Submit This Form Only by 2Nd Week of December 2013 To

Audit Results Form

Complete the audit for a 4 week period during November 2013 then transfer ranking for each answer from the Tally Charts to this Audit Results Form.

Submit this form only by 2nd week of December 2013 to

Pharmacy Name
Pharmacy Address
Pharmacy Tel No.
Person Completing Audit
Pharmacist In Charge
Person/ persons detecting the near miss error / Ranked (most common =1)
Pharmacist / Pre-registration pharmacist
ACT
Dispenser
Counter assistant
Person/ persons detecting the dispensing error
GP
Nurse
Patient / patient’s representative
Hospital staff
Other – includes pharmacy staff
Stage at which near miss detected / Ranked (most common =1)
Labelling
Dispensing
Final check
Bagging up
Handing out
Stage at which dispensing error detected
Filling prescriptions
Endorsing prescriptions
Before taking medication
After taking medication
GP visit
In hospital
Type of error – labelling / Near miss
Ranked (most common =1) / Dispensing error
Ranked (most common =1)
Wrong drug name on the label
Wrong strength on the label
Wrong directions on the label
Wrong patient name on the label
Type of error - selection / Near miss
Ranked (most common =1) / Dispensing error
Ranked (most common =1)
Wrong drug selected
Wrong form selected
Wrong strength selected
Wrong quantity supplied
Type of error - bagging / Near miss
Ranked (most common =1) / Dispensing error
Ranked (most common =1)
Wrong name on the bag
Wrong address on the bag
Item (s) omitted from the bag
Extra item(s) in the bag
Type of error / Near miss
Ranked (most common =1) / Dispensing error
Ranked (most common =1)
Labelling
Selection
Bagging
Possible cause of error / Near miss
Ranked (most common =1) / Dispensing error
Ranked (most common =1)
Similar drug name
Similar packaging
Picked next medicine on the shelf
Medicine in wrong place on the shelf
Hand written prescription
Ambiguous directions
Misread prescription
Typing mistake
Used previous drug / dose on PMR
Incorrect drug selected
Labels swapped
Other
Circumstances associated with the error / Near miss
Ranked (most common =1) / Dispensing error
Ranked (most common =1)
Busier than normal
Quieter than normal
Less staff than usual
Not the usual pharmacist
Not the usual dispenser
Telephone interruption
Staff query
Customer / patient query
Busy OTC trade
Other

Information summary

Errors are most commonly detected at the stage of the dispensing process

The person most likely to find errors is

The most common type of error is

The most common possible cause of dispensing errors is

The most common circumstance associated with dispensing errors is

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