. 2018 Dec 7;18(Suppl 5):113. doi: 10.1186/s12911-018-0687-6

Table 2.

Two similar medication event reports

Cases	Report Details
Report_1	Patient ordered: Take 1/2 of Drug A 0.5 mg tab for total dosage of 0.25 mg TID. When looking at the narc book to check what had been signed out since yesterday I noticed that [x] who gave the patient’s AM dose did not 1/2 the tablet that she gave. I double checked with the destruction log to see if anything was wasted and it was not. Patient received 0.5 mg instead of 0.25 mg. Informed adult day nurse [x] who will follow up with the charge nurse and inform the physician.
Report_2	39 units of Drug A drawn and administered instead of the required 14 units of Drug A as ordered. (Does have an order for 25 units of Drug A not QID)

Cases

Report Details

Report_1

Patient ordered: Take 1/2 of Drug A 0.5 mg tab for total dosage of 0.25 mg TID. When looking at the narc book to check what had been signed out since yesterday I noticed that [x] who gave the patient’s AM dose did not 1/2 the tablet that she gave. I double checked with the destruction log to see if anything was wasted and it was not. Patient received 0.5 mg instead of 0.25 mg. Informed adult day nurse [x] who will follow up with the charge nurse and inform the physician.

Report_2

39 units of Drug A drawn and administered instead of the required 14 units of Drug A as ordered. (Does have an order for 25 units of Drug A not QID)