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It was late December 2025 and the CQI+ implementation date was less than two months away. Licensee Nicole Schettler and her team were gearing up to make sure all the CQI+ requirements were in place when the pharmacy had its scheduled ACP routine pharmacy assessment.
As part of the CQI+ requirements, Nicole’s team identified the need to conduct a safety self-assessment based on discussions with ACP’s pharmacy practice consultant. Completed every two years, or within six months of a new licensee taking responsibility for the pharmacy, the safety self-assessment helps the team identify risks that can be proactively addressed.
“It was an honest look at what we were doing in the pharmacy,” said Nicole. “It was the first time we’ve ever done a safety self-assessment—it felt like a great starting place. We went through the checklist and made sure that we’re largely compliant. Then we identified some simple changes we could make. The safety self-assessment really helps set us up for success. It helps us look at what can we do from an environmental standpoint so that in the busy day to day of the pharmacy, little changes become guardrails so that you’re less likely to make an error.”
One of the changes her team identified during the safety self-assessment process was how they arrange insulin in the pharmacy’s fridge.
“We decided to put all the short-acting insulins together and all the long-acting insulins together instead of organizing them by brand name,” said Nicole. “The Institute for Safe Medication Practices (ISMP) Canada recommends organizing them this way to prevent practice incidents. The changes we made weren’t anything extraordinary and didn’t take much time. A pharmacy technician on the team and I reflected on each other’s opinions to make sure we were on par with each other, and we made the changes immediately.”
Nicole’s team has also started participating in quarterly CQI meetings, another of the requirements of the CQI+ program. These meetings provide the team an opportunity to discuss and reflect on safety at the pharmacy. Nicole says the meeting is a safe place where team members can speak openly about practice incidents, close calls, and ideas to prevent both.
“There’s no assignment of blame,” said Nicole. “We approach the discussion from a team perspective and ask questions like: ‘What do you think happened?’ and ‘What do you think could be improved?’ These meetings have been helpful and are good opportunities for the team to bring up ideas and concerns that they’ve run across over the last three months. We can suggest changes so that practice incidents and close calls that we did come across don’t happen again. We’ve also brought up some ideas that have helped to improve workflow while also improving safety. It’s been great so far. The meetings are productive, and they only take about 10 or 15 minutes.”
Nicole said in the past, a team member would document a practice incident or close call, it would go to her for sign off, there would be a discussion about what to do to prevent a future incident, and the incident would get filed. Under CQI+, the ideas generated during a quarterly meeting are documented, implemented, and revisited regularly to monitor progress and support ongoing improvements.
“Pharmacy moves fast so documenting helps you keep on track,” said Nicole. “It’s sometimes easy to forget what happened a year ago, so documentation can help identify trends. Then we know if we’re finding similar things keep happening, then clearly what we’ve changed isn’t working. That documentation of what happened that time and what happened this time gives you have a better picture of the overall, historical data.”
So far, Nicole says her team has benefitted from incorporating CQI+ into their daily practice routines.
“It’s improved the day-to-day conversations around safety,” she said. “If somebody notices something that could become an issue, they flag it before it does. CQI+ helps puts safety at top of mind. Nobody’s trying to blame anybody. Everybody’s just trying to make things better.”
