United States Health Information Knowledgebase

 

Medication or Other Substance


Form ID: F8
Form Name: Medication or Other Substance
Version: 1.2
Form Short Name: Medication
Synonym: Medication
Definition: A medication or other substance event involves medications, biological products, nutritional products, expressed human breast milk, medical gases, or contrast media.
Setting: Hospitals, including outpatient pharmacies and outpatient departments located within the hospital
Language: U.S. English
Guide For Use: Use this form to report any patient safety event or unsafe condition involving a substance such as a medications, biological products, nutritional products, expressed human breast milk, medical gases, or contrast media. Do not complete this form if the event involves appropriateness of therapeutic choice or decision making (e.g., physician decision to prescribe medication despite known drug-drug interaction). If the event involves a device, please also complete the Device or Medical/Surgical Supply including Health Information Technology (HIT) form. Narrative detail can be captured on the Healthcare Event Reporting Form (HERF).
Comments: None defined at this time
Description Of Change: Not Applicable
Data Element ID Sort Data Element Name Sort Question Number Sort Version Sort Effective Date Sort Until Date Sort
DE270 Type of substance involved 1 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE273 Type of medication involved 2 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE276 Compounded preparation ingredients 3 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE279 Type of biological product 4 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE282 Vaccine lot number 5 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE285 Type of nutritional product 6 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE288 Description of substance event 7 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE291 Incorrect action(s) involving a substance 8 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE294 Description of incorrect dose 9 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE297 Description of incorrect timing 10 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE300 Description of incorrect rate 11 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE303 Description of incorrect strength or concentration 12 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE306 Expiration date of substance 13 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE309 Documented history of allergies or sensitivities to medication administered 14 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE312 Substance contraindication 15 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE315 Stage event originated 16 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE318 Identification of the generic or investigational drug name 17 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE319 RXCUI ingredient 18 Hospital Version 1.2 04/03/2012 - -
DE321 Identification of the brand name 19 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE322 RXCUI brand name 20 Hospital Version 1.2 04/03/2012 - -
DE324 Identification of the manufacturer 21 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE327 Identification of the strength or concentration 22 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE328 Clinical drug component RXCUI 23 Hospital Version 1.2 04/03/2012 - -
DE330 Dosage form of product 24 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE331 Dose form RXCUI 25 Hospital Version 1.2 04/03/2012 - -
DE333 Medication/substance prescribed 26 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE336 Medication/substance given 27 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE348 Intended administration route 28 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE351 Actual administration route 29 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
Effective Date: 04/01/2012
Until Date: - -
Update Date: 04/24/2013
Submitting Organization: Agency for Healthcare Research and Quality (AHRQ)
Date of Submission: - -
Responsible Organization: Agency for Healthcare Research and Quality (AHRQ)
Creator: Amy Helwig, MD, MS
Data Steward: Agency for Healthcare Research and Quality
References: Not Applicable
Administrative Status: Final
Administrative Status Date: 01/24/2014
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