Publications

The ISMP Canada Safety Bulletins are designed to disseminate timely, targeted information to reduce the risk of medication incidents. View ISMP Canada Safety Bulletins.

• HYDROmorphone Knowledge Assessment Survey Results Report
• Multiple IV Infusions Project: Mitigating Risks Associated with Multiple IV Infusions
• Error management - Checking it twice: an evaluation of checklists for detecting medication errors at the bedside using a chemotherapy model
• Optimizing Communication about Medications at Transitions of Care in Ontario
• Joint CAPCA and ISMP Canada Project - Application of TALLman Lettering for Drugs Used in Oncology
• Checking it twice: an evaluation of checklists for detecting medication errors at the bedside using a chemotherapy model
• Identification of Medication Safety Indicators for Public Reporting
• Pharmaceutical Bar Coding to Improve Patient Safety: Options for Technical Standards in the Canadian Environment
  (Proceedings of a Stakeholder Invitational Roundtable, June 2008)
• Pharmaceutical Bar Coding to Improve Patient Safety - Options for Technical Standards in the Canadian Environment
  (Roundtable Discussion Paper, January 2008)
• Striking a Balance: Facilitating Access to Patient Safety Data While Protecting Privacy Through Creation of a National Harmonized Standard
• Canadian Root Cause Analysis Framework - A tool for identifying and addressing the root causes of critical incidents in healthcare
• ISMP Canada Independent Double Check Usability Test Report
• ISMP Canada Position Paper — Guidelines for Sharing Medication Incident Data in the Era of Ontario's PHIPA and QCIPA
• Drug Safety in Canada — Letter to CMAJ re Bupivacaine
• Is Consent Required For Publication of Medical Errors?
• Medication Errors and Risk Management in Hospitals
• Ontario Pharmacists Can Help Provide a Safer Medication Use System
• Medication Error Reporting Systems: Problems and Solutions

The following articles appeared in CACCN Dynamics, a journal published by the Canadian Association of Critical Care Nurses.

• Drug name alert: Potential for confusion between Pradax and Plavix - Fall 2011
• ALERT: Mix-ups between conventional and lipid formulations of amphotericin B can be extremely dangerous - Spring 2011
• Hospitals report on medication safety in Canada - Fall 2010
• Hospital-acquired acute hyponatremia and reports of pediatric deaths - Spring 2010
• National Collaborative: Top five drugs reported as causing harm through medication error in pediatrics - Winter 2009
• Pharmaceutical bar coding: Moving forward in Canada - Fall 2009
• ALERT: Revatio is another brand name for Sildenafil - Summer 2009
• A near miss involving cyclophosphamide - Spring 2009
• Prefilled syringes of epinephrine and compatibility with intravenous tubing: Learning from an incident - Winter 2008
• Desmopressin (dDAVP) incident signals the need for enhanced monitoring protocols - Fall 2008
• Preventing substitution errors involving high-concentration heparin products - Spring 2008
• Enhancing safety with potassium phosphates injection - Winter 2007
• Epidural medications given intravenously may result in death - Fall 2007
• Neuromuscular blocking agents: Enhancing safety by reducing the risk of accidental administration - Spring 2007
• Secondary lines require "primary" attention - Winter 2006
• To Err is Human,To Share is Divine - Fall 2006
• Communication of medication orders by telephone – “Writing it right” - Spring 2006
• The challenge: Balancing competency and error management - Winter 2005
• Dangerous abbreviations: “U” can make a difference! - Fall 2005
• Meperidine (Demerol^®) safety issues - Spring 2005
• Reports of epidural infusion errors - Winter 2004
• Preventing narcotic adverse events in critical care units - Fall 2004
• High alert: Preventing insulin errors - Spring 2004

Abstracts of articles that appeared in Healthcare Quarterly.

