Get Medication Incident And Discrepancy Report Form

Filling out the Medication Incident And Discrepancy Report Form is a crucial step in ensuring patient safety and the appropriate handling of medication errors. This guide provides clear, step-by-step instructions to help users complete the form effectively online.

Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the error date in the designated field, including the hour, day, month, and year of the incident.
3. Enter the discovery date when the medication incident was brought to your attention, ensuring all date components are filled out.
4. Assign an incident report number for tracking purposes in the related field.
5. Provide the patient information, including their name, address, phone number, sex, date of birth, prescription number, and PHIN number.
6. Identify the pharmacist initiating the report by providing their name and entering the required date of submission.
7. Specify the drug ordered, including the drug name, dose, form, route, and directions for use in the summary field.
8. Indicate the type of incident by selecting from the provided options for the patient's received drug, checking all that apply.
9. Detail any incidents or discrepancies where a patient did not receive the drug, selecting the appropriate category and providing specifications.
10. Describe the incident or discrepancy in detail, including all pertinent facts and observations at the time of discovery.
11. Complete the contributing factors section by checking all relevant factors that contributed to the incident.
12. Fill out the notification information, including whether the patient and physician were notified of the incident and the respective notification times.
13. Assess and select the severity of the incident, choosing from none, minor, or major severity levels.
14. Outline the outcome of the investigation and any follow-up actions that were identified.
15. Sign and date the form where indicated for both the pharmacist completing the report and the pharmacy manager, ensuring that all sections are reviewed.
16. Once the form is fully completed, save changes, and choose to download, print, or share the form as necessary.

Complete your Medication Incident And Discrepancy Report Form online today to ensure accurate documentation and patient safety.