Assessment of Risk in Medication-Use Systems: Learning from the Medication Safety Self-Assessment

Abstract

INTRODUCTION

Interest in tools for enhancing patient safety has grown with the patient safety movement. The Medication Safety Self-Assessment (MSSA), a comprehensive assessment program originally developed by the Institute for Safe Medication Practices (ISMP) in the United States, is one such tool. The MSSA was adapted for use in Canada in 2001 and has been used by individual hospitals, regional health authorities, and provincial governments to identify and prioritize areas for improvement in medication-use systems.1 The Canadian MSSA program is administered by ISMP Canada, independent of ISMP (US), and includes additional features not available with the US version. The MSSA assists interdisciplinary hospital teams to evaluate the safety of medication practices in their institutions and to heighten awareness of the characteristics of a safe medication system. The MSSA consists of a series of safe medication practice characteristics, which are grouped into 10 key elements of medication-use systems (Table 1). Each key element is defined by one or more core distinguishing characteristics. Several self-assessment items describing safe medication practices are then used to determine the level of success for each of the key elements. Some of the items purposely represent innovative practices and system enhancements that are not widely implemented in Canadian hospitals but that are grounded in scientific research and expert analysis of medication errors and their causes. When completing the self-assessment, respondents must select 1 of 5 responses, ranging from no activity or discussion about a particular item to full implementation throughout the organization. Although ISMP Canada is not itself a standardssetting organization, several items are under consideration for inclusion in the new standards of the Canadian Council on Health Services Accreditation. The principal values of the MSSA are the ability of individual hospitals to identify opportunities for improvement and to track their improvement efforts over time. These values are enabled through a unique feature of the Canadian MSSA, whereby a Web-based program allows participants to immediately compare their current results to the aggregate national, provincial, and regional results, as well as to their own previous results in real time, as soon as responses have been electronically submitted. This functionality is not available for the US version. At the time of writing, in late 2006, a total of 273 Canadian hospitals had completed at least one self-assessment. This article describes one hospital’s experience with the MSSA program.