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Map of 5 Qs to Ask Endorsing organizations

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Map of 5 Qs to Ask Endorsing organizations

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5 Questions to Ask About Your Medications has been endorsed in over 19 countries around the world!

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5 Questions to Ask About Your Medications - Endorsement Map - Google My Maps

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This map represents leading organizations who have endorsed the 5 questions to ask about your medications. Request your customized PDF of the “5 questions to ask” with your organization’s logo today! For more information check out:
https://www.ismp-canada.org/medrec/5questions.htm#l=tab2

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As she ended their phone calls, Santina Nato would always ask her mother, Carmela, whether she had taken all of her medications for the day. It was a constant worry since the 85-year-old from Toronto was juggling 12 different oral medications to manage various chronic conditions, including type 2 diabetes and high cholesterol. Deciphering the instructions on a dozen different bottles was often confusing, especially since English is not Carmela's first language. Doses were missed, or taken incorrectly, which would contribute to periodic falls causing injuries.

Five years ago, Carmela's doctor and pharmacist suggested trying blister packs to neatly organize all of her medications in one place organized by day and the time period when they needed to be taken. It's easy for Carmela and for her son, who helps care for her, to see if a dose was skipped.

For her daughter, who lives an hour away, this new tool has meant a world of difference and her mother's health has become more stable. "Having a much less complicated way for my mother to take her medications has lessened everyone's anxiety," says Santina. "Even when I can't be there, especially during COVID, I know that she is able to take care of her health. We all felt like we had some peace of mind again."

Diabetes is one of the top chronic conditions where there is a lack of medication adherence, along with hypertension and mental health issues, like depression and anxiety. Non-adherence is a problem for many with 50 per cent of Canadians not taking medication as directed. That's an issue, especially for older adults who tend to use more medications, which increases the risk of medication non-adherence. With the number of Canadians over age 65 and older set to double over the next 25 years and 9.8 million Canadians estimated to be living with chronic disease by 2036, the stakes are high, prompting some healthcare experts to call it an urgent healthcare crisis.

The ramifications of non-adherence can be widespread and serious, from increased healthcare costs to higher rates of hospitalization. It is estimated that drug non-adherence is the cause of 10 per cent of all hospital admissions. A further 26 per cent of hospital readmissions were medication related and of those 48 per cent were tied to non-adherence.

"In my experience, we see it all the time," says Rose Patodia, a board-certified geriatric pharmacist, based in Vaughan, Ont. "Non-adherence is common. It's not just about people not following instructions or not taking their medications, but it might be about doing it incorrectly. It's a vital issue to tackle."

If you do not take medication as prescribed, and then see your doctor or go for lab tests to check your progress, your noted response to treatment may be inaccurate. A doctor may decide to increase your dosage or add another medication, even though it may not be necessary. "Monitoring is based on the assumption that patients are following instructions as outlined," she explains. "Doctors don't necessarily know that the patient hasn't been taking their medication as prescribed. When they don't have that information about adherence, you can see how it can be an issue for whomever is prescribing or adjusting the therapy."

Pharmacists play a central role in patient education. They can talk about what the medication prescribed is for, what it will do, when it will work, potential side effects and how to manage them. They are in a good position to identify non-adherence and why it's occurring and offer solutions, from blister packs to support services, like in-home visits.

Alice Watt, a senior medication safety specialist at ISMP Canada and a consulting pharmacist, also recommends that patients communicate with their physicians. "Sometimes it's a good question to ask the doctor whether they need to keep taking a certain medication," she says. "It could be reassessed with the patient and their healthcare team. There are a variety of different reasons why patients may not take the medications and it's imperative to understand why. We really believe in partnering with patients. If they're involved in making decisions, they're more likely to stick to the plan."

To manage medications, she suggests that patients can use tools and technology available, like a MedsCheck with their pharmacist at no charge. This can be done annually, or under special circumstances, like being recently discharged from a hospital. Watt cites a recent study done in Quebec that saw one in four medication changes were not adhered to 30 days after a hospital discharge, and 27 per cent of new medication prescriptions not filled.

There are additional tools that Watt recommends to encourage patient adherence, including ISMP's 5 Questions to Ask About Your Medications, which was co-developed with patients and many partners. More new tools and technologies are becoming available to help you, your family, doctor, nurse, pharmacists, and anyone involved in your healthcare to keep track of medicines that you, as well as your family members, are taking. This includes sending reminders for when to take medication and confirmations that doses have been taken.

Other valuable resources include pharmacies and care providers. Most have their own medication management tools and monitoring platforms, which provide Canadians with more ways to manage their health and ensure adherence. Empowerment is the key. And as the number of older adults grows in Canada, they'll be a driving force behind more positive changes to come.
Sponsored by Jones Healthcare Group.

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How New Innovations Help Older Canadians Adhere to Medications As Prescribed

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As she ended their phone calls, Santina Nato would always ask her mother, Carmela, whether she had taken all of her medications for the day. It was a constant worry since the 85-year-old from Toronto was juggling 12 different oral medications to manage various chronic conditions, including type 2 diabetes and high cholesterol.

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Composing the 5 questions is the result of a collaboration between The Institute for Safe Medication Practices Canada (ISMP Canada), the Canadian Patient Safety Institute (CPSI), Patients for Patient Safety Canada (PFPSC), the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists.

Its intent is to provoke the much-needed dialogue between the caregiver, healthcare professionals and the patient.

As next steps the authors discuss collaborating with partners committed to advancing medication safety one conversation at a time. They outline concrete next steps, amongst which the following two caught our eye here at MUUTAA.

"Incorporate results from an 18-month safety improvement project co-ordinated by CPSI and launched in the spring of 2019. Teams are focused on safe medication use and medication reconciliation at discharge. The learnings will inform additional knowledge translation efforts including incorporating the 5 Questions into medication reviews, de-prescribing and patient engagement efforts."

"Continue to work with partners to integrate the 5 Questions more explicitly into de-prescribing, medication reconciliation processes, patient portals and related technologies and other related safe medication initiatives."

How to effectively deploy technologies and automation in order to accelerate these efforts and specifically the medication de-prescribing and reconciliation, is a question that MUUTAA is answering every day.

Do we have the data at our fingertips to deploy algorithms to answer some or all of the 5 questions? Very often we actually do. This is an area that is under-explored and where MUUTAA can be a facilitator for change.

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AI could be our partner in answering the 5 crucial medication questions... | MUUTAA

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In Healthcare Quarterly (the February 2020 edition), Alice Watt, Maryann Murray, Donna Herold, Sylvia Hyland, Carolyn Hoffman and Mike Cass discuss the background, the success and the importance of embedding the '5 questions to ask about your medications' in any interaction with pharmacists, doctors and nurses.

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5Qs quotes from patients

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PHC Questionnaire for Health Care Providers February 2020  DRAFT

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5 questions to help patients and caregivers start a conversation about medications to improve communications with their health care provider. (English)

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By Carol Nguyen and Certina Ho
Medication errors can occur at transitions of care, such as hospital discharge, following-up with a specialist or family doctor, and updating medication regimens at the pharmacy. Incidents often occur when there are medication changes that are not properly communicated among healthcare providers within the circle of care of the patient.

The " 5 Questions to Ask About your Medications " is a tool designed for patients and healthcare providers to use as a guide when discussing changes in medications. These questions will help both patients and caregivers start a conversation about their medications and become knowledgeable about their medication therapy management.

Below is a patient case scenario that is used as an example to illustrate the application of this tool.
"A patient admitted with uncontrolled hypertension had been discharged from hospital with changes to her blood pressure medications. She was sent home with a new script for Tiazac®XC 120 mg once a day and advised to stop her metoprolol which she had been taking before admission. She filled the prescription and started the new medication. One week later, she had a follow-up visit with the family doctor, who was unaware of the recent changes in hospital and increased the dose of metoprolol, which had previously been stopped. The metoprolol prescription was filled. The patient was re-admitted to the hospital a few days later due to a low heart rate and it was discovered that she was taking both Tiazac®XC and metoprolol. Her metoprolol was discontinued; she was stabilized and discharged home on Tiazac®XC."
The opportunities for the patient and healthcare providers to use the tool in this case could have been at the moment of discharge from the hospital, at the family doctor's office, and at the community pharmacy. For the purposes of this demonstration, the questions will be applied to the patient when she was discharged from the hospital the first time.

CONTINUE?

Which medications do I need to keep taking, and why?

This would be the opportunity to ensure that you (as the healthcare provider) and your patient are on the same page about which medications they need to keep taking.

Assess the appropriateness of the patient's other medication(s) and explain which ones can be continued safely with the new medication, Tiazac®

At the end of the dialogue, remind your loved one that it is also important to keep his/her medication record up-to-date. The record should include medications and changes made, and also the patient's drug allergies, vitamins and minerals, herbals or natural health products, and any other non-prescription medications, such as over-the-counter medications. Keeping an up-to-date medication list is one way to keep track of changes and this also helps patients communicate the changes to healthcare providers in their circle of care.

Lastly, encourage patients to initiate a dialogue with their healthcare providers to assess for the possibility of reducing or stopping any of their medications in order to optimize their medication therapy management. If every patient can ask about his/her medications at hospital discharge, during visits to the doctor's office and the community pharmacy, a significant number of medication incidents can be prevented.

Additional Resources:
Carol Nguyen completed a PharmD rotation at the Institute for Safe Medication Practices Canada (ISMP Canada) in 2016; Certina Ho is a Project Lead at ISMP Canada.

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Five questions to ask about your medications - Hospital News

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By Carol Nguyen and Certina Ho Medication errors can occur at transitions of care, such as hospital discharge, following-up with a specialist or family doctor, and updating medication regimens at the pharmacy. Incidents often occur when there are medication changes that are not properly communicated among healthcare providers within the circle of care of the ...

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A new consumer poster is now available in English and te reo Māori to help patients, caregivers, families and whānau talk about medication with their health care providers.

Good communication between patients and health professionals helps to reduce the risk of medication-related harm. Patients are at particularly high risk of fragmented care, adverse drug events and medication errors during 'transitions of care', where a patient moves between one care setting and another.

It is therefore important for patients to be active partners in their health care so they have the information they need to use their medication safely. To support them to do this, the Commission has adopted the following Canadian[1] set of five questions, and adapted a poster for consumers (available in English and te reo Māori):

1. Changes? Have any medications been added, stopped or changed, and why?

2. Continue? What medications do I need to keep taking, and why?

3. Proper use? How do I take my medications, and for how long?

4. Monitor? How will I know if my medication is working, and what side effects do I watch for?

5. Follow-up? Do I need any tests and when do I book my next visit?

Patients can ask these questions whenever they see a health care professional, for example:

at a doctor's appointment (eg, general practitioner or hospital specialist)

when seeing a practice nurse or nurse practitioner

on discharge from hospital

when interacting with community pharmacists, dentists or midwives.

The five questions can also be used by health care professionals when talking to patients about any changes to their medication.
Reference

We would like to thank the following agencies who have given us permission to use their '5 questions' material and translate it into te reo Māori: the Institute for Safe Medication Practices Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists.

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5 questions to ask about your medications - consumer safety poster

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A new consumer poster is now available in English and te reo Māori to help patients, caregivers, families and whānau talk about medication with their health care providers. Good communication between patients and health professionals helps to reduce the risk of medication-related harm.

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5 Questions to Ask About Your Medications

Date: March 9, 2017
Filed under: Advance the Patient Voice, Patient Engagement, Tools

Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.

ISMP Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists have collaborated to develop a set of 5 questions to help patients and caregivers start a conversation about medications to improve communications with their health care provider.

It may be particularly helpful for patients to ask these questions at transitions of care. Examples include:

doctor's appointment (e.g. family physician or specialist, dentist)

interaction with a community pharmacist

discharge from hospital to home

visit by home care services

Share a story of how the "5 questions to ask about your medications" have impacted you or take a photo of where you've seen it and send it to medrec@ismp-canada.org or using #5questionsaboutmeds tweet or post to Facebook.

The Council endorses the 5 Questions to Ask About Your Medications resource for patients. Click the image below to download the poster.

Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.

ISMP Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists have collaborated to develop a set of 5 questions to help patients and caregivers start a conversation about medications to improve communications with their health care provider.

It may be particularly helpful for patients to ask these questions at transitions of care. Examples include:

doctor's appointment (e.g. family physician or specialist, dentist)

interaction with a community pharmacist

discharge from hospital to home

visit by home care services

Share a story of how the "5 questions to ask about your medications" have impacted you or take a photo of where you've seen it and send it to medrec@ismp-canada.org or using #5questionsaboutmeds tweet or post to Facebook.

The Council endorses the 5 Questions to Ask About Your Medications resource for patients.
Download the Poster

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5 Questions to Ask About Your Medications / BC Patient Safety & Quality Council

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Date: March 9, 2017 Filed under: Advance the Patient Voice, Patient Engagement, Tools Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.

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Longwoods Publication - shared Pinterest

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Longwoods Publication - shared Pinterest

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Empowering Patients: 5 Questions to Ask About Your Medications | This or that questions, Medical, Questions to ask

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Feb 5, 2020 - The authors describe a quality improvement initiative to help prevent known medication-related failures. The work evolved into the â5 Questions to Ask about Y

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When you choose a cell phone, you ask questions: "is there coverage outside the city?" Same thing when buying a car: "what are the safety features?". But do you ever ask questions about your healthcare? About taking medications safely?

Medication mix-ups can and do happen.

Asking questions is a powerful action that every member of the public can take to improve medication safety. To help improve medication safety we are encouraging the public to "Take medication with Questions"!

Seniors are particularly vulnerable to medication mix-ups. In 2008, the Canadian Institute of Health Information found that two-thirds of seniors were on five or more drugs, and 21 per cent of these took at least 10 drugs. It's easy to see how the average person can lose track of what they are taking and how often they are taking it.

Ask your pharmacist and other members of your healthcare team about your medications.

Five important questions are:

What has changed about your prescription and why?

