Wrong dose administered Patient split their tablet No The report does not mention (labelling doesn’t advise an error, instead it confirms against splitting the tablet) that this is not a medication error because the label does not advise not to split. There is nothing to code in the provided text. Prescriber advised patient to Yes Drug prescribing This is a prescribing error split the tablet, unaware that error that resulted in the patient the labelling states to splitting the tablet. This is swallow whole. Patient split not a case of off label use, Tablet split by the tablets. as the prescriber was mistake unaware that the tablet should not be split. Patient should be on Drug A Yes Wrong drug This is a drug” “Wrong but instead got Drug B; it is medication error; the stage unclear where the error where the error occurred is occurred not stated (e.g., at prescribing, dispensing, selection, or administration) A generic was incorrectly Yes Product substituted for the brand substitution name product although the (HLT Medication physician specifically errors, product prescribed the brand name use errors and product with no substitution issues NEC) Patient had thrown Yes Incorrect disposal medicated opioid patches in of medication the open bin instead of disposing as recommended Accidental in the label. Their child exposure to experienced an overdose product by child after playing with the patches. Accidental overdose
Wrong dose administered Patient split their tablet (labelling doesn’t advise against splitting the tablet) No The report does not mention an error, instead it confirms that this is not a medication error because the label does not advise not to split. There is nothing to code in the provided text. Prescriber advised patient to split the tablet, unaware that the labelling states to swallow whole. Patient split the tablets. Yes Drug prescribing error Tablet split by mistake This is a prescribing error that resulted in the patient splitting the tablet. This is not a case of off label use, as the prescriber was unaware that the tablet should not be split. Patient should be on Drug A but instead got Drug B; it is unclear where the error occurred Yes Wrong drug This is a “Wrong drug” medication error; the stage where the error occurred is not stated (e.g., at prescribing, dispensing, selection, or administration) A generic was incorrectly substituted for the brand name product although the physician specifically prescribed the brand name product with no substitution Yes Product substitution (HLT Medication errors, product use errors and issues NEC) Patient had thrown medicated opioid patches in the open bin instead of disposing as recommended in the label. Their child experienced an overdose after playing with the patches. Yes Incorrect disposal of medication Accidental exposure to product by child Accidental overdose
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