Medication safety is defined as “freedom from preventable harm with medication use”; it can affect health outcomes, length of stay in a health care facility, readmission rates, and overall costs to Canada’s health care system. Globally, unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems. Medication errors happen for many reasons, including fatigue; poor environmental conditions; staff shortages; and mistakes in prescribing, transcribing, dispensing, administration, and monitoring practices. Medication errors can result in severe harm, disability, and even death. Half (50%) of reported critical medication incidents occur during administration, and 19.4% occur during prescribing.
The populations at greatest risk of harm related to medication safety incidents include:
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Children and young people
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Older people (including the frail older people and those near the end of life)
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People taking multiple medications (polypharmacy)
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People who are pregnant or breastfeeding
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People with mental health conditions
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People with mild cognitive impairment or dementia
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People with a first language other than English
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People with disabilities that make communication difficult (e.g., vision or hearing impairment)
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People with learning disabilities
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People with low literacy or health literacy
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People who have religious restrictions
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People who are of low socioeconomic status or do not have a drug plan, making access to medication difficult
To protect patients from medication-related harm, the World Health Organization has identified three key action areas, each of which poses substantial risk to patient health and safety:
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High-risk situations or medications that have a higher risk of serious patient harm when errors occur
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Transitions in care, including the movement of people between home, hospital, and residential care settings, and consultations with health care providers (for detailed quality statements related to medication practices at transitions in care, please refer to Ontario Health’s Transitions Between Hospital and Home quality standard)
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Polypharmacy, often defined as the routine use of five or more medications, including over-the-counter, prescription, and traditional and complementary medicines
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In 2017 in Ontario, 53.5% of people aged 75 years and older were taking five or more medications concurrently (the Canadian average for people aged 75 years and older was 47.7%)
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According to the Canadian Institute for Health Information, 61% of residents of Ontario long-term care homes in 2012 were taking 10 or more different prescription medications concurrently
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A study of Ontario home care clients in 2008 and 2009 found the overall incidence of adverse events was 13%. Medication-related adverse events were among the most common, and polypharmacy was associated with an increased risk of adverse events
Medications are the most common therapeutic intervention; ensuring safe medication use and improving patient safety are priorities across the health care system. For example, medication administration is one of five areas of focus related to patient safety in “Acute-Care Hospital Patient Safety and Drug Administration,” part of the Auditor General of Ontario’s 2019 value-for-money audit. The Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System, led by Justice Eileen E. Gillese, identified medication management as a key area for improvement to enhance the safety and security of residents living in long-term care homes, as well as those accessing home care services. Safety in home care has become a focus at the provincial and national levels, and safety reviews have identified medications as a major cause of adverse events for people at home, many of which were considered preventable. The Protecting Canadians from Unsafe Drugs Act, also known as Vanessa’s Law, requires hospitals to report all serious adverse drug reactions and medical-device incidents to Health Canada to strengthen Health Canada’s ability to take quick and appropriate action when serious risks are identified. Medication safety is also a key area of focus for regulatory colleges, accreditation organizations, and professional bodies, who provide best practice recommendations, accreditation standards, guidelines, and regulatory requirements to improve safe medication use.
This quality standard includes five quality statements that address areas identified by the Medication Safety Quality Standard Advisory Committee as having high potential to improve medication safety in Ontario, for people of all ages in all settings.