What medication do I need to continue taking? Why?

What is the correct way to take the medication? How long?

How do I know that the medication is working? What are the side-effects?

What follow-up do I need?

Ask these questions every time a new medication is prescribed or given, and when over the counter medications are purchased. Ask questions in the hospital, at the pharmacy, and during healthcare appointments.

To assist you with asking questions about your medications, the Manitoba Institute of Patient Safety has two resources. Use our It's Safe to Ask medication card to list all of your prescription and over the counter medications, including vitamins, minerals and herbal/natural products. Use our 5 Questions to Ask About Your Medications - Patient Notes to write down the answers to the important 5 questions. Print the tools and fold them into a handy wallet size. Keep your medication card up-to-date and share it with your pharmacist, doctor and nurse.

For information about medication safety and other patient safety topics, please visit safetoask.ca and browse through the You may also call 204-927-6477 or 1-866-927-6477.
Learn to be safe!

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When you choose a cell phone, you ask questions: "is there coverage outside the city?" Same thing when buying a car: "what are the safety features?". But do you ever ask questions about your healthcare? About taking medications safely? Medication mix-ups can and do happen.

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When you choose a cell phone, you ask questions: "is there coverage outside the city?" Same thing when buying a car: "what are the safety features?". But do you ever ask questions about your healthcare? About taking medications safely?

Medication mix-ups can and do happen.

Asking questions is a powerful action that every member of the public can take to improve medication safety. To help improve medication safety, here are five questions we suggest, as part of our public patient safety presentations, based on our S.A.F.E. Toolkit.

Ask your pharmacist and other members of your healthcare team about your medications. Five important questions are:

Use our

What has changed about your prescription and why?

What medication do I need to continue taking? Why?

What is the correct way to take the medication? How long?

How do I know that the medication is working? What are the side-effects?

What follow-up do I need?

Ask these questions every time a new medication is prescribed or given, and when over the counter medications are purchased. Ask questions in the hospital, at the pharmacy, and during healthcare appointments.5 Questions to Ask About Your Medications - Patient Notes to write down the answers to the important 5 questions.
For more information, tune in on October 23rd for the full presentation, you can register to watch at mips.ca.

Learn to be safe!

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5 Important Questions to Ask About Medications

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When you choose a cell phone, you ask questions: "is there coverage outside the city?" Same thing when buying a car: "what are the safety features?". But do you ever ask questions about your healthcare? About taking medications safely? Medication mix-ups can and do happen.

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Medication Management Quality Project Eastern Zone

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Medication Management Quality Project Eastern Zone

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Quality Project -Objective statement  Medication Self Management Draft 2 - April 8, 2019

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PHC Questionnaire for Patients - Medication Self Management Feb. 25, 2020  DRAFT

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We are promoting the use of the 5 Questions tools with our PHC teams across our eastern zone.  - - NSHA Eastern Zone

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PHC Questionnaire for Health Care Providers February 2020  DRAFT

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Evaluation of a Novel Audit Tool for Medication Reconciliation at Hospital Discharge

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Evaluation of a Novel Audit Tool for Medication Reconciliation at Hospital Discharge

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. Nov-Dec 2019;72(6):421-427.

Affiliations

¹ , MD, PharmD, MSc, FRCPC, is with the Division of Clinical Pharmacology & Toxicology and the Department of Medicine, McMaster University, Hamilton, Ontario.

² , MD, PharmD, BScPhm, is with the Internal Medicine Residency Program, Department of Medicine, McMaster University, Hamilton, Ontario.

³ , MD, is with the Department of Medicine, McMaster University, Hamilton, Ontario.

⁴ , MBBCh, is a student currently affiliated with the Royal College of Surgeons in Ireland, Dublin, Ireland.

⁵ , MSc, was, at the time of this study, a student with the eHealth Master's Program, McMaster University, Hamilton, Ontario.

⁶ , BA, is with the Division of Clinical Pharmacology & Toxicology, St Joseph's Hospital Hamilton, Hamilton, Ontario.

⁷ , BSc(Pharm), RPh, is with the Institute for Safe Medication Practices Canada, Toronto, Ontario.

Free PMC article

Anne Holbrook et al. Can J Hosp Pharm.

Free PMC article

. Nov-Dec 2019;72(6):421-427.

Affiliations

¹ , MD, PharmD, MSc, FRCPC, is with the Division of Clinical Pharmacology & Toxicology and the Department of Medicine, McMaster University, Hamilton, Ontario.

² , MD, PharmD, BScPhm, is with the Internal Medicine Residency Program, Department of Medicine, McMaster University, Hamilton, Ontario.

³ , MD, is with the Department of Medicine, McMaster University, Hamilton, Ontario.

⁴ , MBBCh, is a student currently affiliated with the Royal College of Surgeons in Ireland, Dublin, Ireland.

⁵ , MSc, was, at the time of this study, a student with the eHealth Master's Program, McMaster University, Hamilton, Ontario.

⁶ , BA, is with the Division of Clinical Pharmacology & Toxicology, St Joseph's Hospital Hamilton, Hamilton, Ontario.

⁷ , BSc(Pharm), RPh, is with the Institute for Safe Medication Practices Canada, Toronto, Ontario.

Background: Discharge medication reconciliation (MedRec) is designed to reduce medication errors and inform patients and key postdischarge providers, but it has been difficult to implement routinely in Canadian hospitals.

Objectives: To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals.

Methods: The discharge MedRec quality audit tool, developed by the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada, was assessed and modified to improve comprehensiveness, clarity, and quality. The modified tool was then used to evaluate the quality of the discharge MedRec process for adult patients discharged to home from the general internal medicine service at 3 academic hospitals. Postdischarge telephone interviews were conducted with consenting patients, their community pharmacists, and their family doctors.

Results: The audit tool required modification to include aspects of admission MedRec, high-risk medication discrepancies, and direct communication of discharge MedRec to key follow-up providers. Thirty-five patients (mean age 67.7 years, standard deviation [SD] 18.0 years; 17 [49%] women), with a mean of 8.8 (SD 4.5) prescribed medications at discharge, participated in the discharge MedRec evaluation. Documentation of any discharge MedRec was found for only 1 patient (3%), and no discharge MedRec was carried out by pharmacists. Postdischarge follow-up interviews elicited major gaps in communication with community pharmacists and with family physicians, which could lead to serious medication errors.

Conclusions: The modified audit tool was useful for identifying gaps in the quality of discharge MedRec.

Contexte: Le bilan comparatif des médicaments (BCM) au moment du congé est conçu pour réduire les erreurs médicamenteuses et informer les patients ainsi que les principaux prestataires de soins de santé après le congé, mais sa mise en oeuvre systématique dans les hôpitaux canadiens s'est heurtée à de grandes difficultés.

Objectifs: Évaluer et optimiser un nouvel outil d'évaluation de la qualité du BCM au moment du congé et l'utiliser dans trois hôpitaux universitaires urbains.

Méthodes: Cet outil développé par l'Institut canadien pour la sécurité des patients (ICSP) et l'Institut pour la sécurité des médicaments aux patients du Canada (ISMP) a fait l'objet d'une évaluation et d'une modification visant à améliorer son exhaustivité, sa clarté et sa qualité. L'outil modifié a ensuite servi à évaluer la qualité du processus du BCM pour des patients adultes ayant obtenu leur congé après un séjour dans un service général de médecine interne dans trois hôpitaux universitaires. Des entretiens téléphoniques après le congé ont été menés avec les patients consentants, leur pharmacien communautaire et leur médecin de famille.

Résultats: L'outil d'évaluation a dû être modifié pour inclure le BCM au moment de l'admission, des écarts de médication à haut risque et une communication directe du BCM aux prestataires de soins de santé principaux chargés du suivi après le congé. Trente-cinq patients (âge moyen: 67,7 ans; écart type [ET] 18 ans; 17 [49 %] femmes), chacun ayant reçu en moyenne 8,8 (ET 4,5) médicaments prescrits, ont participé à l'évaluation du BCM au congé de l'hôpital. Au moment du congé, on n'a trouvé de renseignements relatifs au BCM que pour un seul patient (3 %) et aucun BCM n'avait été préparé par les pharmaciens. Le suivi après le congé a généré des écarts de communication importants entre les pharmaciens communautaires et les médecins de famille, ce qui pourrait entraîner des erreurs médicamenteuses importantes.

Conclusions: L'outil d'évaluation modifié a été utile pour déterminer les écarts relatifs à la qualité du BCM au moment du congé.

Keywords: accreditation; discharge prescription; hospital discharge; medication error; medication reconciliation; quality improvement.

Conflict of interest statement

Competing interests: Alice Watt is employed by ISMP Canada, which developed the initial MedRec Audit tool. No other competing interests were declared.

Figures

Similar articles

Electronic tools to support medication reconciliation: a systematic review.

Marien S, Krug B, Spinewine A. Marien S, et al. J Am Med Inform Assoc. 2017 Jan;24(1):227-240. doi: 10.1093/jamia/ocw068. Epub 2016 Jun 14. J Am Med Inform Assoc. 2017. PMID: 27301747 Free PMC article. Review.

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national center for biotechnology information

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Evaluation of a Novel Audit Tool for Medication Reconciliation at Hospital Discharge - PubMed

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Nov-Dec 2019;72(6):421-427. 1 , MD, PharmD, MSc, FRCPC, is with the Division of Clinical Pharmacology & Toxicology and the Department of Medicine, McMaster University, Hamilton, Ontario. 2 , MD, PharmD, BScPhm, is with the Internal Medicine Residency Program, Department of Medicine, McMaster University, Hamilton, Ontario.

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Abstract
ABSTRACT
Background: Discharge medication reconciliation (Discharge MedRec) was implemented on one unit at a large urban teaching hospital, and was to be expanded across the rest of the hospital and the health authority's various sites by the end of 2018. Clinical pharmacists on the Acute Care for the Elderly unit carried out discharge planning and led Discharge MedRec during a pilot period, to inform the future implementation.

Objectives: The primary objective was to examine the number and type of medication discrepancies before and after implementation of Discharge MedRec. The secondary objectives were to compare documented medication changes, pharmacist recommendations, discharge counselling, communication with community pharmacists, polypharmacy, and 30-day readmission rates.

Methods: Patients seen in December 2015 constituted the control (pre-implementation) group, who received usual care. Patients seen from January to April 2016 constituted the intervention group, for whom pharmacists performed Discharge MedRec and other discharge activities as per the hospital-to-home checklist of the Institute for Safe Medication Practices Canada.

Results: There were 66 patients in the control group and 306 in the intervention group. Median discrepancies per patient decreased from 6.5 to 3 (p = 0.007), median number of documented changes without rationale increased from 2 to 3 (p = 0.01), and median number of documented changes with rationale increased from 1 to 2 (p < 0.001). Pharmacists made a per-patient median of 1 progress note recommenda-tion in the control group and 2 progress note recommendations in the intervention group (p = 0.007), and a per-patient median of 2 orders in both the control and intervention groups (p = 0.62). Median recommen-dation acceptance was 100% for both groups, but twice as many recommendations were made per patient for the intervention group. Discharge counselling increased from 22.7% to 65%. Communication with community pharmacists increased from 10.6% to 60.8%.

Conclusions: Clinical pharmacist involvement improved Discharge MedRec planning and documentation. Decreases in medication discrep-ancies, combined with an increase in discharge counselling, should improve continuity of care across the health care team and increase patient adherence with medication therapy. This study further demonstrates the leadership role that pharmacists play in the assessment and clear documentation of medication changes at all transitions of care.
RÉSUMÉ
Contexte : Le processus de bilan comparatif des médicaments au moment du congé a été mis en place dans une unité d'un important hôpital universitaire en milieu urbain et devait être mis en place dans le reste de l'hôpital et dans les différents sites de la régie de santé avant la fin de 2018. Des pharmaciens cliniciens de l'Unité de soins gériatriques de courte durée ont réalisé la planification des congés et ont dirigé le processus de bilan comparatif des médicaments au moment du congé, au cours d'une période d'essai, afin de contribuer à une future mise en place d'un tel processus.

Objectifs : L'objectif principal consistait en l'étude du nombre et du type de divergences relatives aux médicaments avant et après la mise en place du processus de bilan comparatif des médicaments au moment du congé. Les objectifs secondaires portaient sur la comparaison des éléments suivants : les changements apportés à la pharmacothérapie, les recomman-dations des pharmaciens, l'offre de conseils au moment du congé, les échanges avec les pharmaciens communautaires, la polypharmacie et les taux de réadmissions dans les 30 jours suivant le congé.

Méthodes : Les patients rencontrés en décembre 2015 constituaient le groupe témoin (avant la mise en place du processus) ayant reçu les soins habituels. Les patients rencontrés entre janvier et avril 2016 formaient le groupe expérimental pour lequel les pharmaciens avaient réalisé un processus de bilan comparatif des médicaments au moment du congé et d'autres activités en lien avec le congé, en fonction de la liste de vérification du transfert de l'hôpital à la maison de l'Institut pour la sécurité des médicaments aux patients du Canada.

Résultats : Il y avait 66 patients dans le groupe témoin et 306 dans le groupe expérimental. Le nombre médian de divergences par patient a diminué et est passé de 6,5 à 3 (p = 0,007), le nombre médian de change-ments consignés, apportés sans raison apparente a augmenté et est passé de 2 à 3 (p = 0,01) et le nombre médian de changements consignés, dont la raison apparaissait aux dossiers a augmenté et est passé de 1 à 2 (p < 0,001). Le nombre médian de recommandations par patient dans les notes d'évolution réalisées par les pharmaciens était de un dans le groupe témoin et de deux dans le groupe expérimental (p = 0,007) et le nombre médian d'ordonnances par patient réalisées par des pharmaciens était de deux, tant dans le groupe témoin que dans le groupe expérimental (p = 0,62). Les taux médians d'acceptation des recommandations étaient de 100 % dans les deux groupes, mais il y a eu deux fois plus de recom-mandations par patient réalisées dans le groupe expérimental. L'offre de conseils au moment du congé a augmenté et est passée de 22,7 % à 65 %. Les échanges avec les pharmaciens communautaires ont augmenté et sont passés de 10,6 % à 60,8 %.

