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3/8/2016 5:00 PM


March 9, 2016

Toronto, Canada – Our healthcare system can be an incredibly complex place, even for someone who works in pharmacy.

Like many of us, Ms. Emily Musing, who is the Executive Director of Pharmacy, Clinical Risk and Quality at the University Health Network, was faced with helping her own parents and in-laws access medical care in different care settings and with different care providers. With each visit, they found it challenging to keep track of what was happening with their medications. To assist them, Emily developed a set of questions for them to ask their doctors. It was designed to help them understand what to do with their medications once they left the office or the hospital, which would also help facilitate the conversation with their next care provider.

Inspired by Ms. Musing's experience of navigating her parents and in-laws through the healthcare system, the Institute for Safe Medication Practices Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists have collaborated to develop a set of five questions to help consumers and their caregivers start a conversation about medications to improve communications with their healthcare provider. These five questions were tested by multiple stakeholders.

The five questions are:

  1. Have any medications been added, stopped or changed, and why?
  2. What medications do I need to keep taking, and why?
  3. How do I take my medications and for how long?
  4. How will I know if my medication is working, and what side effects do I watch for?
  5. Do I need any tests and when do I book my next visit?

Medications are the most common intervention used in healthcare around the world. When used safely and appropriately, they contribute to significant improvements in the health and well-being of patients. The Canadian Adverse Events Study (Baker et al 2004) found drug or fluid-related events were the second most common type of adverse events in Canadian hospitals, accounting for 23.6% of the total. The cost attributed to adverse drug events has been reported to be $4,028 per event (Etchells et al 2012). Furthermore, more than half of Canadians are using prescription drugs on a regular basis with 36% taking two or more medications (Health Council of Canada 2014). With millions of varieties, many of which look or sound alike, medication can be incredibly confusing. Mismanagement of your medications can have serious consequences.

From the patient's and family member's perspective, Maryann Murray hopes these questions will not only inform patients as to the kinds of questions to ask their providers, but will remind providers of the importance of involving their patients in the conversation about their medication and care. Maryann's daughter Martha died in 2002, after a series of errors.  Because of these experiences, Maryann is a member of Patients for Patient Safety Canada, a patient-led program of the Canadian Patient Safety Institute. "I think it was important for us to understand that Martha did everything she could to get better," Maryann said. "She was in the healthcare system to get well. And a series of mistakes kept happening that ultimately cost her life."

Some of those mistakes involved the drug lithium, about which different healthcare providers had opposing views on its risk for Martha. The drug contributed to her death as it was contraindicated for her, but was prescribed anyway.  Martha began suffering from cardiac arrhythmias and 13 days after the dosage was increased, she died.

Martha was not advised of any serious risks or side effects and when she went to the doctor's office complaining of episodes of racing heart rate, she was dismissed as having panic attacks and no testing was done. Maryann believes that if Martha had been part of the conversation, and had the opportunity to ask questions about her medication and treatment, her outcome would have been different.

"A safe patient is an informed patient. These five questions can help start important conversations people need to have with their providers about their care plan," said David U, President and CEO of ISMP Canada.

"Healthcare as we currently practice it is not as safe as it could be or should be. We have to acknowledge that preventable harm is an industry issue," said Dr. Peter Pisters, CEO of University Health Network. "Questions like these bring our patients and their family members into the patient safety conversation in a very meaningful way."

"Medication use is so common, and a fact of life for many people these days that we were compelled to find better ways to keep people safe," said Chris Power, CEO of the Canadian Patient Safety Institute. "We believe these five questions will bring much needed clarity to complex situations and we encourage everyone to ask them in every care setting across Canada."

The five questions are featured in a downloadable handout at The handout includes important reminders about keeping your medication record up to date and asking your care provider to review all your medications to see if any can be stopped or reduced.

About Canadian Patient Safety Institute (CPSI)

The Canadian Patient Safety Institute (CPSI) is a not-for-profit organization that exists to raise awareness and facilitate implementation of ideas and best practices to achieve a transformation in patient safety.  Funded by Health Canada, CPSI reflects the desire to close the gap between the healthcare we have and the healthcare we deserve.

About ISMP Canada

The Institute for Safe Medication Practices Canada is an independent national not-for-profit organization committed to the advancement of medication safety in all healthcare settings. ISMP Canada works collaboratively with the healthcare community, regulatory agencies and policy makers, provincial, national and international patient safety organizations, the pharmaceutical industry and the public to promote safe medication practices. ISMP Canada's mandate includes analyzing medication incidents, making recommendations for the prevention of harmful medication incidents, and facilitating quality improvement initiatives. Information about ISMP Canada's work with Canadians to prevent medication incidents is available at:; and also at, a website designed for consumers.

For media inquiries, please contact:
Cecilia Bloxom
Director of Strategic Communications
Canadian Patient Safety Institute
Phone (780) 700-8642