Medication Error Reporting and Prevention Tool
The Making it Safer Together (MiST) Collaborators identified this tool as a useful solution to providing a simple, accurate repeatable measure of the harm that arises from medication incidents.
To provide a universal system suitable to measure the impact of prescribing and administration quality improvement projects.
The (US) National Coordinating Council for Medication Error Reporting & Prevention classification tool provides a 9 point classification system (Cat A-I). It grades the harm that occurs from (A) (circumstances or events that have capacity to cause error), through (B-D) which are no harm incidents, but reflect increasing proximity/impact to the patient, through (E-H) where increasing harm occurs & finally (I) where the error causes a death.
Medication incidents can be easily classified using the simple algorithm provided on the website here.
This Medication Error Reporting and Prevention (MERP) classification system has been successfully incorporated into the reporting systems at Royal Manchester Children’s Hospital and Birmingham Children’s Hospital. A number of other hospitals in the MiST collaborative are also in the process of incorporating into their IT systems.
The scores from this classification can be used directly on a run chart to provide evidence of the effect of local interventions.
Challenges and Learning
Key to success is incorporation into existing reporting systems.
This was a nationally recognised reporting tool in USA. Endorsed and advocated by USA National Coordinating Council for Medication Error Reporting and Prevention.
Project Lead: Peter-Marc Fortune, MiST Chair