Conclusions : La participation des pharmaciens cliniciens a amélioré la planification et l'enregistrement du bilan comparatif des médicaments au moment du congé. Une réduction des divergences concernant les médica-ments, associée à une augmentation de l'offre de conseils au moment du congé, devrait améliorer la continuité des soins au sein de l'équipe de soins de santé et accroître l'observance thérapeutique du patient. La présente étude est un nouvel exemple du rôle de leader que les pharmaciens jouent dans l'évaluation et la description claire des changements apportés à la pharmacothérapie à chaque transfert des soins.

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Evaluation of Pharmacist Intervention on Discharge Medication Reconciliation

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ABSTRACT Background: Discharge medication reconciliation (Discharge MedRec) was implemented on one unit at a large urban teaching hospital, and was to be expanded across the rest of the hospital and the health authority's various sites by the end of 2018.

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LS3 Day 2 - Long Term Success Framework Questionnaire

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Change Ideas for Med Safety at Transitions in care

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Change Ideas for Med Safety at Transitions in care

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Med Safety Change Ideas for PS 2020-01-10

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5 Questions to Ask About Your Medications

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College of Pharmacists of British Columbia

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Guest Post: 5 Questions to Ask about Your Medications
A Counselling Framework for Pharmacists and Pharmacy Students
One of the most rewarding parts of my job as a hospital pharmacist is that I get to talk to patients about their medications before they go home. Over the years, I find this is also one of the most important roles as a pharmacist, because of all the medications changes that can occur in hospital during the patient's stay. While we do important work for patients in our care by optimizing medication therapy, deprescribing and finding the right drugs and dosages for the right duration, we don't always do a great job of keeping the patients informed of all the changes that happen when they happen. As a result, it becomes especially important to clearly communicate drug therapy changes with the the patient/caregiver (and their next health care provider) before they leave.

This is easier said than done. Patients can be overloaded with so much info at discharge, making it easier for miscommunications to happen. When they go home, medication errors can occur because of a misunderstanding about their medications.

Providing a systematic approach to medication counselling along with providing clear, written instructions by way of a medication chart and using the teach-back method can help and prevent unnecessary re-admissions or preventable harm from medication errors.

Last year, I had the incredible opportunity to work on a team to develop a list of questions that patients and caregivers can ask to keep track of the medication changes and know how to take them safely. These questions can be used at the community pharmacy, before they leave the hospital, or at their family health team, family doctor or specialist offices.

The team that worked on this comprised of representatives from Patients for Patients Safety Canada, Canadian Patient Safety Institute, the Canadian Society of Hospital Pharmacists, the Canadian Pharmacists Association and ISMP Canada. We wanted to keep it simple, yet give patients the words to ask the questions that would help keep them safe. After testing the question and receiving feedback from healthcare providers and patients, we developed the 5 Questions to Ask about your Medications.

5 Questions to Ask about Your Medications

The 5 Questions to Ask about Your Medications is available in over 20 languages and can be used as a systematic approach to patient counselling during a medication review or as a teach-back tool. A Patient Notes version is also available with space for patients to record information next to each question.

Watch the video to learn more about the 5 Questions and don't forget to share it with your patients and colleagues.

Since its launch, we've heard stories of how the 5 Questions have been implemented in organizations across all sectors of healthcare and how it can help patients talk to their pharmacists about their medications.

What you can do

As a pharmacist or pharmacy technician, introduce the 5 questions to ask to your patients or clients, pharmacy students and colleagues.

Pharmacists or pharmacy students can use it as an approach to provide medication counselling or as a teach-back tool to confirm a patient's or caregiver's understanding of their medications.

Join this year's Canadian Patient Safety Week campaign, Take With Questions, focused on medication safety. Register now! for a free Canadian Patient Safety Week package!

Request a customized PDF of the '5 questions to ask about your medications' with your organization's logo. Join the over 100 organizations who have endorsed these questions.

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Share Your Story

Share with us how the '5 Questions' is being used in your organization, its impact on you and your patients.

I hope you will give a try and let me know how it is working for you and your patients and caregivers!
Alice Watt, RPh, BScPhm, Medication Safety Specialist
Alice joined ISMP Canada in 2007 as a Medication Safety Specialist and received her BSc. (Pharm.) from the University of British Columbia. She is actively practicing in a community hospital as a clinical pharmacist and has had close to 20 years of experience in community and acute care settings. Alice is involved in medication safety, incident analysis and has a passion for engaging consumers and health care practitioners in safe medication practices.

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Guest Post: 5 Questions to Ask about Your Medications

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Guest Post: 5 Questions to Ask about Your Medications A Counselling Framework for Pharmacists and Pharmacy Students One of the most rewarding parts of my job as a hospital pharmacist is that I get to talk to patients about their medications before they go home.

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5 Questions to Ask About Your Medications

Date: March 9, 2017
Filed under: Advance the Patient Voice, Patient Engagement, Tools

Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.

ISMP Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists have collaborated to develop a set of 5 questions to help patients and caregivers start a conversation about medications to improve communications with their health care provider.

It may be particularly helpful for patients to ask these questions at transitions of care. Examples include:

doctor's appointment (e.g. family physician or specialist, dentist)

interaction with a community pharmacist

discharge from hospital to home

visit by home care services

Share a story of how the "5 questions to ask about your medications" have impacted you or take a photo of where you've seen it and send it to medrec@ismp-canada.org or using #5questionsaboutmeds tweet or post to Facebook.

The Council endorses the 5 Questions to Ask About Your Medications resource for patients. Click the image below to download the poster.

Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.

ISMP Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists have collaborated to develop a set of 5 questions to help patients and caregivers start a conversation about medications to improve communications with their health care provider.

It may be particularly helpful for patients to ask these questions at transitions of care. Examples include:

doctor's appointment (e.g. family physician or specialist, dentist)

interaction with a community pharmacist

discharge from hospital to home

visit by home care services

Share a story of how the "5 questions to ask about your medications" have impacted you or take a photo of where you've seen it and send it to medrec@ismp-canada.org or using #5questionsaboutmeds tweet or post to Facebook.

The Council endorses the 5 Questions to Ask About Your Medications resource for patients.
Download the Poster

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5 Questions to Ask About Your Medications / BC Patient Safety & Quality Council

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Date: March 9, 2017 Filed under: Advance the Patient Voice, Patient Engagement, Tools Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.

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Hospital News article 5 qs to ask about your medications

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Hospital News article 5 qs to ask about your medications

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By Carol Nguyen and Certina Ho
Medication errors can occur at transitions of care, such as hospital discharge, following-up with a specialist or family doctor, and updating medication regimens at the pharmacy. Incidents often occur when there are medication changes that are not properly communicated among healthcare providers within the circle of care of the patient.

The " 5 Questions to Ask About your Medications " is a tool designed for patients and healthcare providers to use as a guide when discussing changes in medications. These questions will help both patients and caregivers start a conversation about their medications and become knowledgeable about their medication therapy management.

Below is a patient case scenario that is used as an example to illustrate the application of this tool.
"A patient admitted with uncontrolled hypertension had been discharged from hospital with changes to her blood pressure medications. She was sent home with a new script for Tiazac®XC 120 mg once a day and advised to stop her metoprolol which she had been taking before admission. She filled the prescription and started the new medication. One week later, she had a follow-up visit with the family doctor, who was unaware of the recent changes in hospital and increased the dose of metoprolol, which had previously been stopped. The metoprolol prescription was filled. The patient was re-admitted to the hospital a few days later due to a low heart rate and it was discovered that she was taking both Tiazac®XC and metoprolol. Her metoprolol was discontinued; she was stabilized and discharged home on Tiazac®XC."
The opportunities for the patient and healthcare providers to use the tool in this case could have been at the moment of discharge from the hospital, at the family doctor's office, and at the community pharmacy. For the purposes of this demonstration, the questions will be applied to the patient when she was discharged from the hospital the first time.

CONTINUE?

Which medications do I need to keep taking, and why?

This would be the opportunity to ensure that you (as the healthcare provider) and your patient are on the same page about which medications they need to keep taking.

Assess the appropriateness of the patient's other medication(s) and explain which ones can be continued safely with the new medication, Tiazac®

At the end of the dialogue, remind your loved one that it is also important to keep his/her medication record up-to-date. The record should include medications and changes made, and also the patient's drug allergies, vitamins and minerals, herbals or natural health products, and any other non-prescription medications, such as over-the-counter medications. Keeping an up-to-date medication list is one way to keep track of changes and this also helps patients communicate the changes to healthcare providers in their circle of care.

Lastly, encourage patients to initiate a dialogue with their healthcare providers to assess for the possibility of reducing or stopping any of their medications in order to optimize their medication therapy management. If every patient can ask about his/her medications at hospital discharge, during visits to the doctor's office and the community pharmacy, a significant number of medication incidents can be prevented.

Additional Resources:
Carol Nguyen completed a PharmD rotation at the Institute for Safe Medication Practices Canada (ISMP Canada) in 2016; Certina Ho is a Project Lead at ISMP Canada.

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Five questions to ask about your medications - Hospital News

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By Carol Nguyen and Certina Ho Medication errors can occur at transitions of care, such as hospital discharge, following-up with a specialist or family doctor, and updating medication regimens at the pharmacy. Incidents often occur when there are medication changes that are not properly communicated among healthcare providers within the circle of care of the ...

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Five Questions to Ask about your Medications - Tools & Resources | CPSI

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For patients who require multiple medications or who are transitioning between treatments, safety can become a concern. You or your loved one may be at risk of fragmented care, adverse drug reactions, and medication errors. To be an active partner in your health, you need the right information to use your medications safely.

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CADTH promotion of OAT tools (methadone/suboxone patient handouts)

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CADTH promotion of OAT tools (methadone/suboxone patient handouts)

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At Northern Health we are working to ensure that our healthcare providers partner WITH our patients and caregivers to make sure that a patient's medication list is complete, accurate, and up-to-date. We call this process Medication Reconciliation, or MedRec. MedRec creates a list that confirms all the medications a patient should be taking every time they move into, out of, or within our care.

But, making sure we have an up-to-date list of a patient's medications isn't enough. We are committed to sharing this information with members of the healthcare team.

Knowledge is the best medicine also offers a create your own customizable PDF Medication Record that can be saved on your devices or printed.

You can help make your care safer by keeping a list of all your medicines and how you take them. Keep the list with you at all times and show the list to your doctor, nurse, pharmacist or other healthcare professional any time you receive care.

This way, your healthcare professional will know what medicines you are taking and how. This can prevent a mistake with your medicines like missing a dose of a medication you need, or getting two medications that shouldn't be taken together.

Your list should include all your medicines, even medicine that you buy without a prescription. Any time you begin to take a new medicine, add it to your list. Don't forget things like vitamins, minerals, herbals remedies and medicines you take for pain!
Learn more about keeping a list of medicines by watching the video Medication Safety by Doc Mike Evans

You know best what medications you take and how you take them.. Your medication list speaks for you in case you can't, or if you don't always remember all the medications you take.

If you take medications, you play a role in your healthcare when it comes to medication safety. Keep an up-to-date list of all the medications you take and carry it with you. Medication, or medicine, doesn't just mean the prescriptions you take

Sharing your updated list every time you see your doctor, nurse, pharmacist, or other healthcare provider helps them give you the best care possible. It could even prevent a dangerous medication situation.

That's a good question. The problem is that you may have seen more than one healthcare provider, gone to more than one pharmacy to have a prescription filled, or may not be taking the medicine the way it was prescribed.

Your medications and the way you take them may change over time, your healthcare team wants to ensure they know exactly what you're taking.

Medications are more than just those that a doctor prescribes. They include a long list of the ones that you buy "over the counter", medications that you do not have a prescription for such as pain medication, cold medicines, laxatives, vitamins, minerals, natural, herbal remedies, and recreational drugs, patches, inhalers, eye/ear/nose drops, creams, lotions, ointments, and even samples that the doctor may give you.

When you meet with your healthcare provider, or go to a healthcare centre, tell them:

The names and strengths of all the medication you take

How you take the medication (for example, time of day, dose (amount), and how often)

This ensures that the medications will be safe and effective for you. There are many ways you can keep track of the medication you take, from a list in your wallet or purse, to something you keep on your mobile device. We have included some Medication tracking tools to help you.

Knowledge is the best medicine has developed a free app "MyMedRec" that among other things helps patients keep a record of their medicines and immunizations. This free app is available for use on Android and iPhone devices.

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At Northern Health we are working to ensure that our healthcare providers partner WITH our patients and caregivers to make sure that a patient's medication list is complete, accurate, and up-to-date. We call this process Medication Reconciliation, or MedRec.

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Linda Hughes shares one thing that stands out as a fine example of patient engagement. (Hint: 5 Qs to Ask)

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Linda Hughes shares one thing that stands out as a fine example of patient engagement. (Hint: 5 Qs to Ask)

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Linda & Theresa a Celebration of Patient Engagement

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Doing MedRec Discharge and teaching patients 5qs to ask

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Medication Reconciliation: A Prescription for Safer Care

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Medication Reconciliation: A Prescription for Safer Care

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Abstract

Four national healthcare organizations - Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada - recently collaborated to better understand and share comprehensive information about medication reconciliation in Canada. This article summarizes the key findings of their joint report titled Medication Reconciliation in Canada: Raising the Bar and profiles innovative approaches and tools for healthcare organizations across Canada.

Medication Reconciliation: Reducing Risks for Patients and the Health System

Medication reconciliation is a systematic process to review all the medications a patient is taking to ensure that medications being added, changed or discontinued are carefully assessed and documented. Endorsed by patient safety organizations around the world, medication reconciliation is intended to ensure accurate communication at care transition points, for example, when patients enter a hospital, transition to another service or provider or are discharged home. Significant system cost savings stand to be achieved given that the total cost of preventable drug-related hospitalizations is about $2.6 billion per year (Hohl et al. 2011).

