Safety Culture for Safer Compounding

A pharmacy technician prepares medications in a community pharmacy dispensary.

As discussed in a previous post, compounding is a high-risk and complex process.  All pharmacies must have the ability to compound, but the scope of compounding services varies from pharmacy to pharmacy. An ISMP Canada analysis identified several compounding incidents in Manitoba that caused patient harm. This makes safety in compounding a top concern for all community pharmacies.

Safety culture plays a key role in safer community pharmacy compounding. Safety culture originates from complex, high-risk industries like aviation and nuclear power. Safety expert James Reason says that members of a safety culture show the following characteristics:

  • They are preoccupied with safety and have current knowledge about the factors that determine the safety of the system;
  • They report incidents and near misses without fear of blame;
  • They learn from incidents and near misses to make improvements;
  • They can trust that their organization will deal with them fairly when something goes wrong; and
  • They adapt to changing pressures and demands.


Build an organization-wide commitment to safety culture using the following principles:

  • Acknowledge the high-risk nature of compounding and potential harms
  • Focus on safe practices over other performance expectations
  • Promote a culture of continuous quality improvement in all compounding practices
  • Collaborate with all team members and stakeholders including prescribers and patients
  • Invest in proper infrastructure and training


High-risk processes like compounding need continuous scrutiny to identify areas for improvement and people need to feel safe bringing their concerns and suggestions forward. A robust safety culture should encourage open discussion and promote a preoccupation with safety.

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