Preview Medication Checklist

(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

Print and copy as needed - organize in binder.

Drug Allergies?

Vitamins and Supplements?

Aspirin?

Laxatives?

Other Over the Counter Meds?

Questions for my provider?

Medication Checklist

Dates (mm/dd/yr)

Time of Day (x)

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

HTML Preview Medication Checklist page number 1.