:SPSC-Medication Error Reporting Form

Application Updates

The Reporter and the Safty Officer can now see the Age Group for the column DOB in the Medication Safety thank you/details page.
The Reporter can now write a comment to the Medication Safety Officer.
The Reporter can now select a location of the error of the event.
We have separated the Event description from the action taken, to be two columns instead of one column. So, The Reporter can now select the action taken of the event
We have renamed the column "Type of medication error" to "Stage of medication error".

Level of Harm

Did the error reach the patient? *

Yes

Location of event

Hospital Name

Maternity and Children Hospital - Al Ahsa Reporting Medication Error Occurred in the above Hospital.

Ownership

Ministry of Health

Medication Error Timing

*Event Date:*

*Prescription type: *

Wasfaty

Other/s

*Patient Information & Error Description

*Patient MRN# *

DOB

*Gender*

*Where It Happens*

*Diagnosis:*

* Write at least the first three letters to have the drop list.

*Stage of Medication Error: *

Type of Medication Error: *

*Description of the event: (how did the event occur and how was It detected?): *

*Action Taken*

Medication Involved -Add atleast One Medication

*Medication Name*
Select OTHER if Medication not found.

(Trade_Name\GenericName\Strength\Dosage)

*Possible causes & contributing factors-Add atleast One Factor.

*Factors*

Resources

Reporter Resource

* Note:-

2MB is the maximum image size.
Only the following extensions are acceptable .bmp, .jpg, .jpeg, .png, .gif, .bitmap.
You need to click on the upload button after your select the image.

Comments

Reporter Comment

More Information

Reporter Name

Email** Invalid Email Format

Mobile #.

Staff Category*

*

After you submit the ME form, If you did not get redirected to the Thank You page automatically, kindly

If you face any issues or if you have any suggestions, kindly do not hesitate to contact us on Email: ME@spsc.gov.sa