Medication reconciliation can reduce the potential for readmission by ensuring that patients understand their drug regimens at discharge. More than 180,000 Canadians had an unplanned readmission to acute care within 30 days of discharge in 2010, costing an estimated $1.8 billion and accounting for 11% of all acute hospital costs (Canadian Institute for Health Information [CIHI] 2012).

Medication reconciliation can also play an important role in contributing to patient understanding of complex medication regimens. For example, seniors in Canada take four times more over-the counter medications than any other age group and are therefore more at risk of potential drug interactions (CIHI 2011a, 2011b).

Four national healthcare organizations - Accreditation Canada, CIHI, the Canadian Patient Safety Institute (CPSI) and the Institute for Safe Medication Practices (ISMP) Canada - recently collaborated to better understand and share comprehensive information about medication reconciliation in Canada. This article summarizes the key findings of their joint report titled Medication Reconciliation in Canada: Raising the Bar (Accreditation Canada et al. 2012) and profiles innovative approaches and tools for healthcare organizations across Canada.

Medication Reconciliation in Canada: A Snapshot

Accreditation Canada Required Organizational Practices

Data Sources

Over 1,200 healthcare organizations (6,000 sites) participate in Accreditation Canada programs every year. During the on-site survey, trained surveyors from accredited health organizations assess the leadership, governance, clinical programs and services provided against the Accreditation Canada standards. First introduced in 2005, Required Organizational Practices (ROPs) are evidence-based practices developed with input from healthcare experts that mitigate risk and contribute to improving the quality and safety of health services.

Findings

Since 2008, there has been a gradual improvement in organizational performance on medication reconciliation ROPs across the continuum of care. As shown in Table 1, national compliance with the medication reconciliation requirement (medication reconciliation in two client service areas, plus having a plan to disseminate it throughout the rest of the organization) had a 21% increase from 61% in 2010 to 82% in 2012. At the level where care was provided to patients (e.g., surgical care services, long-term care services), compliance rates for the Medication Reconciliation at Admission ROP improved from 47% (2010) to 71% (2012), and Medication Reconciliation at Transfer or Discharge ROP compliance rates improved from 36% (2010) to 62% (2012) (Accreditation Canada 2013). While these improvements are impressive, there is still much work to be done.

TABLE 1. National compliance rates with the Accreditation Canada medication reconciliation ROPs

Develops and implements a plan for medication reconciliation throughout the organization

61

77

82

Medication Reconciliation at Admission

47

60

71

Medication Reconciliation at Transfer or Discharge

36

50

62

ROP = required organizational practice.

*Some variation is expected in ROP compliance rates from year to year because different organizations undergo on-site surveys each year.

Source: Data from Accreditation Canada (2013).

Safer Healthcare Now! and Medication Reconciliation Practice Leaders

Data Sources

Medication reconciliation was one of the six original Safer Healthcare Now! (SHN) interventions designed to contribute to making the healthcare system safer for Canadians. Since SHN was launched eight years ago, medication reconciliation has been the most highly subscribed intervention, with more than 500 SHN teams (representing 450 different organizations) participating. Healthcare organizations that were identified as potential practice leaders were surveyed in late 2011 (CPSI and ISMP Canada 2012).

Findings

While leaders and teams reported strong support for medication reconciliation, there was also frustration at the unexpected complexity and the need for strong and consistent leadership and sufficient resources to advance this agenda. Table 2 shows the key success factors and the challenges identified. Medication reconciliation requires the engagement of physicians, nurses and pharmacy staff, and effective leadership is critical.

TABLE 2. Key success factors and challenges identified from medication reconciliation practice leaders* in Canada, 2012

Strong leadership support

Lack of both human and fiscal resources

Physician champions/leaders

Limited technology

Information technology support

Insufficient professional and government direction

Comprehensive staff education plan

*Fifty organizations, representing nine provinces, were interviewed using a standardized survey tool. They ranged from small, stand-alone facilities to large, regional healthcare organizations and academic centres. Seventy-four percent of the organizations had fully implemented medication reconciliation on admission, while 44% had full implementation on transfer, and 37% on discharge. The majority had implemented medication reconciliation on medical units (65%) and on surgery units (59%). Of the respondents, 54% used a paper-based system, while 40% used a hybrid electronic/paper system and 15% used a fully integrated electronic system.

Renewing the Focus on Medication Reconciliation: Innovative Resources

MedRec Check-Up Map and Leading Practices

An interactive map was developed to profile Canadian medication reconciliation success ( Figure 1). The map identifies practice leaders, the use of technology, provincial and national supports, Canadian research and publications related to medication reconciliation. This Cross Country MedRec Check-Up map is available on the CPSI and ISMP Canada websites (see www.ismp-canada.org/medrec/map or https://www.saferhealthcarenow.ca/EN/Interventions/medrec/Pages/default.aspx) and is continually updated.

Figure 1. Cross Country MedRec Check-Up Map

Through a searchable online Leading Practices database ( www.accreditation.ca), Accreditation Canada recognizes leading practices in Canadian organizations across the care continuum that are innovative and use cost-effective solutions to improve quality. These resources allow innovative practices in medication reconciliation to be shared, and it provides an opportunity for others to learn from the experiences of these organizations, supporting the successful implementation of medication reconciliation. Some of the practices recognized include customizing medication reconciliation supports for the home care environment, using electronic data to better track patient information as patients move across the system, and developing visual teaching aids so staff can better understand the process as a series of steps with a clear rationale for each one.

MyMedRec

An interactive iPhone and iPad app, MyMedRec ( Figure 2), was developed by ISMP Canada with input from Canadian patient groups and healthcare provider organizations. This new electronic tool is available worldwide to support people in managing their own healthcare and using their medications safely and appropriately. MyMedRec prompts patients and caregivers to have their medication and immunization records at their fingertips. The app helps patients and caregivers to compile a full list of their medications, whether prescription, over the counter or natural health products, and to share this information with their healthcare team. The app is supported by the www.knowledgeisthebestmedicine.org website and includes features such as refill and dosage reminders, medication histories, multiple patient profiles, email and picture capabilities and contact information of prescribers and pharmacies.

Figure 2. MyMedRec

The Future of Medication Reconciliation in Canada: Where To from Here?

To continue spreading medication reconciliation across the system, a number of strategies are designated priorities of the National Medication Reconciliation Strategy, co-led by CPSI and ISMP Canada. These strategies include engaging senior leaders, continuing collaboration with national organizations, and developing and disseminating tools and resources to support front-line providers as well as families, clients and unregulated care providers in the community setting. Accreditation Canada has consulted with its national partners and medication reconciliation leaders from across Canada to inform program enhancements - announced in January 2013 for on-site surveys starting in 2014 - that will permit surveyors to consistently evaluate requirements across organizations in all sectors, with varying structures and sizes, at different stages of the implementation process.

Medication reconciliation continues to be a complex and challenging component of patient safety for healthcare organizations across Canada. Healthcare organizations that have successfully implemented medication reconciliation have an overwhelming sense that medication reconciliation benefits patients, is the right thing to do and makes care safer. Communicating effectively about medications is a critical component of delivering safe high-quality care across all sectors of the Canadian healthcare system. The partnership between Accreditation Canada, CIHI, CPSI and ISMP Canada will continue to provide leadership, comparable data and information on best practices, as well as ongoing support to make care safer for all Canadians.

About the Author(s)

Jonathan I. Mitchell, MSc, CHE, is the manager of policy and research for Accreditation Canada, in Ottawa, Ontario.

Marie M. Owen, RN, MScN, is senior director and national co-lead for Medication Reconciliation Canada, Canadian Patient Safety Institute, in Edmonton, Alberta.

Margaret H. Colquhoun, BScPhm, RPh, FCSHP, is project leader, Institute for Safe Medication Practices Canada, in Toronto, Ontario.

Christina Lawand is the senior researcher in health system analysis and emerging issues, Canadian Institute for Health Information, in Ottawa, Ontario.

Acknowledgment

We send special thanks to Bernadette MacDonald, vice-president of innovation and development for Accreditation Canada, and Kathleen Morris, director of health system analysis and emerging issues for CIHI.

References

Accreditation Canada. 2013. Safety in Canadian Health Care Organizations: A Focus on Transitions in Care and Required Organizational Practices. Ottawa, ON: Author.

Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada. 2012. Medication Reconciliation in Canada: Raising the Bar - Progress to Date and the Course Ahead. Ottawa, ON: Author.

Canadian Institute for Health Information. 2011a. A Snapshot of Health Care in Canada as Demonstrated by Top 10 Lists. Ottawa, ON: Author.

Canadian Institute for Health Information. 2011b. Health Care in Canada 2011: A Focus on Seniors and Aging. Ottawa, ON: Author

Canadian Institute for Health Information. 2012. All-Cause Readmission to Acute Care and Return to the Emergency Department. Ottawa, ON: Author.

Canadian Patient Safety Institute and Institute for Safe Medication Practices Canada. 2012. National Medication Reconciliation Strategy - Identifying Practice Leaders for Medication Reconciliation in Canada. Edmonton, AB: Author.

Hohl, C.M., B. Nosyk, L. Kuramoto, P.J. Zed, J.R. Brubacher, R.B. Abu-Laban et al. 2011. "Outcomes of Emergency Department Patients Presenting with Adverse Drug Events." Annals of Emergency Medicine 58(3): 270-79. DOI: 10.1016/j.annemergmed.2011.01.003.

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Medication Reconciliation: A Prescription for Safer Care

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Abstract Four national healthcare organizations - Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada - recently collaborated to better understand and share comprehensive information about medication reconciliation in Canada.

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Medication Safety at transitions of care

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Medication Safety at transitions of care

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"Introducing ISMP 5 Q’s early in admission promoted patients to ask more questions at discharge about their medication changes. " Niagara Health

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Medication Safety at Care Transitions: Safety Improvement Project - An 18 month learning collaborative

What is happening?

The Canadian Patient Safety Institute launched its Medication Safety- Safety Improvement Project in April 2019. This learning collaborative approach is being, delivered by expert faculty and coaches, with mentoring provided over 18 months. Participating teams will learn and apply strategies to decrease readmissions related to medication safety issues at discharge among frail patients.

Participating teams are:

Learning to identify Frail clients who are at risk for medication safety issues,

Learning and applying new processes for medication management at discharge,

Learning and utilizing Knowledge Translation and Implementation Science techniques to successfully implement and sustain new evidence-based practices for medication safety at transitions,

Sharing key learnings and challenges, and networking with colleagues across Canada,

Accessing, sharing and adopting advanced patient safety knowledge, tools, and resources within a learning network,

Improving the team's approach to patient safety while taking action to deliver safer care.

What is Medication Safety?

Medications are the most common treatment intervention used in healthcare around the world. When used safely and appropriately, they contribute to significant improvements in the health and well-being of patients.

Medication safety is defined as freedom from preventable harm with medication use (ISMP Canada, 2007). Medication safety issues can impact health outcomes, length of stay in a healthcare facility, readmission rates, and overall costs to Canada's healthcare system.

For more information, contact medsafety@cpsi-icsp.ca.

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Medication Safety at Care Transitions: Safety Improvement Project - Tools & Resources | CPSI

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The Canadian Patient Safety Institute launched its Medication Safety- Safety Improvement Project in April 2019. This learning collaborative approach is being, delivered by expert faculty and coaches, with mentoring provided over 18 months. Participating teams will learn and apply strategies to decrease readmissions related to medication safety issues at discharge among frail patients.

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Safer Choices for Pain Control after Wisdom Tooth Removal

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Safer Choices for Pain Control after Wisdom Tooth Removal

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#SuperSHIFTERS - Encourage conversations between patients and providers: 5 Questions to Ask About Your Medications

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#SuperSHIFTERS - Encourage conversations between patients and providers: 5 Questions to Ask About Your Medications

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4/10/2019 6:00 PM

SuperSHIFTERS Alice Watt, Medication Safety Specialist at the Institute for Safe Medication Practices Canada (ISMP Canada) and Mike Cass, Senior Project Manager at the Canadian Patient Safety Institute, were instrumental in the development and widespread dissemination of the 5 Questions to Ask About Your Medications. The 5 Questions creates a platform for patient engagement and promotes safe medication practices.

What are the 5 Questions to Ask About Your Medications?

The 5 Questions are a launching pad to encourage conversations between patients and healthcare providers. Patient Advocate Jill Adophe has been quoted as saying, "Patients want a dialogue, not a monologue. They want a choice and a voice." The 5 Questions tool gives patients something to think about in preparing for these conversations.

How did you land on these particular questions for the 5 Questions tool?

In 2014, a Medication Safety Summit concluded that a checklist would engage patients in medication safety. ISMP Canada was asked by the Canadian Patient Safety Institute to lead this opportunity, working with patients and a number of patient safety and medication specialists. Co-designed with representatives from Patients for Patient Safety Canada (PFPSC), the working group took a collaborative approach, ensuring that the patient voice guided the questions.

An initial environmental scan of medication safety literature and tools produced questions for consideration. Safety tools reviewed included medication reconciliation materials that had been developed following analyses of medication incidents at transitions of care (and shared with the Canadian Medication Incident Reporting and Prevention System). Those questions were narrowed down to create the final 5 Questions that would resonate most with the target audience.

What we ended up with went beyond our expectations!

What do patients and providers have to say about the 5 Questions?

In a recent Canadian Patient Safety Week survey, 63 per cent of healthcare providers said that patients are asking more questions about their medications, and 60 per cent of patients said they are asking more questions about their medications. Healthcare providers say they are distributing the 5 Questions to patients, posting them in examination rooms and clinics, and using the tool as a guide for conversations between patients and providers.

What is being done to spread the use of the 5 Questions?

