CQA Volunteer Application Form

Thank you for your interest in participating in our Continuous Quality Assurance for Medication Safety Phase 1 implementation.

To support you as a Phase 1 volunteer, the College will provide in-person training on the reporting system as well as resources and support for all other elements of the CQA program. You will also be able to access technical support and reference materials and tools. There is no cost to your pharmacy to participate in Phase 1.

As a Phase 1 volunteer, you will be expected to:

Fully implement the program in your pharmacy starting in January 2018, involving all appropriate staff;
Attend in person training in November or December 2017 (two participants from the pharmacy need to attend);
Provide comprehensive and regular feedback to the College and our reporting system vendor, including feedback on barriers to implementation, challenges encountered with the program and use of the technology/software; and
Participate in evaluation exercises to measure results of the program.

To help us in our selection of practice sites, we would like to gather more information from you about your pharmacy.

Please note that the College is looking for a diversity of practice environments. We welcome all interested pharmacies to complete the form; however, the College does not guarantee that your pharmacy will be selected as a volunteer site.

Thank you for considering working with the College as a partner in this important patient-safety program.