Health care providers often unintentionally re-expose patients to the same or similar medications as ones that previously caused harm because they lack effective means to share adverse drug event (ADE) information with one another and across health sectors (e.g., between hospitals, doctors’ offices, clinics, pharmacies). ActionADE is a web-based software application that allows health care providers to document standardized ADE information in a user-friendly manner at the patient’s bedside in under 2 minutes. ActionADE is currently implemented for use in hospitals across Vancouver Coastal Health and Providence Health and integrated with PharmaNet, BC’s medication dispensing database. This integration allows this standardized ADE information to be transmitted to PharmaNet, making it available to other providers in the ADE patient’s circle of care. In community pharmacy computer information systems in BC, ADE alerts pop up when patients with an ActionADE report in PharmaNet attempt to fill a prescription for the same drug or same class of drug. Community pharmacists can contact the prescriber to confirm whether re-exposure is appropriate. This reduces uninformed redispensations, preventing repeat ADEs. ActionADE is scalable and can be integrated with existing electronic medical records and medication dispensing databases in other provinces to improve appropriate medication use and patient safety.

The Appropriate Use of Antipsychotics (AUA) Toolkit and accompanying resources provides individuals, families, clinicians, and care teams with guidance regarding the assessment and management of responsive behaviours associated with cognitive impairment (dementia, delirium) and appropriate use of medications in older adults. 

The AUA Toolkit contains resources and tools such as eLearning modules, guidelines, standards, policy, procedures, worksheets, tracking records and audit tools, algorithms, behaviour mapping guide, care planning resources, and family supports. It supports more appropriate use of antipsychotics by guiding prescribers and care teams in the prevention, recognition, and management of responsive behaviours, pharmacological restraints, sleep disruption, and delirium. It highlights effective quality improvements and aims to support a dementia-friendly environment, meaningful activities, and family and caregiver involvement.

The toolkit’s primary audience is care teams in environments providing care to older adults including long-term care and supportive living. When it was first developed in conjunction with a provincial initiative to reduce the inappropriate use of antipsychotics, the focus was on long-term care but with an eye on applicability to supportive living. While not specifically designed for other sectors, the approaches and strategies it contains are also applicable to home care and acute care.

The BC Provincial Academic Detailing (PAD) service is a provincially funded initiative that provides prescribers with evidence-based drug information to support clinical decision–making. The PAD service consists of 12 regionally based pharmacists who collaborate to review current literature on selected therapeutic topics (e.g., medications for COPD, weight loss, osteoporosis) and deliver academic detailing sessions. PAD typically launches 2 topics per year with topic choices informed by participant requests as well as consideration of a topic’s relevance to primary care, known or perceived prescribing issues, and availability of quality evidence to guide practice change. The PAD team summarizes the evidence and practical drug information into a focused, accredited topic which can be discussed in a 30- to 45-minute academic detailing session with individuals or small groups of clinicians, enabling the PAD pharmacists to meet individual learning needs. Academic detailing sessions usually occur at the clinician’s office or clinic, or via web conference. In addition, PAD provides educational sessions to medical residents on current PAD topics and offers academic detailing rotations to pharmacy residents and students to learn how to critically appraise clinical practice guidelines and how to access regulatory materials (US FDA, EMA, Health Canada).

The Canadian Medication Appropriateness and Deprescribing Network (CADeN) is a group of people with lived experience, clinicians, educators, policy-makers, and researchers. CADeN produces, shares, and applies information to promote the safe and appropriate use of medications, through:

Public awareness and education: Enhancing public understanding of medication safety by providing access to tools, multilingual resources, and through an ongoing public awareness campaign. The goal is to foster informed conversations between members of the public and health care professionals. The voices of patients, caregivers, and community leaders are integral to raising awareness.

Health care professional training: Improving health care professionals’ knowledge and competencies regarding safe prescribing practices by developing evidence-based tools and resources. CADeN collaborates with educators to incorporate deprescribing competencies into health care professional curricula.

Research agenda: Driving innovation in the field of medication appropriateness and deprescribing, CADeN identifies knowledge gaps and opportunities, supports clinical trials, secures research funding, research trainees, and knowledge mobilization. They are committed to measuring effectiveness of interventions through continuous quality improvement efforts.

Policy support: Collaborating with policy-makers to design and implement large-scale medication appropriateness and deprescribing interventions.

CADeN is committed to learning from and partnering with Indigenous Peoples, incorporating Indigenous ways of knowing, thinking, and doing in all their endeavours.

The Centre for Effective Practice (CEP) is a nationally recognized leader in fostering appropriate prescribing in Canada. As a trusted health care behaviour change partner, CEP bridges the gap between evidence and clinical practice.

Through its academic detailing program, CEP provides clinicians with 1:1 tailored, evidence-based discussions led by clinical pharmacists, focusing on safe and effective prescribing practices. Additionally, CEP develops comprehensive clinical decision-support tools and resources empowering health care providers to make safe, effective, and patient centred prescribing decisions. 

