Date of incident: 16/2/2015

Error type: dispensing error

Patient age: 54

Patient sex: male

Brief summary of incident: dispensed wrong strength of plendil (10mg instead of what should have been 5mg tablets)

Name of medication: Plendil;

Level of harm that could have occurred: 4

The reason you think the potential harm is at the level you have chosen:
because the wrong strength was dispensed this could have resulted in a potential over dose

Possible cause/contributory factors: not doing a second accuracy check and not being thorough enough

Reasons why incident occurred and actions required to prevent reoccurence:
i have already made a checklist for clinical and accuracy checking and the labelling process so that no steps are missed in the dispensing process

Best description of this error/near miss:
wrong dose strength