Using Continuous Quality Improvement to enhance medication safety


It is often said that all improvement requires change, but not all change results in improvement. That’s where the concept of continuous quality improvement, also known as CQI, comes in.

In pharmacy, the objective of CQI is to improve all aspects of practice with the goal of increasing patient safety. This may include learning from medication incidents and implementing errors prevention strategies to reduce the chances of recurrence, such as process standardizations or improvements.

CQI is about change, and increasing the chances that the changes made in pharmacy result in improved patient safety. To achieve safer care for patients, CQI must focus on both system improvements as well as the tasks that individual practitioners perform.

How AIMS supports CQI

The College’s mandatory Assurance and Improvement in Medication Safety (AIMS) Program is based on a CQI approach. With the goal of reducing the risk of patient harm caused by medication incidents in, or involving, Ontario pharmacies, AIMS enables practitioners to learn from medication incidents and better understand why they happen and how they can be prevented.

AIMS Cycle Diagram
Click here to read a text-only version of this graphic

How AIMS Supports CQI
Step 1: Record medication incidents and near misses in the AIMS platform.
Step 2: Identify learnings and actions to implement in the pharmacy.
Step 3: Reduce the risk of harm to patients and enhance patient safety.

As shown in the diagram, pharmacy professionals record medication incidents and near misses in the AIMS Pharmapod platform, and analyze the incident to identify learnings and actions that can be implemented in the pharmacy to reduce the risk of harm to patients and enhance patient safety.

The data recorded in the AIMS Pharmapod platform is then de-identified and aggregated with data from other pharmacies across the province to create a snapshot of trends or opportunities for system-level improvements. A sub-set of this data is available on the OCP website as an interactive tool, and the College is currently working with a group of subject matter experts from various environments that have experience related to medication safety, such as community pharmacy, academia and health data analysis, to support the AIMS program goals of sharing lessons learned across the province.

Creating a culture of medication safety

For AIMS to effectively inform CQI, pharmacy owners and DMs must enable a just culture that supports learning and a system-based approach to incident analysis over a blame and shame culture that focuses on human behaviours. A culture of medication safety can be described as shared values, norms, competencies and attitudes towards patient safety among individuals within an organization[1]. Members of a safety culture report incidents without fear of blame, learn from incidents to make improvements, and trust their organization will deal with them fairly when something goes wrong[2]. A culture of medication safety encourages staff to engage in open, honest discussions about medication incidents and near misses. It also permits staff to identify the causes of incidents and to share lessons learned with an emphasis on preventing errors from recurring and supporting meaningful, sustainable change at the pharmacy level and, eventually, across the health system.

It is an expectation that all pharmacy operations are conducted in a manner that supports the AIMS program and the requirements outlined in the Supplemental Standards of Practice (sSOP) that were designed to enable pharmacy professionals to meet this goal.

Resources to support AIMS

Creating a culture of medication safety is a journey, and the College has compiled a number of resources to support pharmacies on that journey as they integrate CQI and AIMS into their workflows.

  • AIMS Program e-training: Community pharmacy staff must complete the six e-Learning modules that introduce the AIMS Program and provide information on the expectations for pharmacy professionals and on how to use the AIMS Pharmapod platform. The modules take less than one hour to complete. After completing each module, registrants can print a certificate of completion to confirm they have reviewed the content. This certificate of completion may be kept for your own records and does not need to be submitted to the College.
  • Pharmacy Safety Self Assessment (PSSA): Community pharmacies are required to complete the PSSA for the first time by December 31, 2021. A Pharmacy Safety Self-Assessment User Guide has been developed to support Designated Managers and pharmacy staff in the PSSA completion.
  • Pharmacy Connection articles about AIMS: Review past articles written about AIMS in Pharmacy Connection.
  • ISMP Canada Safety Bulletin, March 30, 2021: Review articles on Never Events for Community Pharmacy and Analysis of Findings from Safety Assessments of Community Pharmacies.
  1. https://www.ismp-canada.org/download/hnews/201802-HospitalNews-MedSCIM.pdf ?

  2. https://cphm.ca/wp-content/uploads/Resource-Library/SafetyIQ/CPSC-Toolkit-FINAL.pdf ?