Definitions of error and discrepancy types
| Discrepancy/error type | Definition |
|---|---|
| Medication administration errors | |
| Unauthorised medication/fluids (no documented order) | Fluids/medications are being administered but no medication order is present. This includes failure to document a verbal order if these are permitted as per hospital policy. |
| Wrong medication or fluid | A different fluid/medication/diluent as documented on the intravenous bag (or bottle/syringe/other container) is being infused compared with that specified on the medication order or in local guidance. |
| Concentration discrepancy | An amount of a medication in a unit of solution that is different from that prescribed. |
| Dose discrepancy | The same medication but the total dose is different from that prescribed. |
| Rate discrepancy | A different rate is being delivered from that prescribed. Also refers to weight-based rates calculated incorrectly including using a different patient weight from that recorded on the patient's chart. |
| Delay of dose or medication/fluid change | An order to change the medication or rate not carried out within 4 h of the written medication order, or as per local policy. |
| Omitted medication or intravenous fluids | The medication prescribed was not administered. |
| Allergy oversight | Medication is prescribed/administered despite the patient having a documented allergy or sensitivity to the drug concerned. |
| Expired drug | The expiry date/time on either the manufacturer's or additive label has been exceeded. |
| Roller clamp discrepancy | The roller clamp is not positioned appropriately/correctly. |
| Procedural and documentation discrepancies | |
| Patient identification error | Patient either has no identification (ID) band on wrist, or information on their ID band is incorrect. |
| Wrong or missing information on additive label | Any incorrect or missing information on the additive label, as required by hospital policy |
| Tubing not tagged according to policy | Tagging or labelling of tubing is different (either missing or incorrect) from requirements in hospital policy. |
| Documentation error | Medication/fluids administered but not documented correctly on chart, eg, missing signature, start time, etc. |