Healthcare Excellence Canada (HEC) is a pan-Canadian health care organization focused on shaping a future where everyone in Canada has safe and high-quality health care through collaboration with diverse partners across the country, and driving the rapid adoption and spread of innovations. HEC has supported over 1,000 long-term care (LTC) homes to implement quality improvement initiatives related to enhancing person-centred care strategies, workforce experience, and the appropriate use of antipsychotic medications (AUA). 

With a history of successful AUA quality improvement collaboratives, HEC has published many helpful resources outlining the use of an AUA approach for reducing or discontinuing potentially inappropriate antipsychotics.

In 2024, HEC launched the Sparking Change in the AUA program aiming to support the appropriate use of antipsychotics in LTC homes through improved person-centred care and nonpharmacological interventions. The program offers resources, coaching, and financial award opportunities for up to 500 LTC homes seeking to continue or start new AUA initiatives.

In addition to its mandate in health technology assessment, INESSS counts on a large team of scientists, economists, pharmacists, data analysts and knowledge transfer specialists to produce clinical guidelines, tools, and algorithms to support decision-making and promote optimal use of drugs, technologies, interventional methods, diagnostic tests, and biomedical analyses. This work covers a wide range of areas in physical health as well as social and mental health sectors: oncology, traumatology, cardiology, critical care and emergency services, chronic disease screening and management, dementia, depression, imaging, wound care, pain, end-of-life care, relevance and organization of care and service trajectories, as well as low value practices. It also develops national medical protocols and different types of associated prescribing tools, and carries out various actions to support the improvement of front-line practices. 

Note: INESSS English website offers translated versions of some of its productions — but not all. However, for most publications, a translated summary is available. Many optimal use tools and guidelines are also available in English.

ISMP Canada is an independent, not-for-profit, and pan-Canadian organization that purposefully partners to advance medication safety in all health care settings. Their mandate includes medication incident reporting, learning, sharing, and acting to address system issues and reduce preventable harm to patients, residents, and clients.

ISMP Canada work with those that deliver care, and those that receive care, to improve medication safety. A key priority is the advancement of the appropriate use of medications. Programming includes:

Safety Bulletins to inform providers of key emerging risks and strategies for improvement.

Newsletters to inform consumers of key emerging risks and strategies for improvement.

Leading initiatives and/or collaborating with other organizations to develop and implement initiatives that provide tools, education, facilitation, and coaching to teams that have set a goal to reduce preventable harm (e.g., Ontario Strengthening Medication Safety in Long-Term Care, Appropriate Use of Antipsychotics in Long-Term Care, Opioid Stewardship, and the appropriate use of antibiotics).

A key component of this programming is supporting providers to have the ability to analyze local medication incidents or issues and design effective actions for improvement. This includes identifying system contributing factors causing preventable harm and using human factors to inform their Plan-Do-Study-Act cycles. For more information: [email protected]

MedSafer is a tool to help guide older adults, caregivers, and health care provider(s) through the process of a medication review focused on deprescribing opportunities. The software has a patient portal and provider portal. Health data are kept secure. Some opportunities can be actioned on by the patient or caregiver immediately through links to evidence-based consumer brochures, whereas other opportunities require health care provider input and supervision. The provider view contains a rationale with a “how-to” roadmap for deprescribing, complete with tapering instructions when needed. The software was previously tested in a large Canadian clinical trial and found to be safe and effective.

MedStopper is a tool to help clinicians and patients make decisions about reducing or stopping medications. Re-evaluating and sometimes stopping medications is a big part of appropriate use. Clinicians enter the list of medications a patient is receiving, and then MedStopper (based on information from a group of medication experts) sequences the drugs from “more likely to stop” to “less likely to stop” based on 3 key criteria: the potential of the drug to improve symptoms, its potential to reduce the risk of future illness, and its likelihood of causing harm. One of the key parts of this website is it gives specific suggestions for how to taper (if necessary) the medications — this type of information is not readily available.

A key strategy for improving health care is measurement and feedback to health care providers engaged in improvement and innovation. However, physicians and administrators in Ontario do not always have the comparable regional and provincial data they need to inform their improvement efforts.

