Table 1 Examples of medication errors by severity index
MINOR (Severity index between 0 and 3) |
|---|
An excess amount of Hyabak® (ophthalmic solution, 0.15%) was administered into the patient's right eye |
The patient was prescribed dimethicone (drops, 75 mg/mL) but was administered one tablet (40 mg) |
MODERATE (Severity index between 3 and 7) |
Patient was on spironolactone (tablet, 100 mg). However, the medication was not administered |
The patient was prescribed furosemide (solution for injection, 10 mg/mL). The dilution manual advises infusion between 1 and 2 min; however, administration was performed in 11 s |
SEVERE (Severity index higher than 7) |
Warfarin* (tablet, 5 mg) was offered to the patient; however, the medication was prescribed for another patient. Intervention was performed before administration |
Patient on hydralazine (tablet, 25 mg). There was an instruction not to administer the antihypertensive on hemodialysis days. However, the drug was administered on the same day as hemodialysis |