Strengthening medication safety infrastructure in U.S. community pharmacies: Lessons from national survey data, Ontario's AIMS, and California policy.

Community pharmacies dispense most medications in the United States and represent a high-frequency point of patient interaction, yet medication-safety policy in this setting remains fragmented compared to inpatient pharmacy settings. Hospitals benefit from established safety reporting infrastructures, while comparable system-level mechanisms for learning from medication errors and near misses are absent in community pharmacy practice. This commentary draws on publicly available U.S. data from the Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture (SOPS) (2015 and 2019) to illustrate persistent gaps in medication-error documentation, near-miss reporting, and workplace conditions. Across both survey years, documentation was consistently high when errors reached patients but lower for near misses, limiting preventive learning. Staffing, work pressure, and pace were the lowest-performing safety culture factors, reflecting organizational conditions that constrain safety practices. Guided by the American Public Health Association's multicomponent framework and the American Pharmacists Association's call for just culture, these findings are contextualized with two illustrative models: Ontario's standardized medication incident reporting system, and California's Assembly Bill 1286, which links workforce protections to patient safety. Together, these examples show that transparency alone is insufficient. Effective medication-safety improvement requires standardized reporting infrastructures, reporting safeguards, and workforce conditions that enable continuous learning, feedback, and adaptive change. Strengthening medication safety in U.S. community pharmacies will require coordinated investment by federal and state regulators, professional boards, and pharmacy organizations in standardized reporting infrastructures, non-punitive reporting safeguards, workforce protections, and sustained surveillance systems to reduce preventable patient harm.