We conducted several surveys with patients and healthcare providers to validate the 5 Questions and people told us to make it available in multiple languages. This has been another fascinating element of the project. Today, the 5 Questions tool is available in 25 languages from Albanian to Korean and Ukrainian. Organizations are still asking us to make the 5 Questions available in more languages and we're working on that!

Another feature of the 5 Questions is that healthcare organizations can add their logo to the tool, and it has been customized by more than 200 organizations to date.

More than five million patients are learning about the 5 Questions through an eye-catching digital poster campaign in doctors' offices and hospital waiting rooms in Ontario, Alberta, British Columbia and Quebec.

The 5 Questions tool has also been shared with organizations in other sectors through initiatives like the Home Care Collaborative and the Medications Safety at Transitions of Care Safety Improvement Project.

Were there any surprises or key learnings that you can share in developing the 5 Questions?

The enthusiasm of patients to promote the 5 Questions in their communities has been so rewarding. They have asked for copies and distributed them locally in grassroots efforts. There has been interest from sectors outside of acute care, including long term care, home care, primary care, and the 5 Questions have proven useful at transitions of care. We've been delighted by the international interest in the tool and the fact that it's now available in so many languages around the world.

We know that working with patients and having them participate in the co-design was crucial and will continue to be important as we develop new tools.

There's always room for modification, but as they were created, the 5 Questions have become a successful platform for starting a conversation. We tapped into an unmet need and the pick-up has snowballed.

Have you expanded on the initial 5 Questions tool?

A new 5 Questions handout has been developed with the Canadian Deprescribing Network and Choosing Wisely Canada, with the goal of reducing the use of opioids for pain after surgery. Key messages in the handout focus on safe storage and disposal of opioids. We are now looking at developing a 5 Questions tool to address the use of opioids for short-term pain and dental pain.

Where can our readers go for a copy of the 5 Questions, or learn more?

Click on the link to download the 5 Questions to Ask About Your Medications poster.

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#SuperSHIFTERS - Encourage conversations between patients and providers: 5 Questions to Ask About Your Medications - News | CPSI

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4/10/2019 6:00 PM SuperSHIFTERS Alice Watt, Medication Safety Specialist at the Institute for Safe Medication Practices Canada (ISMP Canada) and Mike Cass, Senior Project Manager at the Canadian Patient Safety Institute, were instrumental in the development and widespread dissemination of the 5 Questions to Ask About Your Medications.

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Excellence in Pharmacy Practice - Inter- professional Collaboration 2019 

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Excellence in Pharmacy Practice - Inter- professional Collaboration 2019 

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Opioids for pain after surgery handout
https://cshp.ca/excellence-pharmacy-practice-interprofessional-collaboration

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Excellence in Pharmacy Practice - Interprofessional Collaboration 2019

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2019 CSHP National Awards - Excellence in Pharmacy Practice

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Mentions CHS Handout

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Persistent vomiting mystified her - The Washington Post

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Deprescribing Tools: A review of the clinical tools used in practice

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Deprescribing Tools: A review of the clinical tools used in practice

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5 qs to ask

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Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

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Transitions Between Hospital and Home - Ontario Health (Quality)

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Transitions Between Hospital and Home - Ontario Health (Quality)

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Profiles 5 Qs to ask

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5 Questions to Ask About Your Medications

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Version française
Introduction

Medication errors continue to cause harm, especially at transitions of care (National Transitions of Care Coalition 2010). Improving medication safety at transitions also addresses a Health Standards Organization requirement. Medication Management Standards promote a collaborative approach to prevent and reduce medication errors and near misses by addressing all aspects of the medication management process, from prescription, selection, preparation and dispensing to administration of the medication and ongoing monitoring of clients (Health Standards Organization 2019).

The evidence reveals a need to empower all people and correct the imbalance of information between patients and their care providers. Three-quarters of Canadians surveyed are interested in learning how to keep safe in healthcare, with eight in 10 saying they would like to receive this information from a healthcare provider (Ipsos Public Affairs 2018).

The Institute for Safe Medication Practices Canada (ISMP Canada), the Canadian Patient Safety Institute (CPSI), Patients for Patient Safety Canada (PFPSC), the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists collaborated to develop a set of five questions to help patients and caregivers start a conversation about medications to improve communications with their healthcare provider. The tool can be particularly helpful for patients at transitions of care, including:

at primary care appointments (e.g., family physician or specialist, nurse practitioner, dentist),

when interacting with a community pharmacist,

on discharge from hospital to home and

during a homecare service visit.

The design of the "5 Questions to Ask about Your Medications" (5 Questions) includes the opportunity for organizations to add their logo, to visibly demonstrate their support and endorsement of the initiative ( Figure 1). This approach also allows for these organizations to stay connected informally for shared learning as the 5 Questions spread and are used in unique applications across Canada and around the world. The more than 200 endorsements of the 5 Questions by organizations at the local, provincial, national and international levels demonstrate a commitment to work together to advance medication and patient safety.
FIGURE 1. Five questions to ask about your medications infographic

Evidence

Unsafe medication practices and medication errors are the leading cause of avoidable harm in healthcare systems across the world. Medication errors occur when weak medication systems and/or human factors, such as fatigue, poor environmental conditions or staff shortages, affect prescribing, transcribing, dispensing, administration and monitoring practices, which can result in severe harm, disability and even death (WHO 2017).

Medication errors in the hospital, which are measured and reported, are used to demonstrate the magnitude of the problem. What is unknown is how much harm occurs when people do not take medications as prescribed after leaving the hospital. This complex transition is considered a time of risk for the patient and possible harm.

In Canada, harmful incidents associated with medications are among the most frequent type of adverse event. Medication safety issues can impact health outcomes, length of stay in a healthcare facility, readmission rates and overall costs to Canada's healthcare system (CPSI 2018).

The Canadian Adverse Events Study (Baker et al. 2004) found that drug- or fluid-related events were the second most common type of adverse event in Canadian hospitals, accounting for 23.6% of the total. The cost attributed to adverse drug events has been reported to be $4,028 per event (Etchells et al. 2012). Furthermore, more than half of Canadians are using prescription drugs on a regular basis, with 36% taking two or more medications (Health Council of Canada 2014).

A 2008 study found that more than one in nine emergency department visits were due to drug-related adverse events and 68% of them were preventable (Zed et al. 2008). According to the Canadian Medical Protective Association, close to 25% of patients involved in a medication adverse event died or suffered some other catastrophic event (CPSI 2014). Furthermore,

an estimated 37% of seniors in nine provinces received a prescription for a drug that should not be taken by this population;

two out of three Canadians (66%) over the age of 65 take at least five different prescription medications, whereas 27% take at least 10 different prescription medications; and

in 2016, one in 143 Canadian seniors were hospitalized due to the harmful effects of their medication (CIHI 2018a).

The World Health Organization (WHO) states that unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world (WHO 2017). One source indicates that the estimated cost of preventable medication errors is $125 million CAD (RiskAnalytica 2017). Globally, the cost associated with medication errors has been estimated at over $55 billion(CPSI 2018).

Creating the 5 Questions

CPSI, in partnership with ISMP Canada, hosted a national medication safety summit in Toronto, Ontario, in June 2014 to create the synergy and coordination required to accelerate improvements in safe medication use in Canada. The resulting Medication Safety Action Plan was incorporated into the national Integrated Patient Safety Action Plan.

During the summit, the 37 attendees participated in a world café, a meeting model used to stimulate creative thinking in large groups. A patient story sparked the idea for the creation of a checklist of questions about medications for patients to use at transitions of care:

"My father was well-organized, independent and energetic," says Emily Musing, Executive Director, Pharmacy, Clinical Risk and Quality and Patient Safety Officer at [University Health Network]. "But he found himself in a situation where he had to take many drugs, see multiple specialists and it was confusing. He was not sure what each specialist knew, how best to ask questions and what phrases he should use." (University Health Network 2016)

Emily wrote down a few basic questions to help her dad get the information he needed for safe use of each medication. Emily shared her idea that all Canadians should have a list of questions that they can use to start a conversation with their healthcare provider, and that was the beginning of how the 5 Questions about medications started.

ISMP Canada led the development of this work by creating a working group with patient representatives from PFPSC and other stakeholders. The group worked collaboratively to co-design a list of questions that patients could ask, derived from existing tools, recent evidence and learnings from medication incidents. An environmental scan and review of analyses of medication errors leading to harm at transitions formed the basis of the development of this intervention to empower patients. The 5 Questions were derived from evidence-informed medication safety practices, including medication reconciliation (ISMP Canada 2016). The tool was tested across various sectors of care and modifications made using the Plan-Do-Study-Act (PDSA) cycle and based on feedback from electronic surveys. A logic model was created to guide the implementation of the 5 Questions.

The 5 Questions were tested in various sectors (primary care, acute care, long-term care, homecare), with different professionals (nurses, nurse practitioners, doctors, dentists and pharmacists) and with patients, and their feedback helped to make it better. Feedback from PFPSC was also incorporated into the final version.

Creating content for the 5 Questions was not about the questions being perfect or using all the questions all the time. Rather, it was a collective effort to provide consistent messaging about what matters to each patient and family.

In a national online survey of patients and healthcare providers (n = 291), 85% of patients said they felt comfortable asking their healthcare provider the 5 Questions, 75% of patients responded that the answers to the 5 Questions would be a very useful tool to help them understand their medications and 84% of healthcare providers would be willing to answer their 5 Questions. (Watt et al. 2018). One of the speakers who helped to launch the 5 Questions shared her story about losing her 22-year-old daughter, Martha, due to a medication error. Maryann Murray from PFPSC said in The Kelowna Daily Courier that being armed with these 5 Questions will help patients protect themselves:

Not only do people need to feel empowered about their own health care, but the medical people need to know that it's their responsibility to pass on the information. I think with the questions, you're not only telling people it's OK to ask these questions, you're telling the medical people you need to answer these questions ... [T]hose five questions will save people from harm and they'll save some lives. (Ubelacker 2016)

To improve medication safety, patients need to understand the medications they take. "5 Questions to Ask about Your Medications" is an effective tool that frames the conversation between patient and provider by encouraging information sharing. Informed patients can help prevent or reduce incidents of medication harm.

Implementing the 5 Questions

Implementation of the 5 Questions has taken many forms. To date, more than 200 organizations across all sectors of care at local, provincial, national and international levels have formally endorsed the 5 Questions. The poster has been translated into 25 languages, with support from partners. Since the launch of the tool in March 2016, there have been more than 30,000 downloads. See Appendix 1 ( available here) for impact testimonials from patients, providers and leaders.

In June 2016, the 5 Questions tool was also introduced internationally at the 69 th World Health Assembly Side Event, "Addressing the Global Challenge of Medication Safety to Improve Patient Safety and Quality of Care" (CPSI 2016).

ISMP Canada created a video to promote the 5 Questions, in consultation with patients and healthcare providers, to help patients be an empowered part of their healthcare (ISMP Canada 2016). The 5 Questions video has been viewed over 6,000 times.

A digital poster campaign reaches out to patients in some 200 high-traffic waiting rooms in Ontario (75%), Alberta and British Columbia (20%) and Quebec (5%). Each year, some five million patients are learning about the 5 Questions at the point of care, in their doctor's waiting room. This eye-catching form of engagement generates over 32 million impressions annually.

In May 2018, the Canadian Pharmacists Association hosted a webinar, Partnering with Patients on Medication Safety. The 116 attendees learned practical ideas that they can use to advance patient engagement in their everyday practice. The results from a quick poll during the webinar indicated that 68% of participants were using the 5 Questions, whereas 32% had not heard of or previously used the tool. After the webinar, participants surveyed were willing to try using the 5 Questions in their practice (mean: 4.77 strongly agree) (Canadian Pharmacists Association 2018).

Canadian Patient Safety Week promoted the 5 Questions in both the 2017 and 2018 campaigns with the development of a PATIENT podcast series, 5 Questions quizzes for patients and healthcare providers and a catchy phrase contest to help patients remember the questions. Mnemonics for the key words Changes? Continue? Proper Use? Monitor? Follow-Up? were created (e.g., Conversations Can Prevent Medication Failures).

The Manitoba Institute for Patient Safety developed a medication safety module for Grade 11 students, a province-wide supplement to the Active Healthy Lifestyles curricula. The 5 Questions are discussed and included as a student handout for Lesson 1 on alcohol and other drugs (Manitoba Institute for Patient Safety n.d.).

Medication errors continue to be a source of preventable harm, especially for older adults living with frailty. The Canadian Frailty Network created the Frailty Matters Innovation Showcase to put the spotlight on new approaches in the care of older adults living with frailty. The 5 Questions was recognized as one of the top 30 innovations exhibited at the 2018 conference (Canadian Frailty Network 2018).

The uptake of the 5 Questions can also be attributed to grassroots efforts, such as those of patient safety advocates Meredith and Barton Ottoson, from Davidson, Saskatchewan. They have made it their mission to distribute the posters widely. Today, if you drive through Davidson, you will find the posters not only in hospitals, healthcare centres, drugstores and doctor's offices but also in the windows of the local hardware store, gas stations, restaurants and other businesses throughout the surrounding area.

Meredith described why the 5 Questions resonates with her:

5 Questions to Ask empowers patients to act. It affirms that our health matters wherever we are on the age grid. We need to have a clear understanding of proposed treatments and medications to help us make better health care decisions. Patients as partners and shared power is a learning curve for all of us. We can do this! (personal communication with Meredith Ottoson)

Using the 5 Questions to reduce the use of opioids

Another goal of the Medication Safety Action Plan was to address the safe use of opioids. Prescribing opioids to manage pain has increased substantially, with some serious, unintended consequences. Surgical patients are four times more likely to receive opioids at discharge from hospital than their non-surgical counterparts.

A systematic literature review of opioid use after discharge in post-operative patients found that surgical patients are using substantially fewer opioids during the post-operative period than prescribed. A lack of awareness regarding proper disposal of leftover medication is leaving excess opioids in the home, which may be used inappropriately by the patient or others. The study called for education for providers and clinical practice guidelines that provide guidance on prescription of outpatient opioids (Feinberg et al. 2018).

