analysis to inform the development of resources to address gaps in knowledge and skills and support shared learning across the country.

Key Components & Tools of a Standardized CQI Program

These are the 3 key components of a standardized CQI program.

Completion of a medication safety self–assessment on a regular basis, perhaps annually, to proactively identify areas of improvement and monitor progress of the resulting enhancement or action plans at regular CQI or staff meetings at the pharmacy. An example of this resource is the ISMP Canada Medication Safety Self–Assessment® for Community/ Ambulatory Pharmacy™.
Anonymous reporting of medication incidents to an independent third–party organization that has the relevant expertise in medication incident analyses and commitment to sharing learning that is derived from trends and patterns of medication incidents reported by pharmacy professionals. An example of this resource is the ISMP Canada Community Pharmacy Incident Reporting (CPhIR) program. Incidents reported to CPhIR populate the National Incident Data Repository for Community Pharmacy, or NIDR, which is a Canadian database for community pharmacy medication incidents.
An open discussion on medication incidents and their associated contributing factors among pharmacy team members, followed by formal documentation of quality improvements made as a result of regular incident reviews and proactive medication safety self–assessment during CQI or staff meetings at the pharmacy. An example of this is the ‘Quality Improvement’ module within CPhIR.—

Canadian Jurisdictions with Mandatory Reporting Programs

The next few slides list the mandatory reporting programs in certain jurisdictions across Canada.

In October 2010, Nova Scotia started a research project called SafetyNET–Rx as a mandatory standardized CQI program, which was the first of its kind in Canada. No longer called SafetyNet–Rx, Nova Scotia continues to require reporting as part of continuous quality assurance programs in community pharmacies. Years later.
In December 2017, Saskatchewan’s COMPASS mandatory standardized CQI program began.
In 2019, both New Brunswick’s MMIR and Ontario’s AIMS began their respective reporting and medication safety programs.—And although delayed due to the pandemic, Manitoba’s SafetyIQ program will be rolled out in 2021.

This slide summarizes the jurisdictional programs we just discussed, alongside the key components of a CQI program –to be proactive, retrospective, and enable documentation. Most of the jurisdictions require the medication incident data to populate a pan–Canadian database –the National Incident Data Repository for Community Pharmacies, or NIDR, is part of the Canadian Medication Incident Reporting and Prevention System, or CMIRPS. Additionally, some jurisdictions specify a particular reporting platform for the incident reporting –CPhIR in Saskatchewan and PharmaPod in Ontario. This chart is likely to grow in the coming years as more and more jurisdictions recognize the value and importance of CQI in community pharmacy practice. In the following slides, I’ll go over a few key outputs of the CQI programs in each of these jurisdictions to further demonstrate the significance of reporting, sharing and learning, particularly at an aggregate level. Firstly, let’s look at some of the analysis and learning from Nova Scotia’s CQA program.—A retrospective descriptive analysis was conducted by the CPhIR team on quality–related events reported to CPhIR from 301 community pharmacies in Nova Scotia between October 1st, 2010 and June 30th, 2017. Quality–related events are defined as medication errors that reach the patient (for example, incorrect drug or dose), in addition to medication errors that are intercepted before dispensing, also known as near misses.

Of the 131 031 events reported by community pharmacies in Nova Scotia over the study period, 98 097 were quality–related events. Overall, 82.0% (n = 80 488) of the quality–related events did not reach the patient, and 0.95% (n = 928) were associated with patient harm. Most of the quality–related events occurred at order entry, followed by preparation and dispensing, and then prescribing stages of the medication–use process.This type of analysis from CPhIR can help the province target specific areas of pharmacy practice to invest in for safer medication use (for example, system improvements atorder entry).—Secondly, the Community Pharmacy Professionals Advancing Safety in Saskatchewan, or COMPASS, program in Saskatchewan. The COMPASS program includes safety–related tools for anonymous reporting of medication incidents, proactive review of pharmacy processes and documentation of improvement plan development and monitoring. All the tools and processes are provided and supported by ISMP Canada, which is a safety–focused, evidence–based national organization.—Recall from earlier in the course, MedSCIM stands for Medication Safety Culture Indicator Matrix –a qualitative analysis of medication incident reports to determine an organization’s overall level of safety culture. In the case of this analysis, medication incident reports associated with harm from Saskatchewan community pharmacies, reported between December 1st, 2017 to January 31st, 2019, were evaluated on their approach to medication safety culture.Looking at the MedSCIM matrix for this dataset, incident reports were most commonly classified as 2C, 2D, and 1A. The frequency of 2D and 2C ratings reflects room for improvement with respect to the medication safety culture. However, the frequency of 1A ratings demonstrates that several reporters have adopted a highly developed and generative approach to medication safety culture. This analysis was completed by the CPhIR team and, repeated over time, can help the province recognize opportunities to improve reporting and safety culture, and subsequently, CQI efforts.—Additionally, the [directions] newsletter is produced by the Saskatchewan College of Pharmacy Professionals and is intended to provide pharmacy staff with information specific to the COMPASS program and medication and patient safety.The [directions] newsletter was created toprovide participating COMPASS pharmacies with statistics, helpful hints, upcoming deadline reminders and other safety–related information. The [directions] newsletter is sent to all pharmacies to provide needed information on the COMPASS program.Analysescompleted by the CPhIR team, such as an MIA or a MedSCIM, can be included here for shared learning to optimize CQI efforts.—

