Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by filling in the pharmacy details. Provide the pharmacy or branch name, branch number (if applicable), and the reference number from the NRLS report, which you obtain upon completing the NRLS report.
3. Next, proceed to the incident details section. Fill in the date and time of the incident, the location where it occurred, and a detailed description of what happened. Make sure to indicate the degree of harm to the patient, selecting from options such as near miss, no harm, low, moderate, or severe.
4. In the section regarding symptoms experienced by the patient, provide clear details if they took or used the medicine or device involved in the incident.
5. Complete the details of the main patient affected by the incident. This includes the patient's name, address, telephone number, date of birth, sex, and ethnic category. Also, indicate if the patient has any known disabilities or impairments.
6. Identify any contributing factors. This section allows you to select from various factors, including communication, education and training, equipment usability, and more. Choose all that apply to the incident.
7. Specify at what stage of the medication process the error occurred. Options include prescribing, preparation of medicines, administration, monitoring, and others.
8. Detail the medication incident itself by choosing the most accurate description from the options provided, such as adverse drug reactions, omitted medicine, or wrong dosage.
9. List any other important factors that might have contributed to the incident. You can select multiple factors from the provided options.
10. If applicable, provide details for both the correct and incorrect medicines or medical devices involved. Include the name, form, dose and strength, route, manufacturer, batch number, and whether it was a parallel import.
11. Document the names and details of staff involved in the incident, including the prescriber and the individual responsible for completing this report.
12. Finally, indicate any actions required post-incident, such as referrals to other professionals, notification of responsible healthcare personnel, and whether the report should be submitted to the NRLS.
13. Once all sections are completed, review your entries for accuracy. You can save changes, download, print, or share the completed form as needed.

Complete your UK CPE Medication Safety Incident (External) Report Form online today to enhance medication safety within your pharmacy.