Error
DM/
Nama Area RSM Tanda tangan
Komentar
ggal
Pelapor
elamin
ngan Pengobatan
ng Berhubungan
gkin-Tidak Tahu-Tidak
gkin-Tidak Tahu-Tidak
gkin-Tidak Tahu-Tidak
gkin-Tidak Tahu-Tidak
gkin-Tidak Tahu-Tidak
Tidak Tahu
Dosis Tanggal
Lainnya
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Accidental drug intake by child ◦
Accidental exposure ◦
Accidental overdose ◦
Documented hypersensitivity to administered drug ◦
Drug administered at inappropriate site ◦
Drug administration error ◦
Drug dispensing error ◦
Drug dose omission ◦
Drug exposure via breast milk ◦
Drug label confusion ◦
Drug name confusion ◦
Drug prescribing error ◦
Expired drug administered ◦
Inappropriate schedule of drug administration ◦
Incorrect dose administered ◦
Incorrect drug administration duration ◦
Incorrect drug administration rate ◦
Incorrect drug dosage form administered ◦
Incorrect route of drug administration ◦
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Incorrect storage of drug
Intentional overdose
Intercepted drug administration error
Intercepted drug dispensing error
Intercepted medication error
Labelled drug-disease interaction medication error
Labelled drug-drug interaction medication error
Labelled drug-food interaction medication error
Multiple drug overdose
Multiple drug overdose accidental
Multiple drug overdose intentional
Overdose
Poor quality drug administered
Radiation exposure
Radiation overdose
Radiation underdose
Underdose
Vaccination error
Wrong drug administered
Wrong technique in drug usage process