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Frequently Asked Questions
Frequently Asked Questions
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Program Overview |
- What is CIRCL?
CIRCL (Continuous Improvement, Reporting, Collaborating, and Learning) is CPBC's comprehensive medication incident reporting program designed to enhance medication safety through structured reporting, analysis, and learning from medication incidents in pharmacies across British Columbia.
- When do the CIRCL requirements take effect?
CPBC is implementing a transition period that ends June 1, 2026. All requirements must be in place by this date. Initial team meetings and safety self-assessments must be completed by June 1, 2027 (one year after the transition period ends).
- Do these requirements apply to both community and hospital pharmacies?
Yes, all CIRCL requirements apply to both community and hospital pharmacies in the same way and with the same timelines.
- How does CIRCL align with other provinces?
British Columbia joins eight other provinces that have already established mandatory medication incident reporting programs, all aligned with NAPRA Model Standards that form the foundation of the CIRCL program.
Medication Incidents and Near Misses |
- What is considered a medication incident?
A medication incident is any preventable event that may cause or lead to inappropriate medication use or patient harm that has reached the patient and may be related to professional practice, drug products, procedures, and systems, and include prescribing, order communication, product labelling/packaging/nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use.
- What information must be documented for each medication incident?
At minimum, the following must be documented:
- Date the incident occurred
- Type of medication incident
- Who discovered the incident (position/job title only)
- Medication system stages involved
- Medication(s) involved
- Degree of harm to the patient
- Incident description/how it was discovered
- Contributing factors
- What is considered a near miss?
A near miss is an event that could have resulted in unwanted consequences but did not because, either by chance or through timely intervention, the event did not reach the patient.
- When should a near miss be reported to the national database?
Pharmacy professionals are expected to follow their pharmacy’s policies and procedures for near miss management and use professional judgment to determine whether a near miss meets the criteria for reporting.
Within these policies, at a minimum a near miss must be reported if:
- The event had reached the patient, it is likely that actual harm would have been caused
- The event has been a recurring problem for the pharmacy
- The event provides a learning opportunity for the pharmacy specifically or for pharmacy practice in general
Pharmacy professionals should consult their pharmacy’s near miss policy and apply their professional judgment when evaluating whether to report.
- Is it necessary to report every single near miss?
No, not every near miss needs to be reported to the national database. Reporting is intended to capture events that offer learning opportunities or highlight system risks, not to document every isolated or routine occurrence.
If a near miss is caught within an established process, such as a typo intercepted during final check, it may not need to be reported, particularly if it is an isolated event and effectively managed through the pharmacy’s existing safety procedures. However, even these types of near misses should be reported if they are a recurring, or high-risk issue.
Near misses should be reported when:
- They are part of a recurring issue, even if consistently caught
- They highlight a system weakness or process breakdown, such as failures in workflow or verification
- They involve a serious or high-risk error, where harm could have occurred if not intercepted
- They are caught outside of routine processes or safeguards, such as by a patient, another health professional, or pharmacy staff by chance
Repeated errors may signal that existing procedures are not functioning as intended. Reporting such events helps identify risks, support team learning, and in some cases, may prompt a necessary review of internal processes.
Pharmacy professionals are encouraged to apply their professional judgment, guided by their pharmacy’s near miss policy, to determine when reporting is appropriate.
Team Meetings |
- How often must team meetings be conducted?
Team meetings must be conducted at least once a year after the initial meeting, which must be held before June 1, 2027.
- What documentation is required for team meetings?
Documentation must include:
- Date of the meeting
- Names of pharmacy staff members in attendance
- Topics of discussion
- Any resulting improvement plans
- Can we incorporate CIRCL requirements into existing operational meetings?
Yes, these requirements can be met by incorporating the required content and documentation into existing operational team meetings.
Safety Self-Assessments |
- How often must a pharmacy complete a safety self-assessment?
A pharmacy must complete a safety self-assessment at least once every three years after the initial assessment, which must be completed before June 1, 2027.
- What tools should be used for conducting a safety self-assessment?
Pharmacies must use appropriate software tools for their license type such as:
- Medication Safety Self-Assessment (MSSA) from ISMP Canada
- Pharmacy Safety Self-Assessment (PSSA) from ThinkResearch
Reporting Platform and Technology |
- Who is responsible for selecting and implementing a reporting platform?
Pharmacy managers are responsible for selecting, implementing, and maintaining a reporting platform that meets CPBC's requirements.
- What are the minimum requirements for a reporting platform?
By June 1, 2026, the platform must:
- De-identify data (remove all patient, pharmacy staff, and pharmacy identifiers)
- Integrate with national databases (National Incident Data Repository for Community Pharmacies (NIDR) for community pharmacies, National System for Incident Reporting (NSIR)for hospital pharmacies)
- Support all the following mandatory data fields:
- Date the incident occurred
- Type of medication incident
- Who discovered the incident (position/job title only)
- Medication system stages involved
- Medication(s) involved
- Degree of harm to the patient
- Incident description/how it was discovered
- Contributing factors
- What reporting platform can be used?
Any platform that meets the requirements may be used. Pharmacies may use proprietary systems or other platforms, provided they meet the requirements.
Platforms that are used in other provinces or that CPBC is aware of include:
- BC PSLS - BC Patient Safety & Learning System
- Community Pharmacy Incident Reporting (CPhIR) - ISMP Canada
- Pharmapod - Think Research Corporation
- TPSC Cloud - The Patient Safety Company
Privacy and Data Handling |
- What does it mean when data is 'de-identified'?
De-identified data means the information does not contain any identifiers about patients, pharmacy staff, or the pharmacy itself (names, PHNs, registrant ID numbers, etc.) when submitted to the national database.
- Which national databases receive the reports?
Community pharmacies submit to the National Incident Data Repository and hospital pharmacies submit to the National System for Incident Reporting, administered by ISMP Canada and the Canadian Institute for Health Information, respectively.
- Will CPBC have access to individual incident reports?
CPBC will not have access to individual medication incident reports submitted to the national databases. CPBC will only receive aggregate, de-identified data analyses to identify opportunities to improve patient safety across the province.
- Will reporting be used to trigger disciplinary or enforcement action against me or my pharmacy?
No. Reports and data submitted to the national databases are de-identified, meaning they do not include names, license numbers, or other information that could identify a pharmacy or pharmacy professional.
CIRCL is not about blame, it's about building a stronger safety culture through learning and continuous improvement. When you report medication incidents and near misses you’re contributing to a collective knowledge base that helps identify risks, prevent harm, and improve care.
An increase in reporting is often a sign of a healthy safety culture where team members feel safe, supported and empowered to reflect and improve. Your willingness to report demonstrates professional responsibility and a commitment to continuous improvement.
- How is the data used once it's entered into the national incident reporting database?
All data collected and stored in the national incident reporting database is held securely and is used to promote continuous learning and improvement across Canada. ISMP Canada analyzes this aggregated data and shares recommendations through safety bulletins, national snapshots, provincial safety briefs, and medication safety self-assessment data spotlights. This allows pharmacy professionals to learn from collective experiences, improve their practices, and contribute to a safer healthcare environment while benefiting from insights gathered from pharmacies nationwide.
Patient Disclosure and Communications |
- What must pharmacies disclose to patients when an incident occurs?
Pharmacy professionals must:
- Disclose the incident to the patient or patient's agent using a patient-centered approach
- Follow up with the patient to monitor for effects as appropriate
- Share information with other health professionals in the patient's circle of care as appropriate
- Communicate improvements and learnings to prevent recurrence when appropriate