Collaborative Medicines Related Discharge Audit Form

Information

Collaborative Medicines Related Discharge Audit
Ward/Clinical Area
Conducted on
Prepared by

Explanation of codes

List of codes

Discharge Prescription 1

Where was the prescription screened:
Ward/Clinical area where prescription was screened:
Electronic Discharge:
Care area:
Elective patient:
Number of prescribed items on discharge prescription:
Allergy status documented:

Contribution 1:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 2:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 3:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 4:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 5:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 6:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:
Changes since admission recorded with reasons:
GP actions documented by prescriber:
Consultation Details Clear:
PMR
Time for clinical screen (minutes):
Time between identification and resolution of problems (minutes):

Discharge Prescription 2

Where was the prescription screened:
Ward/Clinical area where prescription was screened:
Electronic Discharge:
Care area:
Elective patient:
Number of prescribed items on discharge prescription:
Allergy status documented:

Contribution 1:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 2:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 3:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 4:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 5:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 6:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:
Changes since admission recorded with reasons:
GP actions documented by prescriber:
Consultation Details Clear:
PMR
Time for clinical screen (minutes):
Time between identification and resolution of problems (minutes):

Discharge Prescription 3

Where was the prescription screened:
Ward/Clinical area where prescription was screened:
Electronic Discharge:
Care area:
Elective patient:
Number of prescribed items on discharge prescription:
Allergy status documented:

Contribution 1:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 2:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 3:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 4:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 5:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 6:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:
Changes since admission recorded with reasons:
GP actions documented by prescriber:
Consultation Details Clear:
PMR
Time for clinical screen (minutes):
Time between identification and resolution of problems (minutes):

Discharge Prescription 4

Where was the prescription screened:
Ward/Clinical area where prescription was screened:
Electronic Discharge:
Care area:
Elective patient:
Number of prescribed items on discharge prescription:
Allergy status documented:

Contribution 1:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 2:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 3:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 4:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 5:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 6:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:
Changes since admission recorded with reasons:
GP actions documented by prescriber:
Consultation Details Clear:
PMR
Time for clinical screen (minutes):
Time between identification and resolution of problems (minutes):

Discharge Prescription 5

Where was the prescription screened:
Ward/Clinical area where prescription was screened:
Electronic Discharge:
Care area:
Elective patient:
Number of prescribed items on discharge prescription:
Allergy status documented:

Contribution 1:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 2:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 3:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 4:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 5:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 6:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:
Changes since admission recorded with reasons:
GP actions documented by prescriber:
Consultation Details Clear:
PMR
Time for clinical screen (minutes):
Time between identification and resolution of problems (minutes):

Discharge Prescription 6

Where was the prescription screened:
Ward/Clinical area where prescription was screened:
Electronic Discharge:
Care area:
Elective patient:
Number of prescribed items on discharge prescription:
Allergy status documented:

Contribution 1:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 2:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 3:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 4:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 5:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 6:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:
Changes since admission recorded with reasons:
GP actions documented by prescriber:
Consultation Details Clear:
PMR
Time for clinical screen (minutes):
Time between identification and resolution of problems (minutes):

Discharge Prescription 7

Where was the prescription screened:
Ward/Clinical area where prescription was screened:
Electronic Discharge:
Care area:
Elective patient:
Number of prescribed items on discharge prescription:
Allergy status documented:

Contribution 1:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 2:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 3:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 4:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 5:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:

Contribution 6:

Contribution descriptor:
- A - Allergy Status
- B - Omitted Drug
- C - Innapropriate Addition
- D - Wrong Drug
- E - Wrong or missing dose
- F - Wrong or missing formulation or route
- G - Wrong frequency, timing or duration
- H - Drug Interaction
- I - Legality
- J - Information on changed medicines
- K - GP actions required
- L - MCA required
- M - Other
Clinical impact of contribution:
Medicine involved:
Changes since admission recorded with reasons:
GP actions documented by prescriber:
Consultation Details Clear:
PMR
Time for clinical screen (minutes):
Time between identification and resolution of problems (minutes):

Details of Person completing audit:

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Discharge Prescription 1

Contribution 1:

Contribution 2:

Contribution 3:

Contribution 4:

Contribution 5:

Contribution 6:

Discharge Prescription 2

Contribution 1:

Contribution 2:

Contribution 3:

Contribution 4:

Contribution 5:

Contribution 6:

Discharge Prescription 3

Contribution 1:

Contribution 2:

Contribution 3:

Contribution 4:

Contribution 5:

Contribution 6:

Discharge Prescription 4

Contribution 1:

Contribution 2:

Contribution 3:

Contribution 4:

Contribution 5:

Contribution 6:

Discharge Prescription 5

Contribution 1:

Contribution 2:

Contribution 3:

Contribution 4:

Contribution 5:

Contribution 6:

Discharge Prescription 6

Contribution 1:

Contribution 2:

Contribution 3:

Contribution 4:

Contribution 5:

Contribution 6:

Discharge Prescription 7

Contribution 1:

Contribution 2:

Contribution 3:

Contribution 4:

Contribution 5:

Contribution 6:

Details of Person completing audit:

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