A risk assessment program for medication systems in long-term care

MEDICATION ERRORS EXIST IN LONG-TERM CARE FACILITIES.1 THIS IS not surprising considering the number of medications administered daily to residents.2 Two Canadian reports described a number of concerns related to lack of medication incident reporting and medication management issues in long-term care.3,4 A new risk assessment program, developed by ISMP Canada, assists in identifying medication system vulnerabilities and potential safeguards that on implementation would reduce the potential for errors and problems identified in the above reports. The success of the Medication Safety Self-Assessment for Hospitals led to its use as a template in creating such a program for long-term care. This new program, the Medication Safety Self- Assessment for Long Term Care (MSSA for LTC), is now being rolled out to nursing homes in Ontario, Alberta, and British Columbia. Pharmacists who provide services for nursing homes and continuing care facilities will be invited to participate as members of the multidisciplinary team that completes the MSSA program. The format of the MSSA for LTC is similar to that of the MSSA programs for hospitals, complex continuing care, and community pharmacy. The self-assessment is divided into 10 sections, 1 for each of the key elements of safe medication use. Each of these sections is defined by 1 or more core distinguishing characteristics, which in turn are described by a total of 129 representative self-assessment items. Some of the items refer to innovative practices and system enhancements that are not widely implemented in most nursing homes today. However, their value in reducing errors is grounded in research and expert analysis of medication errors and their causes, and these practices provide direction for future safety enhancements. The nursing homes that participated in the pilot project reported that the MSSA for LTC was a useful quality and risk assessment program that accurately reflected the medication systems used in LTC facilities. The pilot project demonstrated that the program can be used by facilities of various sizes, organizational structures, and geographic locations. The logistics of completing the self-assessment and submitting the results were considered both reasonable and feasible. The program assists and guides individual faculties in identifying opportunities for improvement in medication-use systems and complements other efforts to decrease the risk of harm to residents. By selecting one of the core characte