Pennsylvania Code
Title 55 - HUMAN SERVICES
Part VIII - Intellectual Disability and Autism Manual
Subpart A - Statements of Policy
Chapter 6000 - STATEMENTS OF POLICY
Subchapter R - PROCEDURES FOR SURROGATE HEALTH CARE DECISION MAKING
STATUTES
Appendix H - ABBREVIATED INCIDENT REPORT
Medication Error
The data entry screen is to include the following information:
* DEMOGRAPHICS (pre-populated from HCSIS demographics)
Name of the individual for whom the Medication Error is being reported.
Individual's Base Service Unit (BSU) number.1
1 If the individual is not registered with a County MH/MR Program, the report is to list the county or state where the person is/was a resident.
* CATEGORIZATION
Secondary category of Medication Error.
Date and time when the incident was recognized/discovered.
* MEDICATION ERROR INCIDENT INFORMATION
Staff position of the person giving medication.
Name of medication(s).
Indication if the error occurred over multiple consecutive administrations.
The reason(s) why the Medication Error occurred.
The response(s) to the Medication Error.
The agency system response to prevent this type of error from occurring in the future.
Any additional comments.
Indication if another Incident Report was filed as a result of the Medication Error.
If another Incident Report was filed, the Incident ID number.
In addition to the required information, providers may choose to include optional information to further analyze their medication errors.
* OPTIONAL MEDICATION ERROR INFORMATION
The name or unique identifier of person making the Medication Error.
Indication if the person making the Medication Error was working longer than their regular work hours at the time of the Medication Error.
The length of time the staff person who made the Medication Error has been giving medications.
The number of medications supposed to be given to this person at the same time as the Medication Error was made including the medication when the Medication Error was made.
The number of medications this person receives on a daily basis.
The number of people that the staff person who made the Medication Error has to give medications to around the same time as the Medication Error occurred.
This appendix cited in 55 Pa. Code § 6000.923 (relating to incidents to be reported within 72 hours); and 55 Pa. Code § 6000.924 (relating to incident management contingency plan).