• 2010 Vol. 13 Special Issue — Community Pharmacy Incident Reporting: A New Tool for Community Pharmacies in Canada
• 2010 Vol. 13 Special Issue — Identification of Medication Safety Indicators in Acute Care Settings for Public Reporting in Ontario
• 2008 Vol. 11 Special Issue — Development of Canadian Safety Indicators for Medication Use
• 2008 Vol. 11 Special Issue — Using Human Factors Methods to Evaluate the Labelling of Injectable Drugs
• 2008 Vol. 11 Special Issue — Medication Safety in Operating Room: Teaming Up to Improve Patient Safety
• 2008 Vol. 11 Special Issue — Using ISMP Canada's Framework for Failure Mode Effect Analysis: A Tale of Two FMEAs
• 2006 Vol. 8 Special Issue — Implementing System Safeguards to Prevent Error-Induced Injury with Opioids (Narcotics): An ISMP Canada Collaborative
• 2005 Vol. 8 Special Issue — An Effective Tool to Enhance a Culture of Patient Safety and Assess the Risks of Medication Use Systems
• 2005 Vol. 8 No. 4 — Is Consent Required For Publication of Medical Errors?

Pharmacy Connection is the official publication of the Ontario College of Pharmacists.

• Risk Management in Community Pharmacy - Winter 2013
• Medication Incidents Reported to and Reviewed by the ICRC - An Analysis by ISMP Canada - Summer 2012
• Quality and Safety in Compounding Non-Sterile Preparations - Spring 2012
• Medication Safety in Pediatrics - Fall 2011
• Medication Safety in Community Pharmacies - July-August 2010
• Enhancing MedsCheck, improving outcomes - March-April 2010
• Hands-on learning key to co-op students - November-December 2009
• Medication Incidents Reported to OCP: A Review by ISMP Canada - September-October 2008
• New Medication Safety Assessment Program for LongTerm Care - November-December 2007
• The Role and Impact of the Institute for Safe Medication Practices Canada - May-June 2005

Canadian Pharmacists Journal is the official publication of the Canadian Pharmacists Association. The following articles appeared in the SAFETY FIRST column.

• Failure mode and effects analysis: A tool for identifying risk in community pharmacies - May/June 2007 /li>
• Take a proactive approach with the Medication Safety Self-Assessment - Sep/Oct 2006
• Using root cause analysis to determine the system-based causes of error - May/June 2006
• Overdose a risk of transdermal patch in diverse settings - Sep/Oct 2005

Dialogue is a bi-monthly publication by The College of Physicians & Surgeons of Ontario.

• Screening for Inappropriate Medications in the Elderly - September 2006
• Sharing of Information among Health-Care Professional Is Critical to Patient Safety - March 2006

• Prescription for Safety - September 2007

The following articles were published in a regular column that appears in the Canadian Journal of Hospital Pharmacy (CJHP).

The following articles were published in a regular column that appears in Hospital News.

