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  • Dispensing Errors Incident Form

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    Yoga Mesi
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    This document is a dispensing error incident form that collects information about medication dispensing mistakes. It requests details such as the patient's name and contact information, the drug and prescription in question, the nature of the error like incorrect strength or dosage, whether the drug was ingested, who was contacted about the incident, and the reason for the error and corrective actions taken to prevent future issues.

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    Original Title

    Dispensing Errors Incident Form(1)

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    This document is a dispensing error incident form that collects information about medication dispensing mistakes. It requests details such as the patient's name and contact information, the drug and prescription in question, the nature of the error like incorrect strength or dosage, whether the drug was ingested, who was contacted about the incident, and the reason for the error and corrective actions taken to prevent future issues.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    20 views1 page

    Dispensing Errors Incident Form

    Uploaded by

    Yoga Mesi
    This document is a dispensing error incident form that collects information about medication dispensing mistakes. It requests details such as the patient's name and contact information, the drug and prescription in question, the nature of the error like incorrect strength or dosage, whether the drug was ingested, who was contacted about the incident, and the reason for the error and corrective actions taken to prevent future issues.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Dispensing Error Incident Form

    PATIENT NAME DRUG NAME/STRENGTH PRESCRIPTION NUMBER

    ADDRESS TELEPHONE

    PATIENT AGE DATE INCIDENT DISCOVERED DATE OF DISPENSING

    INCIDENT DISCOVERED BY DISPENSING PHARMACIST

    ❏ New Rx ❏ Repeat Rx

    NATURE OF INCIDENT:
    ❏ Incorrect Drug ❏ Incorrect Strength ❏ Verbal Disagreement
    ❏ Incorrect Directions ❏ Incorrect Brand
    ❏ Incorrect Dosage Form ❏ Incorrect Quantity ❏ Other (please specify):
    ❏ Incorrect Patient ❏ Outdated Medication

    DETAILS OF INCIDENT:

    WAS DRUG INGESTED? ❏ YES ❏ NO If yes, was medical attention required?

    PATIENT CONTACTED BY DATE/TIME

    PRESCRIBER CONTACTED BY DATE/TIME

    PRESCRIBER’S NAME TELEPHONE

    PRESCRIBER’S COMMENTS

    REASON FOR INCIDENT


    PHARMACY CONNECTION March/April 1995

    CORRECTIVE ACTION(S) TAKEN

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