NO.	Failure Mode	S	O	D
Doctor prescription (NO. 1–NO. 13)	NO. 1	Improper drug selection, drug selection without indications
	NO. 2	Incorrect off-label drug use
	NO. 3	Incorrect route of administration
	NO. 4	Incorrect dose of medicine administered
	NO. 5	Solvent error
	NO. 6	No specification of the rational order of administration of chemotherapy
	NO. 7	Failure to give patients reasonable chemotherapy pretreatment steps
	NO. 8	Prescription missing drugs
	NO. 9	Prescribing drugs with incompatibility and drug interactions (incompatibility and drug interactions are unknown)
	NO. 10	Prescription of inappropriate medicines without considering the patient’s contraindications; e.g., certain medicines are not suitable for certain groups of people (children, elderly people, pregnant and lactating women, people with hepatic or renal insufficiency)
	NO. 11	Lack of attention to medical practice and medication records
	NO. 12	Prescription without knowledge of the patient’s previous treatment options or without reference to the patient’s treatment by other doctors
	NO. 13	Failure to inform patients about safe use of medication, precautions for use of medication
Pharmacist deployment (NO. 14–NO. 21)	NO. 14	Mis-issued medicines
	NO. 15	Drugs are missed
	NO. 16	Mixing up patients when giving out medicines
	NO. 17	No review of the doctor’s prescription and prescription error not detected in time
	NO. 18	Prescription error found but not corrected
	NO. 19	No verbal explanation or paper instructions to the patient on use of the medication after it has been dispensed
	NO. 20	When patients make enquiries after taking drugs, pharmaceutical care is not provided in place, medication consultation service is missing
	NO. 21	Pharmacist deployment: pharmacists are far away from clinical practice, exhibit poor participation in ward rounds, and fail to provide pharmaceutical care such as medication consultation and post-medication monitoring to patients in a timely manner
Nurse administration (NO. 22–No. 33)	NO. 22	Not strictly following medical advice, not being familiar with medical advice, dispensing the wrong medication, etc.
	NO. 23	No further review of medical advice
	NO. 24	When equipped with drugs is interrupted, interference, distractions, etc.
	NO. 25	Incorrect choice of solvents
	NO. 26	Incorrect dose conversions, incorrect dose preparation
	NO. 27	Improper time interval between dosing
	NO. 28	Incorrect mode of administration (route of administration)
	NO. 29	Duration of chemotherapy infusion/infusion titration rate is not controlled within the normative time frame (e.g., paclitaxel infusion requires a titration time of >3 h)
	NO. 30	Failure to observe hygiene (e.g., hand hygiene) when administering medication to patients
	NO. 31	Confusion of patients or drugs when giving medication
	NO. 32	Failure to educate patients about safe medication use such as precautions when administering medication
	NO. 33	Failure to closely monitor the patient’s underlying condition after administration
Patient medication and post-medication monitoring (NO. 34–NO. 49)	NO. 34	Failure to take premedication as prescribed before chemotherapy
	NO. 35	Failure to take medication regularly and on time (repeated doses, missed doses, etc.)
	NO. 36	Increase or decrease in the dose of medication and adjustment of the drip rate without permission
	NO. 37	Unauthorized change of medication
	NO. 38	Unauthorized use of Traditional Chinese medicine and folk prescription and unauthorized drug addition (incorrect self-medication)
	NO. 39	Refusal of medication and random discontinuation of medication
	NO. 40	Noncompliance with dietary and behavioral restrictions and recommendations
	NO. 41	Incorrect storing or differentiating of one’s own medicines
	NO. 42	No attention to drug instructions
	NO. 43	No care given to the risk of adverse drug reactions during medication administration
	NO. 44	Poor patient understanding of prescribed medication and treatment
	NO. 45	Patient unable to adequately self-administer medication and requires supervised administration
	NO. 46	Poor communication of information between patients and medical staff
	NO. 47	Patients’ chemotherapy complications, adverse reactions, etc., are overlooked by medical staff or carers
	NO. 48	Patients are given too little information about antineoplastic drugs before starting treatment, and patients do not know or recognize the signs of complications or serious disease
	NO. 49	Inadequate post-medication monitoring by medical staff to detect anemia, thrombocytopenia, or chemotherapy-induced electrolyte disturbances
Medical organization management (NO. 50–NO. 60)	NO. 50	No clear pharmaceutical administration, or the division of responsibility is not clear
	NO. 51	Insufficient continuing education and drug safety knowledge training, failure to become updated in the latest knowledge in the field, and lack of training on relevant operating procedures
	NO. 52	No regular organized prescribing reviews or summary learning of medication safety incidents
	NO. 53	Hospital prescription system is not well computerized and is not equipped with a front-end prescription review system (unable to alert and intercept doctors when they prescribe unreasonably)
	NO. 54	The reporting system of adverse drug reactions/adverse events is incomplete and the reporting system is missing
	NO. 55	Lack of rules and regulations for safe medication use or inadequate enforcement of the system; inadequate patient safety culture in the hospital
	NO. 56	Insufficient cooperation among doctors, pharmacy staff, and nursing staff; poor communication among multidisciplinary teams and less exchange of learning
	NO. 57	Inadequate medical staffing, stressful rotations, long personal working hours, multitasking, overload, etc.
	NO. 58	Substandard storage conditions and scientific care of medicines
	NO. 59	The pharmacy has deteriorated and expired drugs
	NO. 60	The department does not have an environment for chemotherapy drug preparation, the environment of infusion drug dispensing is poor, the PIVAS is missing or in poor condition