Medication incidents that occur in hospital outpatient departments are entered into the NL Health Services Clinical Safety Reporting System (CSRS). In the event of an incident, the outpatient department conducts an internal review with the pharmacy staff involved and shares it with other staff as a learning experience.

Following a recommendation from NLPB staff, the NLPB board of directors gave direction at the June 2023 board meeting to revisit the implementation of MedSTEP NL for hospital outpatient pharmacies when the Standards of Pharmacy Operation for Hospital Pharmacies is next revised. More formal consultations on implementing national reporting of MIR for hospital outpatients will begin soon.

Every pharmacy team member has an active role to play in CQI, including identifying potential safety concerns and solutions and leading and modeling patient safety culture.

PHARMACISTS-IN-CHARGE (PICs)

PICs are responsible for implementing CQI and MIR in their pharmacies in accordance with the NLPB's Standards of Practice for Continuous Quality Improvement and Medication Incident Reporting (Standards of Practice for CQI and MIR) and the MedSTEP NL requirements. This involves:

• developing policies and procedures for addressing, reporting, investigating, documenting, communicating, and learning from medication incidents;
• appointing a CQI coordinator (in addition to themselves), if feasible, to help ensure the policy and procedure manual is updated as required, training is ongoing, and medication incidents and near-misses are reported in a timely manner. This person can assist with encouraging reporting, promoting a safety culture, and organizing CQI meetings and informal huddles to discuss events and learnings, and monitoring action plans for areas for improvement;
• ensuring all pharmacy staff are trained and comfortable with the reporting platform and participate in MIR and CQI, as required;
• establishing the culture to support pharmacy professionals to meet the standards of practice with a focus on learning and identifying opportunities for improvement to prevent future recurrences;
• ensuring a pharmacy-specific safety self-assessment is completed in accordance with NLPB's Standards of Practice for CQI and MIR;
• leading and documenting formal CQI meetings to educate on medication safety and encourage open dialogue with pharmacy staff at least every 6 months with informal huddles occurring as medication incidents or near-miss events occur.

PHARMACY PROFESSIONALS

Pharmacy professionals are responsible for incorporating CQI and MIR into their daily practice. This involves reviewing, understanding, and meeting NLPB's Standards of Practice for CQI and MIR, CQI and MIR resources, and their pharmacy's CQI and MIR-related policies and procedures.

Pharmacy professionals are responsible for:

• contributing to a culture of patient safety and a just culture in the workplace environment;
• engaging in determining contributing factors for medication incidents and near-miss events;
• engaging in pharmacy staff meetings to discuss summary reports and analyses of pharmacy-specific date, and shared learning from the National Incident Data Repository (NIDR).
• engaging in the pharmacy-specific Safety Self-Assessment process;
• implementing procedural improvements established by the PIC.

All pharmacy professionals should review the MedSTEP NL: CQI and MIR Implementation Plan for Community Pharmacies for key implementation steps and deadlines for MedSTEP NL.

ALL PHARMACY STAFF

All pharmacy staff should be knowledgeable about pharmacy procedures for CQI and MIR and must be familiar with the medication incident and near-miss event reporting platform. Everyone should play an active role in CQI and MIR, including understanding the reporting tool and being aware of CQI and MIR policies and procedures to comply with MedSTEP NL.

Continuous improvement of quality and safety in pharmacy practice is a shared goal of both NLPB and pharmacy professionals. Through the development of the MedSTEP NL program, NLPB is committed to sharing information and learning opportunities based on meaningful analysis of national and provincial-level data with pharmacy professionals. NLPB plays a key role in supporting pharmacy professionals to engage in CQI and MIR with the common goal of reducing the number of medication incidents, mitigating risks to patients, and improving the quality and safety of patient care.

NLPB will receive de-identified, anonymous provincial data summaries from ISMP Canada. The aggregate data will inform key trends and will be used to communicate error prevention and safety improvement strategies. NLPB will aim to begin sharing aggregate data within 6 months of MedSTEP NL implementation or as soon as enough data is available.

NLPB will also assess how pharmacies participate in CQI and MIR and engage with the MedSTEP NL program during routine practice site inspections.

The following documentation should be retained in the pharmacy and available for audit or during an NLPB site visit, if requested:

• all communications with patients and prescribers regarding medication incidents or near-miss events (this is not limited to the information that is reported to the medication incident reporting platform);
• all CQI improvement plans and outcomes developed following a medication incident or near-miss event;
• all CQI improvement plans and outcomes developed following completion of an SSA; and
• documentation from formal CQI meetings with pharmacy staff, including date, staff members present, topics of discussion, and shared learning.