• Mistakes With Medicines Can Happen. Are They Preventable? - November 1, 2012
• CMIRPS Presentations for Virutal Forum - November 2, 2011
• Why is Critical Incident Reporting and Shared Learning Important for Patient Safety? OHA Video and Webcast - August 24, 2011
• Medication Safety Self Assessment for Community/Ambulatory Pharmacy - May 2011
• SHRTN Communities of Practice on Medication Safety in LTC webinars:
  • Medication Safety Self-Assessment (MSSA) for Long Term Care: What the Results Tell Us, October 2012
    (slide presentation)
  • Drug Interaction Pairs Associated with an Increased likelihood of Hospitalization: A New Look at the Evidence, September 20, 2012
    (slide presentation)
  • Part 1: The Changing Culture in Healthcare, September 22, 2011
    (slide presentation)
  • Part 2: Vulnerabilities in the Medication Use Process and Strategies to Enhance Medication Safety, October 20, 2011
    (slide presentation | view recording)
  • Part 3: How MedsCheck for Long-Term Care Can Improve Medication Management in Long-Term Care Homes, November 17, 2011
    (slide presentation | view recording)
  • Part 4: An Update from Accreditation Canada on Medication Reconciliation in Long-Term Care, February 16, 2012
    (slide presentation | view recording)
  • Part 5: Contemporary Issues in the Use of Psychotropic Medications in Long-Term Care, March 21, 2012
    (slide presentation | view recording)
• Solution Development: Examining Possible Interventions - August 2010
• Canadian Medication Incident Reporting and Analysis - April 2010
• Medication Safety 101 - April 2010
• ISMP Canada Presentation for ORNAO Conference - April 27, 2010
• Canadian Medication Incident Reporting and Analysis, ISMP Canada Medication Safety Conference (Long Term Care), Ottawa, March 11, 2009, slide presentation
• Medication Safety Panel Discussion: Oncology Medication Safety - October 19, 2008
• ISMP Canada Mental Health and Patient Safety OHA Conference - September 19, 2008
• ISMP Canada Anticoagulant Project Fall 07 with Carmine Stumpo (Toronto East General Hospital, Toronto).
• ISMP Canada Anticoagulant Project Fall 07 with Judy Chong (Royal Victoria Hospital, Barrie).
• ISMP Canada Anticoagulant Project Fall 07 with Ming Lee (York Central Hospital, Richmond Hill).
• ISMP Canada Anticoagulant Project Fall 07 with Patti Cornish (Sunnybrook Health Sciences Centre, Toronto).
• MOHLTC - ISMP Canada's Medication Safety Support Service (MSSS) Initiatives for 2007/2008.
• 2007 CSHP Professional Practice Conference Workshop Slide Presentation
  Medication Reconciliation for Safer Health Care: Where Are We Now?
• Medication Safety: Lessons Learned, CINA 30^th Anniversary Conference - October 20, 2005
• Human Factors: From Theory to Critical Care Bedside, CACCN Conference Ottawa - 2005
• Medication and System Safety in Long Term Care slide presentation - 2005
• ISMP Canada Failure Modes and Effects Analysis (FMEA) slide presentation - 2005
• Medication Safety: What You Cannot Afford to Ignore, CACCN Nursing Conference Banff, October 2004, slide presentation
• Medication Safety: The Important Role of Pharmacy Technicians, CAPT - Alberta Pharmacy Technician Conference 2004, slide presentation
• Patient Safety: Preventing Adverse Events, OHA Conference June 14, 2004, slide presentation
• 2004 CSHP Professional Practice Conference Workshop Slide Presentations
  "Applying Engineering Principles to Medication Safety – Making Sense of HFE, FMEA and RCA"
• Next Step Meeting Slide Presentations - July 2003

• Medication Incident Reporting and Analysis in Professional Practice lab: Continuous Quality Assurance Starts in Pharmacy School - June 2013
• Risk Management in Community Pharmacy Practice - May 2013
• Medication Safety in Compounding Non-Sterile Preparations - May 2013
• Evaluation of the Effectiveness of Multi-Incident Analysis Workshops - May 2013
• Safe Use of Medications in Seniors - May 2012
• Medication Safety in Pediatrics - May 2012
• Extending Hospital-Based Medication Incident Reporting to Enhance Medication Safety and Continuous Quality Assurance in Pharmacy Practice - February 2012
• Analysis of Medication Incidents in Community Pharmacy - July 2011
• Identification of Medication Safety Indicators in Acute Care Settings for Public Reporting in Ontario - March 2011
• Medication Incidents Involving Psychotropic Drugs: An Aggregate Analysis - January 2011
• Canadian Pharmaceutical Bar Coding Project Conference Poster - January 2010
• Analysis of Medication Incidents in Ontario - January 2010
• Conducting a Best Possible Medication History and Resolving Medication Discrepancies in the Community - October 2009
• Aggregate Analysis of Medication Incidents in Community Pharmacy - May 2009
• Advancing Medication Safety in Paediatrics - 2010
• Enhancing Opioid Medication System Safety: The Alberta Experience - 2010
• Using A Web Based Community Of Practice To Drive Change With Medication Reconciliationication Reconciliation - 2010
• SHN! Medication Reconciliation in the Home Care Pilot Project - 2010
• Operating Room Medication Safety Checklist - 2009
• Fentanyl Patches: Analysis of International Medication Incidents - 2009
• ISMP Canada Priority Recommendations for Narcotics (Opioids) - 2005
• Analyse des modes de défaillance et de leurs effets (AMDE)
• List of Dangerous Abbreviations

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