SUMMARY OF NEAR MISSES (DAILY QAP 1 RECORDING FROM)

Month: Location: OPD / IPD

Pt's Particulars Data Entry PHIS Labelling Error Filling Error

Counter-checker/ D: Dispenser)

1) ETD 2) Discharge 3) Others

(T: Transcriber/ F: Filler/ CC:
Reporter's Name & Role
Contributing Factors
Dose/Freq/Dosage Form

Dose/Freq/Dosage Form

Personnel Involved

(refer to back page)

Strength/Dosage Form
Wrong Patient's Name

Wrong Patient's Name

Wrong Drug Name

Wrong Instruction

(PF/PRP/PPF)
Omission of Drug

Wrong Quantity

Type of Rx
Peak Hour
Unfilled Drug

Name of
Wrong Drug

Wrong drug
Time of MERS Ref
Diagnosis
Gender

Date Intended Error

Wrong

Wrong

Wrong
Age

Event No.

Metoprolol 50mg Tablet Metoprolol 50mg Tablet

2/5/2024 10:00 AM 77 M / F hypertension ✓ ✓ PF Ali A3, A4, C2 ✓ PF Abu (D) 08882 2
Discontinued Transcribed & Filled

M/F

M/F

M/F

M/F

M/F

M/F

M/F

M/F

M/F

M/F

M/F

M/F

M/F

M/F

http://mers.pharmacy.gov.my
Username : farmasi.hkapit
Password : P@ssword1234
Contributing Factors
A. Staff factors
B. Medication related
C. Work and environment
D. Task and Technology
E. Team Factor
Note: If the contributing factor is different from the MERS online classification, please report it as "Others, and please specify:
…...."
1 Inexperienced personnel
2 Inadequate knowledge
3 Distraction
4 Careless
5 Fatigue/Tired
1 Sound alike medication
2 Look alike medication
3 Look alike packaging
1 Heavy workload
2 Peak hour
3 Stock arrangements/ storage problem
4 Disturbance at workplace
5 Working environment
1 Failure to adhere to work procedure
2 Use of abbreviations
3 Illegible handwriting
4 Patient information/ record unavailable/ inaccurate
5 Wrong labeling/ instruction on dispensing envelope or bottle/ container
6 Incorrect computer entry
7 Availability/ Realiability of information
8 Computerized system error
1 Communication