A recent study of post-surgical patients (Brat et al. 2018) showed that each additional week of opioid prescription refills is associated with a significant increase in opioid misuse among opioid-naïve patients. The study also revealed the following:

Up to 10% of opioid-naïve patients who received a post-operative opioid prescription require an opioid to control pain symptoms at one year after the surgery.

Prolonged post-operative opioid use is associated with increased morbidity and decreased quality of life.

Over the past 10 years, there has been a 53% increase in the rate of hospitalizations for opioid poisoning. The age group most affected is 15-24-year-olds (CIHI 2018b). The Centre for Addiction and Mental Health (n.d.) says that one in 10 high school-aged teens in Ontario have tried an opioid recreationally; 60% of the time, those opioids were obtained from home.

The opioid safety handout (a modified version of the 5 Questions) shown in Appendix 2 ( available here) was co-developed with patients as a response to address the opioid crisis. It provides the answers to the 5 Questions for patients who are taking opioids after surgery. This patient resource was developed collaboratively with and is endorsed by several healthcare organizations (see Acknowledgements), in accordance with recent guidelines and preferred practice. Since its launch during the Opioid Wisely campaign in March 2018, there have been more than 4,500 downloads of the handout.

Evidence that the handout does have an impact on patient education and prescription practices was provided in a study at North York General Hospital (NYGH) led by Dr. Sanjho Srikandarajah.

The primary goal of the study was to determine the effect of standardized prescriptions and patient education on the amount of opioid prescribed and used by surgical patients undergoing laparoscopic appendectomy or cholecystectomy following discharge.

The NYGH study was conducted between April and June 2017. During that period, a total of 2,672 opioid pills were prescribed to 127 patients. Those patients reported taking only 458 of the pills prescribed, or 17%, leaving 2,314 unused pills, or 83%, in three months (Feinberg et al. 2019)

The data were used to create a standardized evidence-based electronic prescription (decreasing the number of pills prescribed, with a default limit of 20 tablets) and a patient education pamphlet (a modified version called "Opioids for pain after day surgery: Your questions answered"). With the new interventions in place, patients were then recruited to assess the effectiveness of the new prescription and education initiative using the same survey from the previous study. This survey was conducted between November 2017 and January 2018. During that period, 1,490 fewer opioid pills were prescribed (a 56% decrease). If this was extended over a year, that would mean there would be 11,000 fewer opioid pills prescribed at one institution alone and several thousand unused opioid pills no longer available for potential inappropriate use. After the introduction of the patient education handout and the intervention to standardize opioid prescription quantities, the percentage of patients who received information about opioids increased over five-fold, from 8.5 to 44%, and the average number of pills consumed decreased by 45%, from 3.6 to 2, with no significant change in pain scores reported by patients.

The results from this study (Feinberg et al. 2019) were presented by Dr. Srikandarajah to several international and national conferences, including the 2019 International Forum in Glasgow, Scotland. It was recognized with the 2018 Abstracts of Distinction Award at the Health Care Transformations Conference in Ontario, the Richard Knill Award and the Best Paper in Chronic Pain at the 2019 Annual Canadian Anesthesia Society Conference.

Next Steps: Expanding Our Reach With New Partnerships

Taking this educational approach to the next level will involve embedding the 5 Questions in the everyday conversations held by patients and their healthcare providers. The goal with expanding our reach is collaborating with partners committed to advancing medication safety one conversation at a time. Here is what that will look like:

Incorporate results from an 18-month safety improvement project co-ordinated by CPSI and launched in the spring of 2019. Teams are focused on safe medication use and medication reconciliation at discharge. The learnings will inform additional knowledge translation efforts including incorporating the 5 Questions into medication reviews, de-prescribing and patient engagement efforts.

Continue to work with partners to integrate the 5 Questions more explicitly into de-prescribing, medication reconciliation processes, patient portals and related technologies and other related safe medication initiatives.

Partner with organizations across Canada to use the 5 Questions as a foundation to develop specialized patient resources. For example, work to develop a patient handout based on the 5 Questions, to advance opioid safety for patients with short-term pain and managing pain after wisdom teeth removal.

Evaluate the 5 Questions through research by various teams. This is one key mechanism of supporting the next steps including spread and sustainability of the 5 Questions initiative.

Develop new technologies to help patients access medication information at their fingertips. Apps such as My MedRec will help patients keep track of their medications and prompt them to ask questions and take notes.

Incorporating a broader approach, CPSI and ISMP Canada are supporting the WHO in its global campaign to reduce medication errors. The goal for the Medication Without Harm global patient safety challenge is to reduce the level of severe, avoidable harm related to medications by 50% over 5 years.

As a WHO Collaborating Centre for Patient Safety and Patient Engagement, CPSI is coordinating the Medication Without Harm campaign in Canada. "Know. Check. Ask." is the call to action to encourage patients and healthcare providers to take an active role in medication use and for global solidarity and action by the international community to reduce avoidable medication-related harm (WHO 2017).

Over the course of the next 5 years, CPSI, together with patients and partners, will develop and execute an implementation plan, monitor and evaluate progress made and work closely with WHO to ensure the long-term sustainability of strategies implemented over the course of the Medication Without Harm campaign.

Conclusion

Healthcare organizations that embrace the 5 Questions demonstrate a positive safety culture and patient engagement. Patients and families say that the 5 Questions empower them to start a conversation with their healthcare provider about their medications. Being open to hearing what matters to patients and having a dialogue that gives patients a way and time to voice their concerns and questions will ensure that patients and families have the knowledge they need for safe medication use. The use of 5 Questions in all areas of the health system is an important recognition and reminder of the complexity of safe medication use, as well as the pivotal role of patients and families within this process.
Sécurité des Médicaments
Donna Herold est membre de Patients pour la sécurité des patients du Canada. Elle a été membre de l'équipe de travail et co-auteure du Guide canadien de l'engagement des patients en matière de sécurité.

Maryann Murray est membre de Patients pour la sécurité des patients du Canada. Elle lutte pour un langage clair et des caractères lisibles sur les étiquettes des médicaments et pour la sécurité des patients dans les soins de santé, à domicile et à l'étranger.

Alice Watt, pharmacienne autorisée, B.Sc.Pharm., est spécialiste de la sécurité des médicaments à ISMP Canada. Elle a travaillé pendant une vingtaine d'années dans des établissements de soins communautaires et de courte durée et se consacre à l'engagement des patients et des praticiens de la santé dans des pratiques sécuritaires en matière de médication.

Sylvia Hyland, pharmacienne autorisée, B.Sc.Pharm., ACPR, M.Sc. (bioéthique), est vice-présidente, responsable des opérations et de la protection des renseignements personnels à ISMP Canada. Dans le cadre de son travail, elle a participé à l'analyse des événements indésirables liés aux médicaments et a participé à des examens ciblés des systèmes d'utilisation des médicaments dans les soins de santé.

Carolyn Hoffman, inf. aut., B.Sc. inf., M.Sc. inf., est présidente et chef de la direction d'ISMP Canada. Elle a une expérience de cadre dans les opérations hospitalières, le gouvernement provincial, la réglementation des soins infirmiers et l'amélioration de la qualité dans les soins de santé, le tout axé sur la sécurité des patients.

Mike Cass, inf. aut., est gestionnaire principal de programme à l'Institut canadien pour la sécurité des patients. Il dirige actuellement une initiative de collaboration en matière d'amélioration de la sécurité des médicaments dans les organisations de soins de courte durée pour les personnes âgées fragilisées.

Adresse pour correspondance: Alice Watt, pharmacienne autorisée, spécialiste de la sécurité des médicaments, ISMP Canada; téléphone : 416-733-3131 poste 250; courriel : alice.watt@ismpcanada.ca.

Résumé

Cette initiative d'amélioration de la qualité, qui vise à prévenir les échecs connus liés aux médicaments lors des transitions de soins, a été codirigée par le programme Patients pour la sécurité des patients du Canada, par l'Institut pour la sécurité des médicaments aux patients du Canada, par l'Institut canadien pour la sécurité des patients, par l'Association des pharmaciens du Canada et par la Société canadienne des pharmaciens d'hôpitaux. Au départ, l'intervention consistait à élaborer, tester, évaluer et diffuser une " liste de contrôle " pour la sécurité des médicaments à l'intention des patients et des prestataires de services de santé. Suite à de petits changements, la liste a été redéfinie en " Cinq questions à poser au sujet de vos médicaments ". Le résultat témoigne de l'engagement de plus de 200 organisations à responsabiliser les patients au sujet de leurs médicaments.

Introduction

Les erreurs de médication causent des préjudices, en particulier lors des transitions de soins (National Transitions of Care Coalition 2010). L'amélioration de la sécurité des médicaments lors des transitions répond également aux exigences de l'Organisation de normes en santé. Les normes pour la gestion des médicaments préconisent une approche collaborative qui vise à prévenir et à réduire les erreurs et les quasi-oublis de médicaments en abordant tous les aspects du processus de gestion des médicaments, depuis la prescription, le choix, la préparation et la délivrance jusqu'à l'administration du médicament et la surveillance des usagers (Health Standards Organization 2019).

Les données montrent la nécessité de responsabiliser toute personne et de corriger les déséquilibres en matière d'information entre patients et prestataires de soins. Les trois quarts des Canadiens interrogés souhaitent apprendre comment assurer la sécurité dans les soins de santé, huit répondants sur 10 déclarant vouloir recevoir ces informations de la part d'un fournisseur de services de santé (Ipsos Public Affairs 2018).

L'Institut pour la sécurité des médicaments aux patients du Canada (ISMP Canada), l'Institut canadien pour la sécurité des patients (ICSP), le programme Patients pour la sécurité des patients Canada (PPSPC), l'Association des pharmaciens du Canada et la Société canadienne des pharmaciens d'hôpitaux ont collaboré à l'élaboration d'une série de cinq questions pour aider les patients et les proches aidants à entamer un dialogue sur les médicaments avec leur professionnel de la santé. L'outil est particulièrement utile pour les patients lors des transitions de soins, notamment dans les situations suivantes :

lors d'un rendez-vous dans une clinique de soins primaires (p. ex. un omnipraticien ou un spécialiste, une infirmière praticienne, un dentiste)

chez le pharmacien communautaire

de retour à la maison après un congé de l'hôpital

lors de soins à domicile

Le concept des " Cinq questions à poser sur vos médicaments " (ci-après, Cinq questions) offre aux organisations la possibilité d'ajouter leur logo et de démontrer leur soutien à l'initiative ( Figure 1). Cette approche permet également aux organisations de rester en contact pour échanger leur apprentissage alors que l'initiative se déploie au Canada et dans le monde. Plus de 200 organisations locales, provinciales, nationales et internationales ont adopté les Cinq questions, témoignant ainsi de leur volonté de travailler ensemble pour faire progresser la sécurité des médicaments et des patients.
FIGURE 1. Représentation des Cinq questions à poser à propos de vos médicaments

Les données probantes

Les pratiques médicamenteuses non sécuritaires et les erreurs de médication constituent la principale cause de préjudices évitables dans les systèmes de santé du monde entier. Des erreurs de médication surviennent lorsque de faibles systèmes de médication ou des facteurs humains, tels que la fatigue, de mauvaises conditions environnementales ou une pénurie de personnel, affectent les pratiques de prescription, de transcription, de délivrance, d'administration et de surveillance, ce qui peut entraîner des conséquences graves, des incapacités et même la mort (WHO 2017).

Les erreurs de médication à l'hôpital, lesquelles sont consignées et rapportées, sont utilisées pour démontrer l'ampleur du problème. Ce qui est inconnu, c'est l'ampleur des dommages causés lorsque les personnes ne prennent pas les médicaments tels que prescrits après leur sortie de l'hôpital. Cette transition complexe est considérée comme une période de risque et de préjudice possible.

Au Canada, les incidents nocifs associés aux médicaments figurent parmi les événements indésirables les plus fréquents. Les problèmes liés à la sécurité des médicaments peuvent avoir une incidence sur les résultats pour la santé, sur la durée des séjours dans un établissement de santé, sur les taux de réadmission ainsi que sur les coûts globaux pour les systèmes de santé au Canada (CPSI 2018).

Une étude canadienne sur les effets indésirables (Baker et coll. 2004) a révélé que les événements liés aux médicaments et aux solutés arrivent au deuxième rang des types d'incident indésirable les plus répandus dans les hôpitaux canadiens, à savoir 23,6 % du total. Le coût attribué aux événements indésirables médicamenteux a été estimé à 4 028$ par événement (Etchells et coll. 2012). En outre, plus de la moitié des Canadiens consomment régulièrement des médicaments sur ordonnance, et 36 % en prennent deux ou plus (Health Council of Canada 2014).

Une étude réalisée en 2008 a révélé que plus d'une visite sur neuf à un service d'urgence était due à un effet indésirable lié aux médicaments, dont 68 % auraient pu être prévenus (Zed et coll. 2008). Selon l'Association canadienne de protection médicale, près de 25 % des patients impliqués dans un événement indésirable médicamenteux sont décédés ou ont subi un autre type de préjudice grave (CPSI 2014). De plus,

on estime que 37 % des personnes âgées dans neuf provinces reçoivent des ordonnances pour des médicaments qui ne devraient pas être pris par cette population

deux Canadiens sur trois (66 %) âgés de plus de 65 ans prennent plus de cinq médicaments sur ordonnance et 27 % d'entre eux en prennent au moins 10

en 2016, au Canada, un aîné sur 143 a été hospitalisé en raison d'effets néfastes causés par les médicaments (CIHI 2018a)

L'Organisation mondiale de la santé (OMS) affirme que les pratiques médicamenteuses non sécuritaires et les erreurs de médication figurent parmi les principales causes de préjudices évitables dans les systèmes de santé du monde (WHO 2017). Une source indique que le coût estimé des erreurs de médication évitables s'élève à 125 millions de dollars canadiens (RiskAnalytica 2017). À l'échelle mondiale, le coût associé aux erreurs de médication est estimé à plus de 55 milliards de dollars (CPSI 2018).

