Standards › Standard S1 › Forms
Form · HOS-FRM-014 · Version 1.0 · Approved by the ASF Expert Committee
Supports: System S1 (Hospital), criterion S1.22
Purpose
The paper prescription and dispensing record used when the electronic system is down. It carries the checks the software normally makes.
How to complete
- Use for every prescription during downtime.
- Make the software checks by hand, and tick each one.
- Dispense against the form, and check the item.
Checks
| Check | Entry |
|---|---|
| Allergies checked | Yes |
| Weight and renal function checked | Yes |
| Interactions checked | Yes |
| Dose and route checked | Yes |
| Independent check for high-alert items | Yes |
| Entered into the system when it is back | Yes |
Evidence
| Reference | Note |
|---|---|
| E-007 | WHO Nine patient safety solutions (2007). |
| E-006 | ASF Policy Framework v1.2. Adapted. |
| E-009 | ASF Expert Committee consensus. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version | set Expert Committee approval |
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References
- Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)
- World Health Organization (2007). Nine patient safety solutions, including correct patient identification. Geneva: WHO. Open source (E-007)
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