Patient Identification

Are identification labels attached to all pages in the patient record?
1) Patient name
2) Date of birth
3) UR number
4) Allergy status

Was the patient's body weight documented?

Is there evidence that patient identification was confirmed before the medication was prescribed?
(YES if Surgical Safety Checklist paperwork used and box ticked for UR and patient's name, OR Timeout completed)

Has the allergies and ADR box been filled in?
(Signed, name printed, date, drug, reaction and initials, nil known or unknown box ticked)
If NO please add details of what is missing.

If an ADR was documented, are there alert stickers in the appropriate places?

If there was any previous ADR, was a similar class of medication prescribed at this visit?

Medication History

Does the patient have a documented Medication Management Plan?

Is the drug name and frequency documented for variable doses?


Is the patient currently taking any anti-coagulant medication?
Warfarin (Coumadin/Marevan) Apixaban (Eliquis) Rivaroxaban (Xarelto), Dabigatran (Pradaxa), heparins, enoxaparin (clexane)

Prescribing Medication

Are the medication orders clear with dose to be given?

Are the medication orders clear with route to be given?

Are the medication orders clear with time given?

PINCH -High Risk Medicines

Are any PINCH drugs prescribed?
( Potassium, insulin, clexane/enoxaparin, heparin, morphine, pethidine, ketamine, alfentanil)

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.