Thirdly, the Mandatory Medication Incident Reporting practice directive in New Brunswick, which ensures that pharmacy professionals anonymously report medication errors that reach the patient to an external, central Canadian database.—Recall from earlier in the course, the multi–incident analysis, or MIA, is a qualitative aggregate analysis of medication incident reports to determine key safety–related themes and subthemes. In the case of this analysis, medication incident reports that resulted in harm from New Brunswick’s community pharmacies participating in the CPhIR program, reported between July 1st, 2015 to February 28th, 2017, were qualitatively evaluated; potential contributing factors and recommendations were included in the analysis.I won’t go into the actual findings, as this is just to show you the type of analysis that’s possible at a jurisdictional level. This analysis was completed by the CPhIR team and can help the province target specific pharmacy practices (such as clinical and technical checks) to optimize patient care and safety. —Fourthly, the Safety Improvement in Quality, or Safety IQ, patient safety initiative created through a partnership between the College of Pharmacists of Manitoba and ISMP Canada, which is a specialized, third–party organization. Safety IQ is a standardized system of continuous improvement designed to prevent medication incidents from happening in Manitoba’s community pharmacies.—In the case of this MIA, medication incident reports that reached the patient from Manitoba’s community pharmacies piloting the CPhIR program, reported between September 1st, 2017 to June 30th, 2018, were qualitatively evaluated; potential contributing factors and recommendations were included in the analysis.Again, this demonstrates the type of analysis that’s possible at a jurisdictional level. This analysis was completed by the CPhIR team and can help the province target specific processes (such as information management and product management) to improve safe and effective care in the community.—Additionally, eQuipped is the official e–newsletter for the Safety IQ program, produced by the College of Pharmacists of Manitoba. Each issue helps prepare pharmacies for Safety IQ, with notable statistics, CQI tips and tricks, and resources and information to keep pharmacy teams updated on all things Safety IQ.Analyses completed by the CPhIR team, such as an MIA or a MedSCIM, can be included here for shared learning to optimize CQI efforts.—And last but not least, the Assurance and Improvement in Medication Safety program in Ontario.—

Produced by an independent team of medication safety and pharmacy experts, theTaking AIMSbulletinis based on an initial analysis of 1,801 medication incidents and 2,331 near misses recorded by community pharmacies between Feb. 1, 2018 and May 31, 2019. At the time, community pharmacies continued to be onboarded to the AIMS Program,so this is preliminary data. This information is important to helping pharmacies, the public, and the broader health system understand the information that is now being collected in Ontario to promote patient safety.—The PSSA is similar to the MSSA in that it is a quality improvement tool that acts as a baseline of the pharmacy’s efforts to enhance patient safety over time. It can be used to proactively identify areas of potential risk, enabling pharmacy teams to plan improvement activities effectively and demonstrate system improvements. Under the AIMS Program, as required under the supplemental Standards of Practice and Standards of Operations, the PSSA must be completed within the first year it is available and then at least once every two or three years. It can be done more frequently if desired.—This is to re–summarize the CQI process in community pharmacy. Report to reporting platforms such as CPhIR or Pharmapod.Analyze medication incidents to identify contributing factors and develop solutions to prevent recurrence.Share the information and learning externally. Examples of this from ISMP Canada include: ISMP Canada Safety Bulletins (for health care practitioners); SafeMedicationUse.ca Newsletters (for consumers); and CPhIR Newsletters and Medication Safety Agendas (for community pharmacies). At a jurisdictional level, ISMP Canada can perform quantitative analyses such as descriptive statistics, as well as qualitative analyses such as MedSCIM and MIA, on aggregate data for broader learning.Document for internal communication and sharing of CQI action plans, which can be done in the ‘Quality Improvement’ module of CPhIR, for example.—And we’ll end with a quote from an OCP article that sums up the impact of CQI –“Continuous quality improvement consists of systematic and continuous actions that lead to measurable improvements in healthcare services and the health status of targeted patient groups.”Thank you for your attention, and I hope you found this information interesting and useful to your practice.

CQI IN COMMUNITY PRACTICE

Learning objectives

CQI Process in Community Pharmacy Using CQI Tools