Examples of errors identified
| Potentially serious prescribing errors | Less serious prescribing errors |
|---|---|
| An elderly patient was prescribed 10 ml IV diazepam (equivalent to 50 mg) to be given when required, instead of the intended 10 mg. | A patient already taking lansoprazole 30 mg daily was additionally prescribed ranitidine 150 mg twice daily. |
| Captopril 250 mg twice daily was prescribed when 25 mg twice daily was intended. | Beclomethasone inhaler was prescribed without specifying the intended strength (100 mu;g per inhalation). |
| A patient had a phenytoin level of 5.5 mg/l on a dose of 350 mg daily. The dose was erroneously reduced to 120 mg daily. | A patient was prescribed 20 mg lansoprazole daily when 30 mg was intended. Capsules are available only as 15 mg or 30 mg strengths. |
| A patient was prescribed metoclopramide 10 mg 8 hourly on each of his 3 drug charts, resulting in the patient receiving 90 mg daily until the pharmacist intervened. | Isosorbide dinitrate was prescribed instead of isosorbide mononitrate. |
| Intravenous ranitidine 50 mg tds was inadvertently omitted for a critically ill patient with peptic ulcer disease whose drug chart was rewritten. | Glyceryl trinitrate was prescribed without specifying the dose or formulation to be administered. |
| Sustained release nifedipine 20 mg daily prescribed when 20 mg twice daily was intended. |