Community Practice Environment, Registrar's Reflection, Winter 2020

Registrar’s Reflections – Patients First, Safety Always

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Shared Accountability in the Delivery of Safe and High Quality Care in Community Pharmacy

We’re listening.

That’s the first and most important message I’d like to convey in my inaugural edition of Registrar’s Reflection which will be published in each issue of Pharmacy Connection. This will be a new way to allow me to share my thoughts, insights, views and ideas related not just to the regulation of pharmacy, but to overall quality and safe pharmacy practice in the province.

Over the past few years, we have conducted a number of engagement activities with registrants including Regional Meetings, open consultations for the College and on behalf of other stakeholders such as government, and engaged with stakeholders informally through direct communication and dialogue on various topics, from new regulations to quality improvement initiatives. These are valuable mechanisms to listen to and learn from those whom we have all entrusted to provide safe pharmaceutical care to our patients and each other.

The most common feedback theme received through these engagement activities is related to the practice environment in community pharmacy. Specific concerns that have been raised include reduced professional autonomy, increased workload and other pressures placed on pharmacists and pharmacy technicians to meet operational priorities and the impact this has, real or perceived, on their ability to meet practice expectations and standards.

Similar issues have also been identified by patients. While we consistently hear through our public engagement activities about the important role pharmacies and pharmacy professionals play in the lives of patients, we have also heard concerns about the ability of patients to access care in increasingly busy pharmacies and the need for adequate staffing as the expansion of pharmacists’ scope of practice is considered.

I want to assure everyone, especially registrants, that we are very much aware of the feedback and are taking the concerns being shared with us very seriously. Ultimately, safe patient care is everyone’s business, and ensuring safety and quality in pharmacy at all times is a shared accountability not just among pharmacy professionals, but among those who own, operate or influence the operation of pharmacy as well.

Indeed, these are not new issues nor are they unique to Ontario. However, patients deserve to be assured that their pharmacies, those who own and operate them and those who work in them are all committed to quality care above all else. They are, after all, patients first and their safety and health outcomes should always be the number-one priority.

As we consider the ongoing roll out and maturity of our medication safety program, the implementation of important quality improvement initiatives, and the evolution and expansion of pharmacist scope of practice in the province, I believe very strongly that shared accountability within pharmacy is more important than ever.

Data on its own isn’t information. But data with context is.

It’s important to note that we’re not just listening to the feedback received through our consultations and engagements. As an organization increasingly focused on risk-based regulation, we’re also ‘listening’ to data to help us make informed decisions. This was an important part of our message shared at last year’s Regional Meetings.

Medication incidents anonymously reported by pharmacy professionals through our AIMS Program are providing important insights into various causal factors that may be contributing to errors and near misses. The September AIMS snapshot indicated that staffing, workload and environmental factors were the single most commonly noted contributors to medication incidents, comprising 23.6% of the 4,426 incidents reported by onboarded community pharmacies.

Data like this is powerful, and empowering. There is no question that the AIMS Program data along with the ongoing concerns being expressed by registrants together make it evident that workload and staffing related challenges are top-of-mind for many community pharmacy professionals. And as the regulator with a mandate to protect the public, it is top-of-mind for us too.

Recognizing the limitations of our authority over business practices in pharmacy, we believe that we do have a role to play within our legislated mandate and objects to help better understand and identify appropriate solutions to what is a complex issue. After all, those who own and operate pharmacies are accountable to the Standards of Operation, just as pharmacy professionals are accountable to the Standards of Practice. Patient safety is a shared accountability which is why addressing patient safety in community pharmacy is best informed through thoughtful, respectful and meaningful collaboration and engagement with pharmacy professionals, those who own, control and operate pharmacies, system stakeholders and patients.

Bringing stakeholders together and listening to diverse perspectives

As you will have seen in eConnect and other communication, the College is launching a Community Practice Environment Initiative that will involve the active collaboration and participation of stakeholders with the initial goal of better understanding confirmed and potential barriers to professional autonomy and patient safety in community pharmacy.

The first phase of this initiative will be aimed at developing a set of essential shared accountability principles. It is expected that these principles will guide the development of specific solutions and strategies to further strengthen the quality and safety of pharmacy care and address the issues that have been made apparent in our consultations and AIMS Program data. Ultimately, we believe this work will help position pharmacy for ongoing success as it plays an increasingly important role in the health and wellbeing of Ontarians.

Just as we have listened to the feedback of stakeholders and used data to help make informed decisions in the launch of this new initiative, we will continue to listen to and engage pharmacy professionals, patients, and other stakeholders throughout this work. There will be many opportunities to get involved and provide input and I encourage you all to watch for these opportunities that will be promoted in eConnect and on our website.

The bigger picture: the role of provider experience on quality health care

The feedback being shared with us is a reminder that pharmacy, like other areas of healthcare, is a people industry, where patients are cared for by highly qualified healthcare professionals – pharmacists and pharmacy technicians – who dedicate their lives to meeting the health needs of others.

Given this, it is becoming increasingly acknowledged that the needs of healthcare professionals must be better understood and considered in the health system’s ability to influence, and improve, quality and patient outcomes. Pharmacy should be no different. In fact, our work with Health Quality Ontario (now a part of Ontario Health) in the development of our Quality Indicators for Pharmacy over the past two years has led us to commit to developing indicators specific to provider experience within the pharmacy setting, and doing so is a priority for us in 2020.

Along the way, we will need your ongoing input, insights and ideas to help us better understand the issues being expressed by the profession, along with your commitment to work collaboratively toward addressing them to help protect the interests, health and wellbeing of the public – our shared accountability.


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