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    Medication Error Reporting Form

    Uploaded by

    Rani Wulandari
    The document provides information about medication error reporting at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). It defines medication error, provides examples, and explains that reporting is blame-free and confidential. It encourages reporting all errors to help improve patient safety and prevent future errors. It outlines who can report errors, when they should report them, and how to complete and submit the medication error reporting form.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Medication Error Reporting Form

    Uploaded by

    Rani Wulandari
    2K views3 pages
    The document provides information about medication error reporting at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). It defines medication error, provides examples, and explains that reporting is blame-free and confidential. It encourages reporting all errors to help improve patient safety and prevent future errors. It outlines who can report errors, when they should report them, and how to complete and submit the medication error reporting form.

    Original Description:

    MEDICATION ERROR

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    The document provides information about medication error reporting at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). It defines medication error, provides examples, and explains that reporting is blame-free and confidential. It encourages reporting all errors to help improve patient safety and prevent future errors. It outlines who can report errors, when they should report them, and how to complete and submit the medication error reporting form.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    2K views3 pages

    Medication Error Reporting Form

    Uploaded by

    Rani Wulandari
    The document provides information about medication error reporting at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). It defines medication error, provides examples, and explains that reporting is blame-free and confidential. It encourages reporting all errors to help improve patient safety and prevent future errors. It outlines who can report errors, when they should report them, and how to complete and submit the medication error reporting form.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)

    Medication Error Reporting Form


    (A blame free reporting tool)
    Please tick the appropriate box. All fields must be filled except details of reporter which is optional.
    he appropriate box. All fields are mandatory.
    1. Date of event: _____________
    2. Location of event:
    Ward
    OPD
    Pharmacy
    Others ___________
    Time of event: _____________
    3. Type of error:

    4. Patient details:

    Prescribing

    Dispensing

    Age:

    Gender:

    Administration

    Others (specify)

    Diagnosis:

    ------------------------

    5. Description of the event: (how did the event occur and how was it detected?)

    6. Details of medicines involved in the event:

    7. Did the error reach the patient?


    Yes

    S. No.

    Dosage
    Form

    Generic Name

    8. Outcome of the event:


    No error
    A. Events have
    potential to
    cause error

    9. Possible causes & contributing factors:


    Lack of
    knowledge /
    experience
    Illegible prescription

    No

    Strength Frequency

    Unavailable
    patient information
    Peak hour
    Miscommunication

    Look alike / sound alike


    medication

    Failure to adhere to work

    Wrong labeling / instruction

    procedure

    Use of abbreviations

    Others ____________

    Error, No harm
    B. Error did not
    reach patient
    C. No harm
    D. No harm but
    requires
    monitoring

    Error, harm
    E. Temporary harm
    requiring treatment
    F. Temporary harm
    requiring
    hospitalization
    G. Permanent harm
    H.

    Near
    death event

    Error, death
    I.

    Death

    10. Details of reporter: (optional)


    Name:
    Designation:
    Mobile No:

    11. Intervention done:


    Administered antidote
    Education / training provided

    Changed to correct drug / dose / frequency


    Communication process improved

    No action needed
    Others (specify)

    Informed staff who made error

    Policy / procedure changed / instituted

    Report All Medication Errors

    Its blame free


    What is medication error?
    Medication error is defined as any preventable event that may cause or lead to inappropriate medication use or
    patient harm, while the medication is in the control of health care professional, patient or consumer. Such
    events may be related to professional practice, health care products, procedures and systems including
    prescribing, dispensing and administration.
    Examples of medication errors

    Therapeutically incorrect order (drug / dose / frequency / route)


    Illegible / incomplete prescription
    Abbreviations, improper use of decimal points (missing leading zero /unnecessary trailing zero)
    Noncompliance with order while dispensing / administration
    Use of deteriorated / expired products

    Why should I report?


    Medication errors are an important preventable cause of morbidity and mortality. If errors are reported,
    corrective measures can be undertaken to prevent them. This will improve the safety of the patients.
    Moreover, medication error reporting is blame free.
    Are there issues concerning the confidentiality of the patient / person committing error?
    There are absolutely no issues regarding confidentiality as the identifier information (like name, hospital
    number) of either the patient or the person committing the error need not be reported. The details of the
    reporter are optional and when furnished, will be kept confidential.
    What to report?
    All medication errors should be reported. Even potential errors (events that have potential to cause error) can
    be reported. A few examples of medication errors are given above.
    Please do remember that there is no blame and you can report any medication error committed by anyone.
    Who can report?
    Any health care professional (doctors, nurses, pharmacists and allied health care professionals) can report
    medication errors.
    When to report?
    Whenever you come across a medication error, committed by self or anyone, you can report. There is no strict
    timeline within which it should be reported. But it is advisable to report immediately.
    How to report?
    Please fill in the medication error reporting form completely (details of reporter is optional) and send it by
    email to JIPMER Quality Council (E-mail : [email protected]). The medication error reporting forms are
    freely available in all wards / OPDs and can also be downloaded from JIPMER website (www.jipmer.edu.in).

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