Medication Error Report

Capture any mistake made while giving a drug to a patient: when it happened, what went wrong, the consequences and the contributing factors. Useful for hospitals and clinics reviewing incidents so they are not repeated.

Use this template

In the Claude connectors directory

Incident date

Incident time

Location

Inpatient ward Emergency department Intensive care unit Pharmacy Outpatient clinic Other

When was it discovered?

Describe the incident and how it happened in detail

What was the outcome of the incident?

No harm to patient Required extra monitoring Temporary harm Permanent harm Near miss, caught in time

Describe the outcome of the incident

Which factors contributed to the incident?

Illegible order Look-alike or sound-alike names Heavy workload Communication breakdown Insufficient training Distractions or interruptions Other

Explain the options you selected above in more detail

What should healthcare staff do to prevent this type of incident?

Section

Patient ID

Patient name

First Name

Last Name

Medical diagnosis

Age

Gender

Female Male Other Prefer not to say

Date of birth

Reporter name

First Name

Last Name

Position/Title

Phone number

Email

Section

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