Date of incident: 29/01/2013

Error type: dispensing error

Patient age: adult

Patient sex: male

Brief summary of incident: strip of ten tablets fell out of box onto floor at beginning of counselling, therefore patient only got some of there medication

Name of medication: desloratadine;

Level of harm that could have occurred: 1

The reason you think the potential harm is at the level you have chosen:
although no harm would come to the patient, it may pose problems if patient where to try to get another months supply as they would be coming to the doctors too early, additionally if this error had have occured in next weeks class, the patient may have recieved the incorrect length of treatment leading to ineffective treatment and possibly encouraging antimicrobial resistance.

Possible cause/contributory factors: carelessness and trying to get through the counselling process whilst remembering all the points to go through, should have used skillet as box was very loose

Reasons why incident occurred and actions required to prevent reoccurence:
checking the packaging is appropriate and secure, if not use skillet instead ensure correct number of tablets in boxes prior to counselling.

Best description of this error/near miss:
wrong quantity