I)-Causes Related Prescribing Phase | III)-Causes Related Administration Phase | ||
 a. New staff | □ |  p. Failure to follow order instructions   □ Wrong drug   □ Wrong Patient   □ Wrong time   □ Wrong rout   □ Wrong dose | □ |
 b. Poor handwriting orders   □ Ambiguous   □ Illegible   □ Incomplete | □ | ||
 c. Understaffing | □ |  q. Workload/fatigue | □ |
 d. Unapproved abbreviations | □ |  r. Medication unavailable | □ |
 e. Verbal order   □ Non-health professional calling in prescription   □ Speech patterns   □ Accents | □ |  s. Inadequate checking | □ |
 t. Extended delay of administration due to other department (Lab levels, x-ray,.) | □ | ||
 u. Incompliant Patient   □ Uneducated Patient   □ Patient off nursing unit | □ | ||
 f. Metric system | □ | ||
 g. Lack of knowledge on the medication | □ | ||
 v. Inadequate medication device   □ Incorrect type of infusion device   □ Adjusting an infusion device incorrectly | □ | ||
 h. Unnecessary decimal points | □ |  | |
 i. Lack of information on the patient | □ | ||
 w. Lack of information   □ On the patient   □ On medication | □ | ||
II)-Causes Related Dispensing Phase | Â | ||
 x. Drug given but not documented | □ | ||
 j. Poor assessment of order   □ Look -alike drug name   □ Sound -alike drug name   □ Miscalculation | □ |  y. Drug documented but not given | □ |
IV)-Causes Related Monitoring Phase | â–¡ | ||
 z. Failure to recognize adverse reactions   □ Allergy not noted | □ | ||
 k. Poor designed Work area   □ Inadequate counter space   □ Poor lighting   □ Distraction   □ Uncomfortable temperature & humidity | □ |  aa. Failure to report adverse reactions | □ |
 bb. Failure to educate patients about potential side effects | □ | ||
 cc. Failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy | □ | ||
 l. Inadequate Distribution system   □ Ward stock | □ |  dd. Inappropriate patient behavior regarding adherence to a prescribed medication regimen | □ |
 ee. Failure to follow established policies and procedures | □ | ||
 m. Labeling & packaging problems | □ | ||
 n. Outdated references | □ |  ff. Policies and procedure NOT established | □ |
 o. Poor inventory arrangement | □ |