HTML Preview Medication Checklist page number 1.
(y/n)
Medication Name
refill # / prescriber / phone
Size, Shape,
Color
Dose Start Stop Refill
With
Food?
Dawn
Break
feast
Lunch Dinner Night Late Purpose (Indication)
Instructions Side Effects
Instructions Side Effects
Instructions Side Effects
Instructions Side Effects
Instructions Side Effects
Print and copy as needed - organize in binder.
Drug Allergies?
Vitamins and Supplements?
Aspirin?
Laxatives?
Other Over the Counter Meds?
Questions for my provider?
2
3
4
5
Medication Checklist
Dates (mm/dd/yr)
Time of Day (x)
1
Common Causes of Medication Errors
Drug incorrectly prescribed by doctor
Drug incorrectly read or prepared by pharmacist
Wrong drug | Missed dose
Drug taken at wrong time | Incorrect dose | Doubled dose
Drug given for longer or shorter durations than intended
Drugs incorrectly recorded
Drug taken past expiration date
Drug storage errors (e.g. not refrigerated, exposed to light/moisture)
Counterfeit drug (purchased online from unreliable source)
Poor handwriting; confusion between drugs with similar name,
color, or shape
Misuse of zeroes and decimal points; confusion of metric and other units
Inappropriate abbreviations
Inappropriate labeling as a drug is prepared and repackaged into
smaller units
Interruptions that can distract health professionals from their medical tasks.
TIP: Ask your physician to include the purpose for the drug
(the indication) along with drug on a prescription -
to reduce errors caused by drugs with similar names.
Informed patient and caregiver: The ultimate quality control system!
Patients Against Lymphoma
Providing support and evidence-based information
independent of health industry funding