Incident Log
Date of incident: 18/01/2023
Error type: dispensing error
Patient age: 64
Patient sex: male
Brief summary of incident: Advised the patient to wait one week before seeking help if glyceryl trinitrate spray not resolving angina symptoms and patient was therefore placed at serious risk .
Name of medication: Glyceryl trinitrate spray ;
Level of harm that could have occurred: 5
The reason you think the potential harm is at the level you have chosen:
The patient could have die from a cardiac incident had they waited this long
Possible cause/contributory factors: Lack of consideration on the safe use of medicines
Reasons why incident occurred and actions required to prevent reoccurence:
Take more time to consider the specific condition indicated and the safe use of medicines surrounding it.
Best description of this error/near miss:
verbal direction to patient wrong or omitted
Error type: dispensing error
Patient age: 64
Patient sex: male
Brief summary of incident: Advised the patient to wait one week before seeking help if glyceryl trinitrate spray not resolving angina symptoms and patient was therefore placed at serious risk .
Name of medication: Glyceryl trinitrate spray ;
Level of harm that could have occurred: 5
The reason you think the potential harm is at the level you have chosen:
The patient could have die from a cardiac incident had they waited this long
Possible cause/contributory factors: Lack of consideration on the safe use of medicines
Reasons why incident occurred and actions required to prevent reoccurence:
Take more time to consider the specific condition indicated and the safe use of medicines surrounding it.
Best description of this error/near miss:
verbal direction to patient wrong or omitted