Medication Error and Near-Miss Report
Report what reached the patient and what did not. No name of the reporter required. Learning, not blame
What it is
A one-page report for any medication error or near miss: what happened, at which stage (prescribing, transcribing, dispensing, administering, monitoring), what reached the patient, harm level, contributing factors, immediate action — anonymous by default.
Where to use it
Every ward, pharmacy; box or online; reviewed weekly by the medication-safety lead. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning. Evidence for: Hospital Standard 4 — medication safety; Sentinel Event Policy; Governance — incident learning.
Translate and adapt
English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.
The same code is printed on the tool itself. Scan it in any facility to reach this page.
My Medicines — Patient Card
High-Alert Medicines — Double-Check Before You Give
Look-Alike / Sound-Alike Medicines — Facility List Template
Medication Reconciliation — Admission and Discharge
Print to share.
