Medication Safety Self-Assessment for Long-Term Care Introduction

This update of the Medication Safety Self-Assessment for Long Term Care (MSSA-LTC), Canadian, Version III has been undertaken as part of the Strengthening Medication Safety in Long-Term Care initiative, a 3-year partnership between the Institute for Safe Medication Practices Canada (ISMP Canada) and the Ontario Ministry of Long-Term Care. The initiative was launched in follow-up to recommendations from the Public Inquiring into the Safety and Security of Residents in the Long-Term Care System (Gillese Report). One of the deliverables of the initiative is to improve and update tools used by the sector to evaluate the safety of medication management systems in LTC Homes, and thereby enhance the ability of the sector to monitor medication safety and risk. One of these tools is the MSSA-LTC.

The MSSA-LTC is designed to support the LTC sector to evaluate the safety of medication management systems by:

  • Heightening awareness of the distinguishing characteristics of a safe medication system;
  • Identifying vulnerabilities and opportunities for improvement related to medication system safety;
  • Creating a baseline measurement of the current level of implementation of recommended strategies for medication safety; and,
  • Monitoring progress over time through periodic repeated measurement.

Development and validation of the revised assessment content was supported by an expert Advisory Panel, which included residents and family representatives, an interdisciplinary group of health care providers with direct care and leadership responsibilities, and representatives from professional associations and regulatory authorities. The validation process included a pilot test, followed by cognitive interviews completed by the Accessing Centre for Expertise of the Institute of Health Policy, Management and Evaluation at the University of Toronto.

Topics and content for this revision have been derived from a variety of sources, including:

  • Recommendations from the Gillese Report
  • Feedback from current users
  • ISMP Canada resources and learning from analysis (e.g., safety bulletins, MSSA programs)
  • ISMP, United States, resources (e.g., newsletters, MSSA programs)
  • National standards of practice and guidelines for medication management in LTC for physicians, nurses, pharmacists and pharmacy technicians
  • A literature search conducted by the Canadian Agency for Drugs and Technologies in Health (CADTH) focused on: medication management in LTC, medication system technology in LTC and incident analysis in LTC
  • This assessment also includes content from the Medication Safety Self Assessment: Focus on "Never Events" in Long-Term Care.


The MSSA-LTC has been widely used by the long-term care community in Canada since it was launched by ISMP Canada in 2006 and updated in 2012. To April 15th, 2021, a total of 852 facilities had submitted at least one assessment. The majority of users are long-term care Homes; however, the program has also been used by other types of organizations providing long-term care, including correctional facilities. An ISMP Canada Safety Bulletin published in 2019 describes 12 years of experience with the program.

ISMP Canada is not a standard-setting organization and the assessment items in this document are not intended to represent a minimum standard of practice. Some of the practices described in the items represent innovative practices and system enhancements that are not yet widely implemented; however, their value in reducing errors is grounded in research and expert analysis of medication incidents and their causes.

Individual Homes/facilities should not expect to score highly in all areas. The process of completing the MSSA-LTC is intended to identify areas of focus for quality improvement and enhancement of medication practices. MSSA-LTC results can be combined with learning from review of medication incident reports to support the Home/facility's quality improvement program. MSSA findings are intended for internal use and become more useful as repeat assessments are performed to see where improvements have been achieved over time and where challenges remain. MSSA findings are also useful for de-identified analysis and learning at a system level.

Structure of the MSSA

The self-assessment includes 176 items divided into 18 sections, referred to as "Key Elements". Each Key Element section is divided into one or more sub-sections, referred to as "Core Characteristics". Each Core Characteristic section includes a number of assessment items. Teams are asked to rank the current level of implementation for each assessment item.

Sections XII to XVII include content originally published in the MSSA: Focus on Never Events in Long-Term Care, 2019 with selected additional new content related to learning from the Gillese Report.

Privacy and Confidentiality

ISMP Canada is committed to protecting the privacy, confidentiality, and security of any information for which it is responsible. All activities related to MSSA data are conducted in compliance with ISMP Canada's privacy policy.

Individual Homes/facilities are able to access aggregate results for comparative purposes. Individual respondents cannot be identified from the aggregate results.

Aggregate data will be used by ISMP Canada for quality improvement, research and education purposes, including sharing de-identified summaries with system partners such as the Ministry of Long-Term Care in Ontario.