Through these initiatives, CEP drives improvements in medication use, prioritizing both provider needs and patient outcomes, while establishing itself as a trusted partner in advancing health care excellence.

Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in Canada. Inappropriate use of medications can expose patients to harm, waste health care resources, and contribute to the climate crisis. Choosing Wisely Canada collaborates with health care providers and organizations to implement evidence-informed recommendations and provides tools to optimize prescribing in primary care, long-term care, and hospital settings.

MD Snapshot-Prescribing resource is an innovative, interactive tool that provides physicians with up-to-date insights into their prescribing patterns for opioids, benzodiazepines and Z-drugs, and antibiotics. Customized for each physician, the tool is accessible quarterly via a secure online portal, offering features such as prescribing trends, comparator groups, and relevant resources.

The primary objective of MD Snapshot is to raise awareness about prescribing practices, identify opportunities for improvement, and enhance patient care. By utilizing patient-level prescribing data, it supports physicians in self-directed, continuous quality improvement. The tool is nonpunitive, offering individualized feedback to foster self-reflection and practice enhancement. Percentiles serve as statistical measures, not as “report cards” or judgments.

MD Snapshot incorporates peer comparisons to provide additional perspectives. Physicians are grouped by their primary specialty, as reported in their annual CPSA Renewal Information Form. Physicians affiliated with a regional primary care network can compare their prescribing data with that of other physicians within their network.

The Dalhousie Academic Detailing Service operates through the Continuing Professional Development and Medical Education office at the Faculty of Medicine, Dalhousie University, and is funded by the Nova Scotia Department of Health and Wellness. Customized, one-on-one or small group educational sessions, delivered in-person or online, by trained health care professionals are offered to primary care providers across Nova Scotia. Topics are identified through evaluation surveys, literature scoping, and consulting with an advisory panel of family medicine physicians from across the province to ensure information is relevant to practice. Topic development is in collaboration with the Nova Scotia Health Drug Evaluation Unit pharmacists and local specialists.

Sessions are individualized, promoting an interactive discussion to identify potential knowledge gaps and barriers to integrating information into practice. The information included with each topic varies with emphasis on pharmacotherapy best practices and awareness of local clinical resources to support clinical shared decision-making. Topics have included acute pain (e.g., opioid prescribing), inhaled device selection for COPD, evidence-based medication options for people living with type 2 diabetes, alcohol use disorder, and obesity as well as appropriate antibiotic use and resources for community-acquired infections.

deprescribing.org creates guidelines, tools, and approaches to support medication decisions and help health care professionals and the public use them. To do this, they generate and synthesize knowledge about medication use, including the process of deprescribing (i.e., stopping or reducing medications) and then partner with interested parties to bring this evidence into practice. 

They are best known for 3 activities:

Evidence-based deprescribing clinical practice guidelines: Their evidence-based clinical practice guidelines support deprescribing decisions across the globe. Developed using rigorous methodology (i.e., GRADE), guideline topics include antihyperglycemics, antipsychotics, proton pump inhibitors, and others (refer to the deprescribing.org website). Each guideline is accompanied by tools, designed with and for health care professionals and the public, to help people apply this information in practice.

Deprescribing in long-term care collaborative: They work with partners to design and test interventions to support medication decision-making in Canada’s long-term care homes.

Talking about medications: In partnership with the public, they developed a learning series (now used across 3 countries) to equip people with the knowledge and skills needed to have medication-related discussions with their health care team.

GeriMedRisk is a federal not-for-profit organization that specializes in medication optimization, which includes appropriate use, for older adults with medical complexity, and polypharmacy. GeriMedRisk provides Ontario-wide clinical support and education and knowledge translation on appropriate use of medications in older adults to all clinicians in Canada. GeriMedRisk’s team comprises an interdisciplinary team of specialists in pharmacy, clinical pharmacology and toxicology, geriatric medicine, geriatric psychiatry, emergency medicine, internal medicine, and adult psychiatry, a significant proportion with faculty appointments. 

GeriMedRisk supports clinicians to address appropriate use of all medications for their older patients with multimorbidity and polypharmacy. Their clinical consults (available in Ontario only) assess the risks and benefits of all medications, and drug interactions with other drugs, food, or diseases, in order to optimize the health and function of the patient. Consults are often accompanied by educational materials.

Educational offerings on the appropriate use of medications include their monthly virtual geriatric clinical pharmacology education rounds, conference presentations, and geriatric drug information knowledge portal, which contains unbiased, evidence-based drug summaries and infographics accessible to clinicians in Canada.

GeriMedRisk collaborates with other organizations to create clinical guidelines on appropriate medication use: Canadian Coalition for Seniors’ Mental Health, Health Quality Ontario, Institute for Safe Medication Practices Canada.