At least once per year, the pharmacy manager must conduct one formal CQI meeting with most pharmacy staff in attendance. You may need to conduct additional meetings if an incident results in harm to a patient or after completion of your pharmacy’s SSA. A CQI meeting should give pharmacy staff a supportive environment to fully discuss incidents, contributing factors and develop recommendations. In regard to the SSA, your CQI meeting is an opportunity for staff to understand how the SSA was conducted and for staff to participate in developing improvement plans.

Try to schedule a meeting time when the majority of staff present. Preferably, give every staff member the opportunity to attend the CQI meeting, if possible. Each meeting should have a set agenda shared in advance, so staff are better prepared and ready to actively participate. The agenda items may be determined by the amount of time you have or if your SSA has been completed recently.

A simple agenda and/or meeting form can help give structure to your meetings and may be useful for documenting discussions. Please see the CPhM CQI Meeting Toolkit for a sample agenda.

Safety IQ aims to improve community pharmacy systems to reduce the chances that patients will be harmed by a medication incident. One of the cornerstones of prevention and improvement is open discussion and team participation, but the fear of punishment or humiliation remains a prominent barrier to CQI across healthcare professions. Fostering a psychologically safe environment will encourage your pharmacy team to participate more fully in CQI and make meaningful contributions to the pharmacy’s CQI program.

In a psychologically safe environment, team members will be more likely to contribute to CQI when

• Anyone can ask questions without looking or feeling incompetent
• Anyone can ask for feedback or help without looking or feeling incompetent
• Anyone can be respectfully critical without appearing negative
• Anyone can suggest innovative ideas without being perceived as disruptive
  
  

Pharmacy team leaders and managers have a critical role to play in supporting psychological safety. The Community Pharmacy Safety Culture Toolkit offers several resources and strategies for modelling and promoting psychological safety to build a more robust safety culture.

1. Review recent medication incidents and near-miss events to decide which ones should be discussed during your CQI meeting. Limit the number incidents for discussion (1-3 incidents) because you want to have sufficient time to effectively discuss contributing factors and develop ideas for improvement. Prioritize incidents that have caused harm or had the potential to cause harm. If your pharmacy does not have any medication incidents to discuss, then consider near- miss events that may have resulted in harm or are being repeated.
   
   
2. Review the results of your SSA and decide which areas you think your pharmacy team should focus on to close safety gaps. Set your team up for success by focusing on one area and starting with a small improvement. Do not overwhelm yourself or your team with multiple, complex improvements at once. CQI, as the name implies, is an ongoing process that will get stronger over time with the commitment and perseverance of your team.
   
   
3. Review your pharmacy’s incident statistics. Reporting to an online platform provides you with valuable information at your fingertips. How is your pharmacy reporting each month? Is your pharmacy staff reporting all incidents and beneficial near misses? What trends do you see – are certain medications more prevalent in incidents or do they include high risk meds such as methadone or warfarin? Your review of pharmacy trends is also an opportunity to assess how engaged your team is with Safety IQ and if further training or encouragement is needed.
   
   
4. Review external sources for shared learning on medication safety and how your pharmacy may incorporate this learning. Examples of shared learning are available on the College of Pharmacists of Manitoba Safety IQ and Shared Learning Can your pharmacy incorporate some of the shared learning recommendations? Consider ISMP Canada Safety Bulletins as tools to educate your staff on medication safety issues and prompt safety improvements in your pharmacy.

The Medication Incidents and Near Miss Events Practice Direction requires that CQI meetings be documented. Your CQI meeting documentation should include:

• Date of meeting
• Who attended
• What was discussed (incidents, SSA items, pharmacy incident statistics, safety education)
• Outcomes or action plans resulting from the meeting
  
  

Some reporting platforms may have CQI meetings tools available to document CQI meetings online. If your reporting platform does not offer a space to document your CQI meeting, you may want to use the CPhM CQI Meeting Toolkit or another format.

The pharmacy manager must also log into the Pharmacy Portal at cphm.ca to declare the date the pharmacy's CQI meeting was completed.

Please see the CQI Meeting Toolkit for supporting materials for your CQI meeting.

Reporting of medication incidents and near-miss events as well as documentation of improvement plans are mandatory elements of Safety IQ. Pharmacy managers and staff need to periodically reflect and assess how well they are using Safety IQ tools and processes to ensure they have an effective CQI program. What areas is the pharmacy team doing well and where are they struggling? CQI is an ongoing process, but engagement may lessen over time and open discussion is needed to address barriers and develop action plans to renew commitment and increase impact.

Yes, every community pharmacy must complete an document at least one formal CQI meeting per year. 

Safety huddles are short informal meetings (10 to 15 minutes) where your pharmacy team can quickly share information about safety issues or concerns in a non-punitive manner. Safety huddles can be as frequent as your pharmacy needs them to be. A safety huddle should promptly occur following a medication incident, especially if the incident harmed a patient.

Safety huddles support prompt communication of incidents and discussion of changes to prevent recurrence. However, they are not a substitute for an annual CQI meeting whereby the pharmacy team can discuss multiple topics such as  incidents and near-miss trends, enablers and barriers to reporting or open discussion, SSA results, or medication safety education.

Yes, an annual CQI meeting is a requirement of Safety IQ. You can use your meeting time to complete meaningful reflection about improving your practice. Some suggestions include:

• Review and reflect on medication incident and near-miss events you have reported to your incident reporting platform. Implementing and monitoring changes based on a single report can make your processes safer. See the Analyze and Act page for resources.
• Review progress on existing improvement plans based on medication incidents and near-miss events or your SSA. This time is also an opportunity to create new action plans.
• Review CPhM and ISMP Canada improvement resources to look for new opportunities to improve your pharmacy practice. The Safety IQ Academy Blog features short, actionable articles on safety improvement. ISMP Canada Safety Bulletins and SMART Medication Safety Agendas also offer actionable safety improvements that help reduce the chances of patient harm.
• Engage in professional development activities that will build your knowledge and help you apply principles of continuous quality improvement.
• Conduct a CQI meeting with your colleagues providing that you do not violate patient or staff confidentiality.
  
  

As a small or one-person team, it is even more important for you to engage in self-reflection because you do not have the benefit of team input when it comes to detecting and analyzing medication incidents.

You must also follow the documentation requirements for CQI meetings.