SuperSHIFTERS Alice Watt, Medication Safety Specialist at the Institute for Safe Medication Practices Canada (ISMP Canada) and Mike Cass, Senior Project Manager at the Canadian Patient Safety Institute, were instrumental in the development and widespread dissemination of the 5 Questions to Ask About Your Medications. The 5 Questions creates a platform for patient engagement and promotes safe medication practices.

What are the 5 Questions to Ask About Your Medications?

The 5 Questions are a launching pad to encourage conversations between patients and healthcare providers. Patient Advocate Jill Adophe has been quoted as saying, "Patients want a dialogue, not a monologue. They want a choice and a voice." The 5 Questions tool gives patients something to think about in preparing for these conversations. 

​ ​	​ Alice Watt
	​ Mike Cass

How did you land on these particular questions for the 5 Questions tool?

In 2014, a Medication Safety Summit concluded that a checklist would engage patients in medication safety. ISMP Canada was asked by the Canadian Patient Safety Institute to lead this opportunity, working with patients and a number of patient safety and medication specialists. Co-designed with representatives from Patients for Patient Safety Canada (PFPSC), the working group took a collaborative approach, ensuring that the patient voice guided the questions.

An initial environmental scan of medication safety literature and tools produced questions for consideration. Safety tools reviewed included medication reconciliation materials that had been developed following analyses of medication incidents at transitions of care (and shared with the Canadian Medication Incident Reporting and Prevention System). Those questions were narrowed down to create the final 5 Questions that would resonate most with the target audience.

What we ended up with went beyond our expectations!

What do patients and providers have to say about the 5 Questions?

In a recent Canadian Patient Safety Week survey, 63 per cent of healthcare providers said that patients are asking more questions about their medications, and 60 per cent of patients said they are asking more questions about their medications.  Healthcare providers say they are distributing the 5 Questions to patients, posting them in examination rooms and clinics, and using the tool as a guide for conversations between patients and providers.

What is being done to spread the use of the 5 Questions?

We conducted several surveys with patients and healthcare providers to validate the 5 Questions and people told us to make it available in multiple languages. This has been another fascinating element of the project. Today, the 5 Questions tool is available in 25 languages from Albanian to Korean and Ukrainian. Organizations are still asking us to make the 5 Questions available in more languages and we're working on that!

Another feature of the 5 Questions is that healthcare organizations can add their logo to the tool, and it has been customized by more than 200 organizations to date.

More than five million patients are learning about the 5 Questions through an eye-catching digital poster campaign in doctors' offices and hospital waiting rooms in Ontario, Alberta, British Columbia and Quebec. 

The 5 Questions tool has also been shared with organizations in other sectors through initiatives like the Home Care Collaborative and the Medications Safety at Transitions of Care Safety Improvement Project.

Were there any surprises or key learnings that you can share in developing the 5 Questions?

The enthusiasm of patients to promote the 5 Questions in their communities has been so rewarding. They have asked for copies and distributed them locally in grassroots efforts. There has been interest from sectors outside of acute care, including long term care, home care, primary care, and the 5 Questions have proven useful at transitions of care. We've been delighted by the international interest in the tool and the fact that it's now available in so many languages around the world.

We know that working with patients and having them participate in the co-design was crucial and will continue to be important as we develop new tools.

There's always room for modification, but as they were created, the 5 Questions have become a successful platform for starting a conversation. We tapped into an unmet need and the pick-up has snowballed.

Have you expanded on the initial 5 Questions tool?

A new 5 Questions handout has been developed with the Canadian Deprescribing Network and Choosing Wisely Canada, with the goal of reducing the use of opioids for pain after surgery. Key messages in the handout focus on safe storage and disposal of opioids. We are now looking at developing a 5 Questions tool to address the use of opioids for short-term pain and dental pain.

Where can our readers go for a copy of the 5 Questions, or learn more?

Click on the link to download the 5 Questions to Ask About Your Medications poster.

For more information, contact alice.watt@ismpcanada.ca or mcass@cpsi-icsp.ca