Guam Medication Data Form - Medication Error and Near Miss Classification

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US-02260BG
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This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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FAQ

Draw a single line through the erroneous entry and write the time, date, and your name. Identify the reason for the correction. Include the rationale in your notation; for example, ?mistaken entry, wrong medication name written.? Follow facility policy when adding late information.

Health care professionals and consumers have the opportunity to report the occurrence of medication errors to a variety of organizations. Examples include the Institute of Safe Medication Practices (ISMP) and the Food and Drug Administration (FDA). These organizations collectively review error submissions.

A Medication Error Report Form is a document used when reporting a medication error incident from health care settings like hospitals or clinics. This type of form helps to improve the way the medications are being administered and ensure the safety of the patient.

Include in your report a description of the error or drug reaction; whether it was actual or potential (that is, did the medication reach the patient, or was the error discovered first?); when and how it was discovered; patient outcome; drug name, dosage, form, and strength; the source of the error (such as the ...

Table of Contents CategoryDescriptionANo error, capacity to cause errorBError that did not reach the patientCError that reached patient but unlikely to cause harm (omissions considered to reach patient)DError that reached the patient and could have necessitated monitoring and/or intervention to preclude harm5 more rows

34.1 Category I An error occurred that may have contributed to or resulted in the patient's death. [ Classify each medication involved in a medication error. Include the intended product for use, as well as the actual product used, if these are different.

Include in your report a description of the error or drug reaction; whether it was actual or potential (that is, did the medication reach the patient, or was the error discovered first?); when and how it was discovered; patient outcome; drug name, dosage, form, and strength; the source of the error (such as the ...

The Institute for Safe Medication Practices further defines a near miss as ?any event or situation that didn't produce patient injury, but only because of chance.?2 For reporting purposes, a near miss is considered an error, as is a medication error that doesn't result in patient harm.

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Guam Medication Data Form - Medication Error and Near Miss Classification