It may not happen often, but there are times in dispensing medication when an error is made and the error affects the patient. In cases like these, a pharmacy incident report needs to be filed.
The incident report is then sent to the manager of the pharmacy, the company headquarters, and anyone responsible for potential liability claims. The purpose of this is to determine why the error occurred and what can be done to prevent it from happening again.
The reports are confidential and protected under HIPAA regulations, but it is important to understand that they can be subpoenaed and used as evidence in litigation. So, when an incident report is put together, this fact needs to be kept in mind.
And because the report can be used as evidence in legal proceedings, it should contain the facts of the case exclusively and avoid opinions or other analysis or criticism about what happened. A second report, one that is protected from outside scrutiny, should be filed as well, and this one should contain a more in-depth analysis of what went wrong that could be useful in making changes to pharmacy operations.
While sticking to the facts, incident reports should be detailed about what happened. To say simply that an error was made in dispensing a certain medication does little to explain the case. The report should detail what occurred at each step of the process from the time the medication was ordered. The person completing the report needs to take care in describing what happened. The report needs to be comprehensive and accurate.
The National Reporting and Learning System (NRLS) lays out the kind of information an incident report should contain. It should, for example, describe the setting, such as a medical center or doctor’s office. It should give the location of the incident, date and time, what factors led to the incident, a description of what happened, what steps will be taken to prevent it from recurring, details about the patient, and any harmful effects to the patient.
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