Background The US Institute for Safe Medication Practices' (ISMP) Medication Safety Self-Assessment (MSSA) tool for hospitals is a comprehensive tool for assessing safe medication practices in hospitals. Aims To adapt and remodel the ISMP MSSA tool for hospitals so that it can be used in individual wards in order to support long-term medication safety initiatives in Finland. Methods The MSSA tool was first adapted for Finnish hospital settings by a four-round (applicability, desirability and feasibility were evaluated) Delphi consensus method (14 panellists), and then remodelled by organizing the items into a new order which is consistent with the order of the ward-based pharmacotherapy plan recommended by the Ministry of Social Affairs and Health. The adapted and remodelled tool was pilot tested in eight central hospital wards. Key findings The original MSSA tool (231 items under ten key elements) was modified preliminarily before the Delphi rounds and 117 items were discarded, leaving 114 items for Delphi evaluation. The panel suggested 36 new items of which 23 were accepted. A total of 114 items (including 91 original and 23 new items) were accepted and remodelled under six new components that were pilot tested. The pilot test found the tool time-consuming but useful. Conclusion It was possible to adapt the ISMP's MSSA tool for another hospital setting. The modified tool can be used for a hospital pharmacy coordinated audit which supports long-term medication safety initiatives, particularly the establishment of ward-based pharmacotherapy plans as guided by the Ministry of Social Affairs and Health.