La création des Cinq questions

L'ICSP, en partenariat avec ISMP Canada, a organisé un sommet national sur la sécurité des médicaments à Toronto (Ontario), en juin 2014, afin de créer la synergie et la coordination nécessaires pour accélérer les améliorations en matière d'utilisation sans risque des médicaments au Canada. Le plan d'action pour la sécurité des médicaments qui en a résulté a été inclus dans le Plan d'action intégré sur la sécurité des patients.

Au cours du sommet, les 37 participants se sont réunis pour un world café, qui est un modèle de réunion utilisé pour stimuler la pensée créatrice au sein de grands groupes. L'histoire d'un patient a suscité l'idée de créer une liste de questions sur les médicaments à laquelle les patients pourraient se référer lors des transitions de soins :

" Mon père était une personne bien organisée, indépendante et dynamique ", affirme Emily Musing, directrice générale, responsable de la pharmacie, des risques cliniques, de la qualité et de la sécurité à University Health Network. " Mais il s'est retrouvé dans une situation où il a dû prendre de nombreux médicaments, rencontrer plusieurs spécialistes et c'était déroutant pour lui. Il n'était pas sûr de ce que chaque spécialiste savait, comment poser ses questions et quelles phrases utiliser. " (University Health Network 2016)

Emily a écrit quelques questions de base pour aider son père à obtenir les informations dont il avait besoin pour une utilisation sécuritaire des médicaments. Emily s'est alors dit que tous les Canadiens devraient avoir une liste de questions qu'ils pourraient utiliser pour engager la conversation avec leur fournisseur de services de santé. C'est ainsi qu'est née l'idée des Cinq questions.

ISMP Canada a dirigé ce projet en créant un groupe de travail avec des patients membres de PPSPC et d'autres partenaires. En s'appuyant sur des outils déjà en place, sur les données probantes et sur les enseignements tirés d'incidents médicamenteux, le groupe a dressé une liste de questions que les patients pourraient poser. Une analyse de l'environnement et un examen des analyses d'erreurs médicamenteuses ayant causé des dommages lors de transitions constituent la base de cette initiative de responsabilisation des patients. Les Cinq questions découlent de pratiques de sécurité des médicaments fondées sur les données probantes, notamment le bilan comparatif des médicaments (ISMP Canada 2016). L'outil a été testé dans divers secteurs de soins et des modifications y ont été apportées à l'aide du cycle de Shewhart (cycle PDSA; planifier, développer, contrôler, ajuster [Plan-Do-Study-Act]) et à partir des commentaires provenant d'enquêtes en ligne. Un modèle logique a été créé pour guider la mise en œuvre des Cinq questions.

Les Cinq questions ont été testées dans divers secteurs (soins primaires, soins de courte durée, soins de longue durée, soins à domicile), auprès d'une variété de professionnels (infirmières, infirmières praticiennes, médecins, dentistes et pharmaciens) et avec des patients. Les réactions ont permis de procéder à des améliorations. Les commentaires de PPSPC ont également été intégrés à la version finale.

L'idée, pour les Cinq questions, n'était pas de formuler des questions parfaites qui seraient toutes utilisées à chaque consultation. Il s'agissait plutôt d'un effort collectif pour favoriser un discours cohérent sur les besoins de chaque patient et famille.

Dans un sondage national en ligne auprès de patients et de prestataires de services de santé (n = 291), 85 % des patients se disent à l'aise de poser les Cinq questions à leur prestataire de services de santé, 75 % déclarent que les réponses aux Cing questions constituent un outil très utile pour les aider à comprendre leur médication et 84 % des prestataires de services se disent disposés à répondre aux Cinq questions (Watt et coll. 2018). Une des intervenantes qui ont participé au lancement des Cinq questions a raconté comment elle a perdu sa fille Martha, âgée de 22 ans, à la suite d'une erreur de médication. Maryann Murray du PPSPC a déclaré dans le Kelowna Daily Courier qu'avec ces Cinq questions les patients seraient mieux protégés :

Non seulement les gens doivent se sentir responsabilisés à propos de leurs soins de santé, mais le personnel médical doit savoir qu'il est de sa responsabilité de transmettre l'information. On ne dit pas seulement aux gens qu'ils peuvent poser ces questions, on dit aux professionnels de la santé qu'ils doivent y répondre ... Au final, ces questions permettront d'éviter des préjudices et de sauver des vies. (Ubelacker 2016)

Pour améliorer la sécurité des médicaments, les patients doivent comprendre ce qu'ils prennent. Les Cinq questions constituent un outil efficace qui encadre la conversation entre patient et fournisseur en encourageant le partage d'informations. Des patients informés peuvent aider à prévenir ou à réduire les incidents liés aux médicaments.

Mise en œuvre des Cinq questions

La mise en œuvre des Cinq questions a pris de nombreuses formes. À ce jour, plus de 200 organisations de tous les secteurs des soins aux niveaux local, provincial, national et international ont officiellement adopté les Cinq questions. Grâce au soutien des partenaires, l'affiche a été traduite en 25 langues. Depuis le lancement de l'outil, en mars 2016, plus de 30 000 téléchargements ont été comptabilisés. Voir l'Annexe 1: ( disponible ici) pour prendre connaissance des témoignages de patients, de prestataires et de dirigeants.

En juin 2016, l'outil des Cinq questions a été introduit au niveau international lors d'un événement, tenu en marge de la 69 e Assemblée mondiale de la santé, qui portait sur le défi global de la sécurité des médicaments pour améliorer la sécurité des patients et la qualité des soins (CPSI 2016).

En consultation avec des patients et des fournisseurs de soins de santé, ISMP Canada a créé une vidéo pour promouvoir les Cinq questions et aider les patients à être autonomes dans le cadre de leurs soins de santé (ISMP Canada 2016). Cette vidéo a été visionnée plus de 6 000 fois.

Une campagne d'affichage numérique vise les patients dans quelque 200 salles d'attente très fréquentées en Ontario (75 %), en Alberta et en Colombie-Britannique (20 %) et au Québec (5 %). Chaque année, environ cinq millions de patients découvrent les Cinq questions à un point de service, dans la salle d'attente de leur clinique. Cette forme d'engagement accrocheuse est ainsi exposée plus de 32 millions de fois par année.

En mai 2018, l'Association des pharmaciens du Canada a organisé un webinaire sur les partenariats avec les patients sur la sécurité des médicaments. Les 116 participants y ont pris connaissance d'idées pratiques pour promouvoir la participation des patients dans leur pratique quotidienne. Les résultats d'un sondage rapide effectué pendant le webinaire indiquent que 68 % des participants avaient recours aux Cinq questions, alors que 32 % n'en avaient jamais entendu parler ou ne l'avaient jamais utilisé auparavant. Après le webinaire, les participants interrogés se sont montrés disposés à utiliser les Cinq questions dans leur pratique (moyenne : 4,77 fortement d'accord) (Canadian Pharmacists Association 2018).

La Semaine nationale de la sécurité des patients a servi à la promotion des Cinq questions en 2017 et en 2018, en élaborant une série de balados PATIENT, des jeux-questionnaires sur les Cinq questions et en organisant un concours de phrases accrocheuses pour aider les patients à se souvenir des questions. On a aussi pensé à des procédés mnémotechniques pour les mots clés Changements, Continuer, Usage correct, Surveiller et Suivi.

L'Institut pour la sécurité des patients du Manitoba a mis au point un module sur la sécurité des médicaments destiné aux élèves de 11 e année, lequel s'inscrit dans le cadre du programme provincial Pour un mode de vie actif et sain. Les Cinq questions sont abordées dans la leçon 1 sur l'alcool et les autres drogues (Manitoba Institute for Patient Safety s. d.).

Les erreurs de médication sont une source de préjudices évitables, en particulier pour les personnes âgées fragilisées. Le Réseau canadien des soins aux personnes fragilisées a mis sur pied le concours Frailty Matters Innovation Showcase pour mettre en lumière les nouvelles approches en matière de soins pour les personnes âgées fragilisées. Les Cinq questions y ont été reconnues comme l'une des 30 principales innovations présentées à la conférence de 2018 (Canadian Frailty Network 2018).

L'adoption des Cinq questions peut également être attribué aux efforts locaux, tels que ceux des défenseurs de la sécurité des patients, Meredith et Barton Ottoson, de Davidson, en Saskatchewan. Ils se sont donné pour mission de diffuser largement les affiches. Aujourd'hui, si vous passez par Davidson, vous trouverez les affiches non seulement dans les hôpitaux, les centres de santé, les pharmacies et les cabinets de médecin, mais également dans les vitrines de la quincaillerie, des stations-service, des restaurants et d'autres commerces de la région.

Meredith explique ce que signifie pour elle les Cinq questions :

Les Cinq questions permettent aux patients d'agir. Elles confirment que la santé est importante à tout âge. Il est important de comprendre les traitements et les médicaments proposés pour nous aider à prendre de meilleures décisions en matière de soins de santé. Les patients en tant que partenaires et les pouvoirs partagés constituent une courbe d'apprentissage pour nous tous. Nous pouvons y arriver! (communication personnelle avec Meredith Ottoson)

Utilisation des Cinq questions pour réduire l'usage des opioïdes

Un des objectifs du Plan d'action sur l'utilisation sécuritaire des médicaments portait sur l'utilisation sécuritaire des opioïdes. La prescription d'opioïdes pour soulager la douleur a considérablement augmenté, avec des conséquences graves et inattendues. Les patients opérés sont quatre fois plus susceptibles de recevoir des opioïdes à la sortie de l'hôpital que ceux qui n'ont pas subi de chirurgie.

Une revue systématique de la littérature sur l'utilisation d'opioïdes après le congé chez les patients postopératoires a révélé que ces patients utilisent beaucoup moins d'opioïdes pendant la période postopératoire que ce qui leur est prescrit. Par manque de conscientisation concernant l'élimination appropriée des médicaments non utilisés, il y a dans certains domiciles des restes d'opioïdes qui peuvent être utilisés de manière inappropriée par le patient ou d'autres personnes. L'étude préconise l'éducation des fournisseurs et des directives cliniques qui donnent des conseils sur la prescription d'opioïdes en consultation externe (Feinberg et coll. 2018).

Une étude récente sur des patients postopératoires (Brat et coll. 2018) a montré que chaque semaine supplémentaire de renouvellement de prescription d'opioïdes est associée à une augmentation significative du mauvais usage d'opioïdes chez les patients n'ayant jamais eu recours aux opioïdes. L'étude a également révélé ce qui suit :

Jusqu'à 10 % des patients n'ayant jamais eu recours aux opioïdes et qui ont reçu une ordonnance d'opioïde postopératoire ont encore besoin, un an après la chirurgie, d'un opioïde pour contrôler la douleur.

L'utilisation prolongée d'opioïdes après une opération est associée à une morbidité accrue et à une baisse de la qualité de vie.

Au cours des 10 dernières années, le taux d'hospitalisation pour intoxication liée aux opioïdes a augmenté de 53 %. Le groupe d'âge le plus touché est celui des 15 à 24 ans (CIHI 2018b). Selon le Centre de toxicomanie et de santé mentale (s. d.), un adolescent ontarien sur 10 a essayé un opioïde à des fins récréatives; dans 60 % des cas, l'opioïde venait du domicile.

Le feuillet sur la sécurité des opioïdes (version modifiée des Cinq questions) présenté à l'Annexe 2 ( disponible ici) a été élaboré conjointement avec des patients pour faire face à la crise des opioïdes. Il fournit les réponses aux Cinq questions pour les patients qui prennent des opioïdes après une chirurgie. Cette ressource a été développée en collaboration avec plusieurs organisations de santé (voir les Remerciements), conformément aux directives les plus récentes et à la pratique recommandée. Depuis son lancement lors de la campagne Prescrire des opioïdes avec soin, en mars 2018, le feuillet a été téléchargé plus de 4 500 fois.

Une étude menée à l'hôpital général de North York sous la direction du Dr Sanjho Srikandarajah a démontré que le document avait un impact sur l'éducation des patients et sur les pratiques en matière de prescription.

L'objectif principal de l'étude était de déterminer l'effet des ordonnances normalisées et de l'éducation des patients sur la quantité d'opioïdes prescrits et utilisés par les patients à leur congé après une appendicectomie ou une cholécystectomie laparoscopique.

L'étude de l'hôpital général de North York a été menée entre avril et juin 2017. Au cours de cette période, 2 672 comprimés d'opioïdes ont été prescrits à 127 patients. Ces patients ont déclaré ne prendre que 458 des pilules prescrites, soit 17 %, laissant ainsi 2 314 comprimés non utilisés, ou 83 %, en trois mois (Feinberg et coll. 2019).

Ces données ont été prises en compte dans la création d'une ordonnance électronique normalisée fondée sur les données probantes (diminuant le nombre de pilules prescrites, avec une limite par défaut de 20 comprimés) et dans la production d'une brochure d'information à l'intention des patients (une version modifiée intitulée " Les opioïdes pour la douleur après une chirurgie d'un jour : réponses à vos questions "). Avec les nouvelles interventions en place, des patients ont ensuite été recrutés pour évaluer l'efficacité de la nouvelle initiative de prescription et d'éducation au moyen du même sondage que dans l'étude précédente. Cette enquête a été menée entre novembre 2017 et janvier 2018. Au cours de cette période, 1 490 comprimés d'opioïdes en moins ont été prescrits (une diminution de 56 %). En projetant ces résultats sur une année, il y aurait 11 000 comprimés d'opioïdes en moins prescrits dans un seul établissement et plusieurs milliers de comprimés d'opioïdes non utilisés ne seraient plus disponibles pour une consommation potentiellement inappropriée. Après l'introduction du feuillet d'information destiné aux patients et après l'intervention visant à normaliser les quantités prescrites d'opioïdes, le pourcentage de patients ayant reçu des informations sur les opioïdes a été multiplié par cinq, passant de 8,5 à 44 %, et le nombre moyen de pilules consommées a diminué de 45 %, soit de 3,6 à 2, sans changement significatif des scores de douleur rapportés par les patients.

