Table 1.

Overview for assessing clinical impact

Level	Descriptor	Examples
1	None/insignificant—no harm would have occurred to the patient.	Wrong timing when optimal timing desirable but not critical ‘As required’ medicines that have only been required minimally during the admission not prescribed on discharge
2	Low/minor—would have caused minimal harm. May have required extra observation or minor treatment.	Regular or ‘as required’ medications taken prior to the admission and not prescribed, eg, topical preparations, laxatives, etc. Inappropriate continuation of a medicine with a good safety profile Brand not stated when this might impact on clinical outcome according to British National Formulary guidance
3	Moderate—could have resulted in a moderate increase in treatment with significant but not permanent harm to the patient.	Omitted or inappropriately prescribed long-term medicine (stopped drug restarted, therapeutic duplicate) Wrong drug or wrong dose; wrong route, wrong dose frequency Wrong brand when this is important according to British National Formulary guidance No instructions to step up or step down medications No stop date for short course of medicines
4	Severe/major—could have resulted in permanent harm	Errors involving the prescribing of high-risk drugs or failure to arrange monitoring in early stages of dose stabilisation New allergy or serious adverse drug event not documented