Ade And Near Miss Incident Classification Form Page 2
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38. Could this event have been prevented by any of the following checks?
(Choose all that apply)
____ ____ ____ ____
____ ____ ____
____
1. Computerized physician order entry (basic
5.
Changes in staffing for:
design which ensure complete field
5a. Physicians
legibility and signature)
5b. Nurses
2. CPOE with drug decision support
5c. Pharmacists
2a. Drug-weight or drug dose check
5d. Other, specify: _____________
(guided dose algorithms)
6. Changes in training for:
2b. Drug-allergy check
6a. Physicians
2c. Drug-drug check
6b. Nurses
2d. Drug-lab check
6c. Pharmacists
2e. Drug frequency check
6d. Other, specify: _____________
2f. Drug-route check
7. Changes in hours for:
2g. Drug-pt. characteristic check: renal
7a. Physicians
function
7b. Nurses
2h. Drug-pt. characteristic check: age
7c. Pharmacists
2i. Drug-pt. characteristic check:
7d. Other, specify: _____________
pregnancy
8. Changes in communication between:
2j. Drug-pt. characteristic check: other,
8a. Physicians and patients
specify: _______________
8b. Nurses and patients
2k. Drug duration
8c. Physicians and pharmacists
3. Electronic transmission of prescription
8d. Physicians and RNs, PAs, NPs, etc.
4. Clinical pharmacist
8e. Parents and other caregivers (babysitter,
4a. Discussing ordering
school)
4b. Discussing administration/monitoring
8f. Other, specify: _____________
4c. Monitoring/dispensing
8g. Pharmacists and patients
9.
Other, specify:
______________________________
10. None
11. Drug specific guidelines
12. Pre printed template
Page 2 of 3
6/6/05
Dataform 5: ADE and Near Miss Incident Classification Form
Version 5.0
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