Les résultats de cette étude (Feinberg et coll. 2019) ont été présentés par le Dr Srikandarajah à plusieurs conférences internationales et nationales, notamment au Forum international de Glasgow (Écosse) en 2019. L'étude a reçu le prix Résumé de distinction 2018 remis lors de la conférence " Transformation qualité de la santé " en Ontario, le prix de recherche Richard-Knill et le prix du meilleur article sur la douleur chronique remis lors de la conférence annuelle de la Société canadienne des anesthésiologistes, en 2019.

Prochaines étapes : accroître la diffusion grâce aux partenariats

Pour porter cette approche éducative au niveau suivant, il faudra intégrer les Cinq questions dans les échanges quotidiens entre patients et prestataires de services de santé. L'objectif est de collaborer avec des partenaires déterminés à faire progresser la question de la sécurité des médicaments. Voici ce que nous envisageons :

Intégrer les résultats d'un projet de 18 mois sur l'amélioration de la sécurité coordonné par l'ICSP et lancé au printemps 2019. Les équipes se concentrent sur l'utilisation sécuritaire des médicaments et sur le bilan comparatif des médicaments au congé de l'hôpital. Les leçons apprises étayeront les prochains efforts d'application des connaissances, notamment l'intégration des Cinq questions aux révisions de la médication, aux déprescriptions et aux activités de participation des patients.

Continuer à travailler avec les partenaires pour intégrer plus explicitement les Cinq questions aux déprescriptions, aux processus de bilan comparatif des médicaments, aux portails et autres technologies pour les patients ainsi qu'à d'autres initiatives relatives à la sécurité des médicaments.

Collaborer avec des organisations du Canada afin de mettre à profit les Cinq questions pour développer des ressources spécialisées destinées aux patients. Par exemple, un feuillet à l'intention des patients afin de promouvoir la sécurité des opioïdes pour les douleurs à court terme et pour gérer la douleur après le retrait des dents de sagesse.

Évaluer les Cinq questions grâce à des recherches effectuées par différentes équipes. Il s'agit là d'un mécanisme essentiel pour accéder aux prochaines étapes, notamment la diffusion et la durabilité de l'initiative des Cinq questions.

Développer de nouvelles technologies pour aider les patients à accéder facilement aux informations sur les médicaments. Des applications telles que " My MedRec " aident les patients à garder une trace de leurs médicaments et les incitent à poser des questions et à prendre des notes.

Plus généralement, l'ICSP et ISMP Canada soutiennent l'OMS dans sa campagne mondiale de réduction des erreurs de médication. L'objectif du défi mondial " Les médicaments sans les méfaits " est de réduire, en cinq ans, 50 % des cas de préjudices graves et évitables liés aux médicaments.

En tant que collaborateur de l'OMS pour la sécurité et l'engagement des patients, l'ICSP coordonne la campagne " Les médicaments sans les méfaits " au Canada. La formule " Informez-vous. Vérifiez. Demandez. " vise à encourager les patients et les prestataires de services de santé à jouer un rôle actif dans l'usage des médicaments. La campagne aspire également à la solidarité mondiale et à l'action de la communauté internationale pour réduire les préjudices évitables liés aux médicaments (WHO 2017).

Au cours des cinq prochaines années, l'ICSP, en collaboration avec les patients et les partenaires, élaborera un plan de mise en œuvre, suivra et évaluera les progrès accomplis et travaillera en étroite collaboration avec l'OMS pour assurer la durabilité à long terme des stratégies mises en œuvre au cours de la campagne " Les médicaments sans les méfaits ".

Conclusion

Les organisations de santé qui adoptent les Cinq questions font preuve d'une saine culture de sécurité et d'une ouverture à la participation des patients. Les patients et leurs familles affirment que les Cinq questions leur permettent d'engager une conversation au sujet des médicaments avec leurs fournisseurs de services de santé. Savoir être à l'écoute des patients et leur permettre de s'exprimer feront en sorte qu'ils disposent des connaissances nécessaires pour utiliser les médicaments en toute sécurité. La présence des Cinq questions dans tous les secteurs du système de santé permet de souligner l'importance et la complexité de l'utilisation sécuritaire des médicaments ainsi que le rôle central des patients et de leurs familles dans ce processus.

Remerciements

Les Cinq questions sont le fruit d'une collaboration entre l'ICSP, ISMP Canada, le programme PPSPC, l'Association des pharmaciens du Canada et la Société canadienne des pharmaciens d'hôpitaux. Y ont également contribué l'Hôpital général de North York, l'ICIS, le National Pain Centre (Université McMaster), le Centre canadien de lutte contre l'alcoolisme et les toxicomanies, Inforoute Santé du Canada, des conseils provinciaux sur la qualité des services de santé, des ministères provinciaux de la Santé, des autorité régionales de la santé, des ordres professionnels, des commissaires provinciaux à la protection de la vie privée, Santé Canada, Gestion de l'information sur la santé, l'Association médicale canadienne (AMC), l'Association des infirmières et infirmiers du Canada (AIIC), l'Association canadienne des individus retraités, des équipes Santé familiale, des centres de santé pédiatriques, des pharmacies, l'informatique de la santé, la Société canadienne des anesthésiologistes, la Fondation canadienne pour l'amélioration des services de santé, Agrément Canada, l'Association canadienne de protection médicale, University Health Network, le Collège des médecins de famille du Canada, l'Agence canadienne des médicaments et des technologies de la santé (ACMTS), la Société de protection des infirmières et infirmiers du Canada, l'Association des infirmières et infirmiers autorisés de l'Ontario, l'Association des équipes Santé familiale de l'Ontario, l'Association des centres d'accès aux soins communautaires de l'Ontario et l'ICES. Le développement de la ressource " Les opioïdes pour la douleur après la chirurgie : réponses à vos questions " est une collaboration entre le PPSPC, l'ICSP, l'Hôpital général de North York, la Société canadienne des pharmaciens d'hôpitaux, le Réseau canadien pour la déprescription, Choisir avec soin, l'ACMTS, l'AIIC, l'AMC, l'Association canadienne des chirurgiens généraux, l'Association canadienne d'orthopédie et ISMP Canada.

Alice Watt, RPh BScPhm, is a medication safety specialist with ISMP Canada. Alice has 20 years of experience in community and acute care settings and is passionate about engaging patients and healthcare practitioners in safe medication practices.

Maryann Murray, patient champion, is a member of Patients for Patient Safety Canada. Maryann is an advocate for plain language and legible print on medication labels and a champion for patient safety in healthcare, both at home and abroad.

Donna Herold, patient champion, is a member of Patients for Patient Safety Canada and was one of the action team members who co-authored Engaging Patients in Patient Safety: A Canadian Guide.

Sylvia Hyland, RPh, BScPhm, ACPR, MHSc (Bioethics), is vice-president, operations and privacy officer of ISMP Canada. In her work for ISMP Canada, she has assisted with analyses of adverse medication events and has participated in focused reviews of medication use systems in healthcare.

Carolyn Hoffman, RN, BSN, MN, is president and CEO of ISMP Canada. Carolyn has senior leadership experience in hospital operations, provincial government, nursing regulation and quality improvement in healthcare, all with a focus on patient safety.

Mike Cass, RN, is the senior program manager at the Canadian Patient Safety Institute. Mike is currently leading a medication safety improvement collaborative focused on acute care organizations that care for frail elderly.

Correspondence may be directed to: Alice Watt, RPh, Medication Safety Specialist, ISMP Canada; phone: 416-733-3131 ext. 250; e-mail: alice.watt@ismpcanada.ca.

The 5 Questions were developed collaboratively by CPSI, ISMP Canada, PFPSC, the Canadian Pharmacists Association and the Canadian Society of Hospital Pharmacists. Input was also received from NYGH; CIHI; the National Pain Centre (McMaster University); the Canadian Centre on Substance Abuse; Canada Health Infoway; provincial health quality councils or equivalents and ministries of health; regional health authorities; regulatory colleges; provincial information privacy officers; Health Canada; Health Information Management; the Canadian Medical Association (CMA); the Canadian Nurses Association (CNA); the Canadian Association of Retired Persons (CARP); Family Health Teams; Canadian Home Care Association; paediatric health centres; neighbourhood pharmacy; health informatics; chain drug stores; the Canadian Anesthesiologists' Society; the Canadian Foundation for Healthcare Improvement; Accreditation Canada; the Canadian Medical Protective Association; University Health Network; the College of Family Physicians Canada; the Canadian Agency for Drugs and Technologies in Health (CADTH); the Canadian Nurses Protective Society; the Registered Nurses' Association of Ontario; the Association of Family Health Teams of Ontario; the Ontario Association of Community Care Access Centres; and ICES. The "Opioids for pain after surgery: Your questions answered" resource was developed collaboratively by PFPSC, CPSI, NYGH, the Canadian Society of Hospital Pharmacists, the Canadian Deprescribing Network, Choose Wisely Canada, CADTH, CNA, CMA, the Canadian Association of General Surgeons, the Canadian Orthopaedic Association and ISMP Canada.

Baker, G.R., P.G. Norton, V. Flintoft, R. Blais, A. Brown, J. Cox et al. 2004. The Canadian Adverse Events Study: The Incidence of Adverse Events Among Hospital Patients in Canada. CMAJ 170(11): 1678-86. doi:10.1503/cmaj.1040498.

Brat, B., D. Agniel, A. Beam, B. Yorkgitis, M. Bicket, M. Homer et al. 2018. Postsurgical Prescriptions for Opioid Naive Patients and Association with Overdose and Misuse: Retrospective Cohort Study. BMJ 360: j5790. doi:10.1136/bmj.j5790.

Canadian Pharmacists Association. 2018, May. CPhA Webinars. Ottawa, ON: Author. Retrieved July 9, 2019.

Feinberg, A., T. Chesney, S. Srikandarajah, S. Acuna and R. McLeod. 2018. Opioid Use After Discharge in Postoperative Patients: A Systematic Review. Annals of Surgery 267(6): 1056-62. doi:10.1097/SLA.0000000000002591.

Feinberg, A., A. Mocon, D. Smith, B. Yau, B. Kashin, S. Acuna et al. 2019. Opioid Crisis! A Standardized, Evidenced-Based Approach to Discharge Opioids after Surgery. Poster presented at the International Forum Quality & Safety in Healthcare, March 27-29, 2019, Glasgow, Scotland. Retrieved July 9, 2019. < https://www.ismp-canada.org/download/posters/opioidcrisis.jpg>.

Watt, A., M. Cass, L. Hughes, and D. Herold. 2018. 5 Questions to Ask about Your Medications - A Shared Aim to Empower Patients. Poster presented at the International Forum Quality & Safety in Healthcare, May 2-4, 2018, Amsterdam, Netherlands.

Zed, P.J., R.B. Abu-Laban, R.M. Balen, P.S. Loewen, C.M. Hohl, J.R. Brubacher et al. 2008. Incidence, Severity and Preventability of Medication-Related Visits to the Emergency Department: A Prospective Study. CMAJ 178(12): 1563-69. doi:10.1503/cmaj.071594.

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Empowering Patients: 5 Questions to Ask About Your Medications

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Version française Medication errors continue to cause harm, especially at transitions of care (National Transitions of Care Coalition 2010). Improving medication safety at transitions also addresses a Health Standards Organization requirement.

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5 Questions to Ask About Your Medications - Endorsement Map - Google My Maps

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This map represents leading organizations who have endorsed the 5 questions to ask about your medications. Request your customized PDF of the "5 questions to ask" with your organization's logo today! For more information check out: https://www.ismp-canada.org/medrec/5questions.htm#l=tab2

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Opioid medications are used to treat pain. Opioids are also known as narcotics. In recent years more and more Canadians are using opioids, and research indicates that we are now the world's second largest consumer of opioids. Along with this increased use of opioids there has also been a corresponding and alarming increase in the harm from opioids.

Through our ongoing analysis of medication safety incidents, we have found that opioids are frequently associated with harmful consequences-including death-when they are prescribed, used or administered incorrectly or in error.

Opioid Stewardship may be described as coordinated interventions designed to improve, monitor, and evaluate the use of opioids in order to support and protect human health. This web page has been developed to help the public and health care practitioners become better informed about opioids and to help reduce and prevent harm.

Opioid Prescribing Supports:

Opioid Prescribing Tools:

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Opioid Stewardship may be described as coordinated interventions designed to improve, monitor, and evaluate the use of opioids in order to support and protect human health. This web page has been developed to help the public and health care practitioners become better informed about opioids and to help reduce and prevent harm.

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Consensus Statement for Prescription of Pain Medication at discharge includes patient handout on opioids for pain after surgery as best practice

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Consensus Statement for Prescription of Pain Medication at discharge includes patient handout on opioids for pain after surgery as best practice

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Shared Care Polypharmacy Risk Reduction in Acute Care

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Shared Care Polypharmacy Risk Reduction in Acute Care

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initiative using 5 questions to ask

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CSHP Excellence Pharmacy Practice Inter-professional collaboration award 2020 with North York General hospital

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CSHP Excellence Pharmacy Practice Inter-professional collaboration award 2020 with North York General hospital

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https://www.cshp.ca/excellence-pharmacy-practice-interprofessional-collaboration

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Opioids for short-term pain: Your questions answered

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Opioids for short-term pain: Your questions answered

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Created for use in ED depts/primary care
Sent to 18,000 Canadian family doctors thru CFPC

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Managing pain after wisdom teeth removal

http://www.cda-adc.ca/en/services/essentials/2019/issue6/17/?fbclid=IwAR0bqrfKHVSvdbNdFpw6-5gzf46GmusSuVL_fKHpUBROHKgi0p-pni55XOc

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ISMP Canada booth with our students and former students