Date of incident: 6/3/2013

Error type: dispensing error

Patient age: N/A

Patient sex: female

Brief summary of incident: oxynorm 5mg/5ml was dispenced from a pcd1 in which the quantity to be dispenced was not written in both words and figures

Name of medication: oxynorm liquid 5mg/5ml;

Level of harm that could have occurred: 5

The reason you think the potential harm is at the level you have chosen:
Although a legal issu the wrong quantity could have been dispenced leadign to an overdose for the patient or the patient continuing to take the medication for longer than the prescriber intended

Possible cause/contributory factors: Confusion around whether this was a requirement for private scripts

Reasons why incident occurred and actions required to prevent reoccurence:
encorporating this into my checking frame work

Best description of this error/near miss:
Legal issue