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What is the Medication Safety at Care Transitions Safety Improvement Project Learning Collaborative?

The Medication Safety at Care Transitions Safety Improvement Project is a learning collaborative designed for acute care organizations that care for frail elderly.  Medication errors continue to be a source of preventable harm, especially for older adults living with frailty. The goal is to decrease readmissions related to medication safety issues at discharge among frail patients. The 18-month Safety Improvement Project begins in January 2019 and concludes in October 2020.

The learning collaborative will be hosted through a series of virtual learning sessions, and in-person learning sessions scheduled at the beginning and the end of the training period. The learning sessions are best described as both workshops and a place for idea exchanges, which prepares teams to make changes during action periods.  During action periods, participants work in their local area (i.e. units) to implement medication safety tools and resources. 

Each of the teams enrolled in the Medication Safety at Care Transitions Safety Improvement Project will test and implement evidence-informed change ideas to improve patient outcomes using a quality improvement and knowledge translation/implementation science approach to support implementation of tools and resources for medication management at discharge.

How will knowledge translation and implementation science benefit this SIP?

The Canadian Patient Safety Institute has engaged Knowledge Translation and Implementation Science subject matter experts to create an integrated quality improvement/knowledge translation approach to the learning design of the SIP. Our aim is to integrate these approaches to maximize contributions from each field and produce a larger, sustainable impact on outcomes. 

Quality improvement and implementation science have different origins and terminology, but ultimately aim to achieve the same goal, drawing from different evidence and methods. Quality improvement uses methods and processes to improve the quality, safety and value of healthcare, often to address a local problem.  Implementation science uses theories, models, and frameworks to promote the systematic uptake of evidence-based interventions and create generalizable knowledge for large-scale impact.

Embedding knowledge translation into existing quality improvement projects will address questions such as: "how and why did the change happen"; "how can changes be scaled up"; "how can improvements be sustained"; and "what contextual factors support or hinder change"?

What are the benefits of joining the collaborative?

The topics and program within the Medication Safety at Care Transitions Safety Improvement Project will help participants to: 

  • Identify frail clients who are at risk for medication safety issues,
  • Learn and apply new processes for medication management at discharge,
  • Learn and utilize Knowledge Translation and Implementation Science techniques to successfully implement and sustain new evidence-based practices for mediation safety at transitions,
  • Track and communicate progress, using run charts,
  • Share key learnings, and challenges with team members, coaches, faculty, and other collaborative participants,
  • Participate in an external evaluation of the medication safety improvement collaborative,
  • Improve your team's approach to patient safety while taking action to deliver safer care.
  • The principles of the Medication Safety at Care Transitions Safety Improvement Project include:
  • Everyone Teaches; Everyone Learns,
  • The Model for Improvement is a methodology used to accelerate movement between knowing and doing,
  • Learning Knowledge Translation and Implementation Science principles to understand your readiness for change and sustainability,
  • Learning sessions are a preparation for the action periods,
  • More active participation; More value and better results,
  • Monthly data collection and reporting are fundamental to understanding the current state of your safety culture,
  • Active participation in the project's virtual social learning network.

Is there a fee to participate in the Safety Improvement Project?

Yes. The Canadian Patient Safety Institute will accept a maximum of eight teams from across the country.

Cost of participation per each four-member core-team is $5,000 (CAD) and $1,250 for each additional member attending the in-person learning session and closing congress.  This will cover the costs for cover travel, accommodation and attendance at two in-person events. Incidentals, ground transportation and meals occurred outside the learning sessions will be the responsibility of the sponsoring organization.

For questions related to the application process, please send an email to: medsafety@cpsi-icsp.ca

Do I need to submit data?

Yes. Measurement is fundamental to understanding if your work is making a difference. For the Medication Safety collaborative, there will be several reasons to collect your data. You will be asked to develop and execute a measurement plan. You will monitor and report data throughout the improvement project (from initiation to sustainability).  We will ask you to share data to provide an insight into your teams understanding and application of the Medication safety at discharge program at your site. In addition, we will be working with the University of Toronto to evaluate the effectiveness of this approach to safety collaboratives and we will be seeking data to assist with that evaluation. Throughout the sessions, a portion of time will be devoted to sharing what you are learning from your measures.

Can I join the Medication Safety at Care Transitions Safety Improvement Project after it has started (i.e. half way through)?

No. The Medication safety collaborative is closed safety learning collaborative because knowledge is cumulative across the duration of the learning sessions and action periods.

Do the same people need to attend all Learning Sessions?

Yes. The core team need to attend all learning sessions and take responsibility to ensure the work continues during action periods. The coaches and faculty will work closely with the core team to advance the work of the safety collaborative from learning sessions to action periods.

What do I need to join the Medication Safety at Care Transitions Safety Improvement Project Learning Collaborative?

  • Executive Sponsor support,
  • A team with previous quality improvement experience and committed to focusing on advancing patient safety,
  • Completed Expression of Interest form,
  • Internet and phone access,
  • Dedicated time and space in your workplace to participate,
  • Time to teach the medication management processes at discharge to unit members,
  • Time to explore, test and evaluate ideas for change during action periods,
  • Time to participate in the project's virtual social learning network,
  • Time to participate in the evaluation of the project, which will include data collection and reporting for the project lifecycle (includes a 6-month sustainability period).

What is the role of the Executive Sponsor?

At the Canadian Patient Safety Institute, we recognize that support from an Executive Sponsor is key to a team's success. An Executive Sponsor is typically an executive or senior level manager whose role may include:

  • Helping to align the participation in the Medication safety collaborative within the organization's strategic and operational objectives,
  • Connecting and communicating with appropriate stakeholders,
  • Allocation of staff and resources to support the collaborative activities,
  • Establishing an accountability mechanism,
  • Facilitating the work of the team within the larger organization and particularly seeking opportunities for spread and sustainability of the initiative beyond the 18-month collaborative,
  • Engaging a team leader and core team members and protecting their time required for successful implementation of the Medication safety discharge processes.

Who should join this Safety Improvement project?

The Medication Safety at Care Transitions Safety Improvement Project Learning Collaborative is most applicable to teams that are seeking support to decrease readmissions related to medication safety issues at discharge among frail patients. Over an 18-month period, participating teams will learn and apply new processes for medication management at discharge that they can spread throughout their organization.

Who guides the content of this initiative?

The Medication Safety at Care Transitions Safety Improvement Project Learning Collaborative will be guided by experienced coaches from the Canadian Patient Safety Institute and expert faculty from across Canada. Teams will receive key content on implementation and knowledge translation that will assist in their implementation efforts to ensure success and sustainability of the project gains.  In addition to receiving education in quality improvement and knowledge translation/behaviour change, each team will receive individual coaching sessions to address barriers and enablers of the implementation project.

Is enrolment limited?

Yes. Enrolment is limited to eight teams from across the country.

Will the Medication Safety at Care Transitions Safety Improvement Project Learning Collaborative be offered in both English and French languages?

Partially. All printed materials including the Call to Action, Enrolment package, and Registration will be available in both English and French.

Want to learn more?

Two information webinars will be held on February 5, 2019 and again on February 12, 2019. These webinars have the same content and are a great opportunity for your team members to learn more about the learning collaborative and to get answers to their questions.

How to apply?

Download the Expression of Interest and complete the application form for the learning collaborate (pages 4-9). The deadline for applications is March 15, 2019. Successful applicants will be confirmed.

Need additional information?

For additional information about the upcoming collaborative, please contact the planning team at medsafety@cpsi-icsp.ca