United States Health Information Knowledgebase

 

Medication or Other Substance


Form ID: F8
Form Name: Medication or Other Substance
Version: 1.1
Form Short Name: Medication
Synonym: Medication
Definition: A medication or other substance event involves medications, biological products, nutritional products, or medical gases.
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 medication, vaccine, nutrient, dietary supplement, medical gas, 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 form. Narrative detail can be captured on the Healthcare Event Reporting Form (HERF).
Comments: None defined at this time
Description Of Change: Not applicable for this release
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 1.1 03/31/2010 - -
DE273 Type of medication involved 2 1.1 03/31/2010 - -
DE276 Compounded preparation ingredients 3 1.1 03/31/2010 - -
DE279 Type of biological product 4 1.1 03/31/2010 - -
DE282 Vaccine lot number 5 1.1 03/31/2010 - -
DE285 Type of nutritional product 6 1.1 03/31/2010 - -
DE288 Description of substance event 7 1.1 03/31/2010 - -
DE291 Incorrect action(s) involving a substance 8 1.1 03/31/2010 - -
DE294 Description of incorrect dose 9 1.1 03/31/2010 - -
DE297 Description of incorrect timing 10 1.1 03/31/2010 - -
DE300 Description of incorrect rate 11 1.1 03/31/2010 - -
DE303 Description of incorrect strength or concentration 12 1.1 03/31/2010 - -
DE306 Expiration date of substance 13 1.1 03/31/2010 - -
DE309 Documented history of allergies or sensitivities to medication administered 14 1.1 03/31/2010 - -
DE312 Substance contraindication 15 1.1 03/31/2010 - -
DE315 Stage event originated 16 1.1 03/31/2010 - -
DE318 Identification of the generic or investigational drug name 17 1.1 03/31/2010 - -
DE321 Identification of the brand name 18 1.1 03/31/2010 - -
DE324 Identification of the manufacturer 19 1.1 03/31/2010 - -
DE327 Identification of the strength or concentration 20 1.1 03/31/2010 - -
DE330 Dosage form of product 21 1.1 03/31/2010 - -
DE333 Medication/substance prescribed 22 1.1 03/31/2010 - -
DE336 Medication/substance given 23 1.1 03/31/2010 - -
DE348 Intended administration route 24 1.1 03/31/2010 - -
DE351 Actual administration route 25 1.1 03/31/2010 - -
Effective Date: 03/31/2010
Until Date: - -
Update Date: - -
Submitting Organization: Agency for Healthcare Research and Quality (AHRQ)
Date of Submission: 03/31/2010
Responsible Organization: Agency for Healthcare Research and Quality (AHRQ)
Creator: John C. Moquin
Data Steward: Agency for Healthcare Research and Quality
References: No specific reference at this time
Administrative Status: Final
Administrative Status Date: 03/31/2010
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