MedSTEP NL

Medication Safety through Error Prevention (MedSTEP NL) is the College of Pharmacy of Newfoundland and Labrador’s standardized continuous quality improvement (CQI) and medication incident reporting (MIR) program for community pharmacies. MedSTEP NL includes elements of reporting, analyzing, documenting, and sharing learning from medication incidents and near-miss events to continuously review and improve the quality and safety of pharmacy practice in the province.

The MedSTEP NL program is mandatory for all community pharmacies as per section 1.3 of the Standards of Pharmacy Operation – Community Pharmacy.
a) Pharmacists-in-charge must implement an ongoing quality management program that:
iii) includes a process for proactive risk assessment, medication incident and near miss reporting, and continuous quality improvement in accordance with the MedSTEP NL program, including the Model Standards for Continuous Quality Improvement and Medication Incident Reporting and related interpretation guides.

As of July 1, 2024, all community pharmacies should be actively participating in continuous quality improvement and reporting medication incidents and near-misses to the National Incident Data Repository. The College will aim to begin sharing aggregate data within 6 months of program implementation or as soon as enough data is available.

Continuous Quality Improvement and Medication Incident Reporting Standards of Practice

The following Standards of Practice describe the minimum acceptable standards for a continuous quality improvement program and are intended to promote consistency in this area throughout the province.

These Standards are based on the National Association of Pharmacy Regulatory Authorities (NAPRA) Model Standards of Practice for Continuous Quality Improvement and Medication Incident Reporting by Pharmacy Standards.

Standards of Practice for the Continuous Quality Improvement and Medication Incident Reporting

About MedSTEP NL

CQI and MIR Implementation Plan for Community Pharmacies
IMPLEMENTATION STEPIMPLEMENTATION DEADLINE
REVIEW STANDARDS AND RESOURCESDECEMBER 31, 2023
Pharmacist-in-charge (PIC) reviews and understands the College’s Standards of Practice for Continuous Quality Improvement (CQI) and Medication Incident Reporting (MIR) and CQI and MIR information and resources available on the College’s website.
PIC starts to develop a pharmacy policies and procedures manual for MedSTEP NL.
Pharmacy staff members, including pharmacists, pharmacy technicians, and pharmacy assistants, review and understand the College’s standards of practice for CQI and MIR and CQI and MIR information and resources available on the College’s website.
CHOOSE A REPORTING PLATFORM TO EXPORT DATA TO THE NATIONAL INCIDENT DATA REPOSITORY (NIDR)MARCH 31, 2024
For more information regarding the implementation of the medication incident reporting platform and data sharing agreement, review the Medication Incident Reporting Steps to Implementation
PIC reviews and understands MedSTEP NL criteria for a MIR platform.
PIC either:
PIC signs and submits a data-sharing agreement with NIDR (contact the NIDR team at NIDR@ismpcanada.ca to start the process).
PIC obtains a Medication Safety Self-Assessment tool included in the chosen reporting platform or from another source.
PIC completes the pharmacy policies and procedures manual for MedSTEP NL.
Pharmacy staff, including pharmacists, pharmacy technicians, and pharmacy assistants, review and understand the policies and procedures for MedSTEP NL.
TRAIN STAFFJUNE 30, 2024
PIC appoints 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 matter.
PIC engages with all pharmacy staff in discussions on processes to report incidents and near-miss events and ensures all staff are trained and comfortable with the pharmacy’s policy and procedure manual and reporting platform.
PIC ensures all pharmacy staff have completed the training provided by the MIR.
COMPLETE IMPLEMENTATIONJULY 1, 2024
Pharmacy starts reporting medication incidents and near-miss events as per the College’s Standards of Practice for CQI and MIR.July 1, 2024
PIC/CQI Coordinator holds and documents a formal CQI meeting within 6 months of MedSTEP NL program implementation and as per the College’s Standards of Practice for CQI and MIR thereafter.December 31, 2024
PIC/CQI Coordinator completes a Medication Safety Self-Assessment during the first year of the MedSTEP NL program and as per the College’s Standards of Practice for CQI and MIR thereafter.July 1, 2025
CQI and MIR Implementation for Hospital Outpatient Pharmacies

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 the College staff, the College’s 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.

Pharmacy Team Roles in MedSTEP NL
Pharmacists-In-Charge (PICs)

PICs are responsible for implementing CQI and MIR in their pharmacies in accordance with the College’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:

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.

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 the College’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.

CPNL’s Role in MedSTEP nL

Continuous improvement of quality and safety in pharmacy practice is a shared goal of both the College and pharmacy professionals. Through the development of the MedSTEP NL program, the College is committed to sharing information and learning opportunities based on meaningful analysis of national and provincial-level data with pharmacy professionals. The College 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.

The College 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. The College will aim to begin sharing aggregate data within 6 months of MedSTEP NL implementation or as soon as enough data is available.

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

MedSTEP NL Documentation Requirements

The following documentation should be retained in the pharmacy and available for audit or during a College 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.

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