To help address this gap, Ontario Health developed personalized reports tailored to the primary care, long-term care, specialist, and hospital sectors. Using existing administrative health databases, these confidential reports give physicians data about their practice and share change ideas to drive quality improvement. 

MyPractice reports measure the prescribing patterns of the following priority medications: opioids, antibiotics, antipsychotics, and benzodiazepines — enabling physicians to confidently interpret their data in relation to their peers. The reports also include practical tools and resources to support the appropriate use of these medications in various care settings.

The Ontario Pharmacy Evidence Network (OPEN) is a team of multidisciplinary researchers across Ontario who are working together to evaluate the quality, outcomes, and value of medication management services that pharmacists and other health care professionals provide. OPEN has 3 primary aims, which focus on facilitating connections, building and sharing evidence together, and supporting researchers. 

Researchers associated with OPEN are conducting an array of research projects focused on appropriate medication use with the overall goal of determining effective, accessible, and system-integrated approaches to help patients, pharmacists, and other health care providers choose, use, and remove medications. 

Specific areas of work include research on the quality, clinical significance, health system impact, and stakeholders’ perspectives with medication or pharmacy services including medication reviews, pharmacist prescribing, minor or common ailments, and immunizations; the implementation of new medication management approaches that promote interprofessional collaboration and enhance health care for underserved communities; and pharmacy service evaluation frameworks that include, for example, deprescribing programs in collaboration with deprescribing.org, the Canadian Medication Appropriateness and Deprescribing Network, and others and developing and implementing patient-oriented experience measures.

PEER is a national team of multidisciplinary clinicians with a mission to produce and present evidence that matters to both patients and providers. PEER collaborates with the College of Family Physicians of Canada (CFPC) to achieve our vision of empowering primary care providers through best evidence. PEER develops biweekly summaries of new and relevant research (Tools for Practice), national primary care guidelines, and continuing medical education offerings — including podcasts and PEER conferences — all which are accessible through CFPClearn.ca

RxFiles, established in 1997, is Saskatchewan’s Academic Detailing Service based at the University of Saskatchewan’s College of Pharmacy and Nutrition. It provides academic detailing to primary care prescribers across Saskatchewan through voluntary sessions lasting 15 to 60 minutes. These sessions cover key topic highlights, rationale for key messages, and allow for the opportunity to further discuss specific questions.

RxFiles also produces a variety of resources, including its well-known Drug Comparison Charts, that offer objective drug information to support the optimal use of medications. These tools support health care providers in enhancing patient care by providing evidence-based and clinically relevant drug therapy considerations. They address both nonpharmacological and drug therapy options, focusing on effectiveness, safety, and cost.

RxFiles resources are used in primary and long-term care settings. Topics for academic detailing campaigns are chosen based on their potential to improve patient care and promote cost-effective drug use without compromising efficacy and safety. Input from prescribers, provincial priorities, drug utilization trends, and the RxFiles Advisory Committee guide topic selection.

Sleepwell is a bilingual research and knowledge mobilization program at Dalhousie University aimed at aligning insomnia care in Canada with the current research evidence and clinical guidelines. Sedative use across Canada is excessive, uneven, and results in serious, avoidable harms. Program objectives are to reduce sedative use and their associated harms (e.g., injurious falls, cognitive impairment) and improve uptake of cognitive behavioural therapy for insomnia (CBT-I), the first-line treatment of insomnia. The stepped care approach to managing insomnia recommends self-help CBT-I and sedative deprescribing options. Shaped by behaviour change theory as well as collaborations with patients, clinicians, and experts in sleep, psychology, medicine, and pharmacy, the Sleepwell program enables access to and use of self-help CBT-I programs and best practice approaches to sedative deprescribing. Sleepwell includes bespoke online and print tools and resources and recommends specific, vetted CBT-I programs (mysleepwell.ca). The program’s team leads innovative research, education, and policy projects to achieve its objectives, emphasizing public health and direct-to-patient approaches. Across Canada, it collaborates with other researchers, clinicians, educators, policy-makers, and community organizations and members of the public to elevate sleep as a national health priority.