National Coordinating Council For Medication Error Reporting And Prevention Research Articles

A Comprehensive Analysis of Medication Errors on Antimicrobials in a Tertiary Care Hospital of Northern India

Background: Medication errors, resulting from incomplete understanding, pose significant risks to patient safety. Antimicrobial medication error is a global concern further exacerbated by underreporting. This study aims to determine the prevalence of antimicrobial medication errors at a tertiary care medical facility. Methodology: A retrospective study was conducted over six months. Antimicrobial medication errors were analyzed and categorized as prescription, transcription, indenting, dispensing, and administration errors. A total of 208 antimicrobial medication errors were analyzed using the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) risk index. Results: Among 6,439 medication charts assessed, 558 (9%) medication errors were identified, with antimicrobial errors accounting for 208 (37.2%). Prescription errors were the most prevalent (61%), followed by transcription errors (16%) and administration errors (11%). Dispensing, indenting, and documentation errors occurred at rates of 8%, 2%, and 2%, respectively. The primary causes of errors were incorrect doses (47.2%) and frequencies (30%). Approximately 55.3% of antimicrobial medication errors were classified as Category C according to the NCCMERP risk assessment. Conclusion: Prescription errors represent the majority of antimicrobial medication errors, underscoring the need for enhanced vigilance among consultant physicians during prescription writing and drug schedule checks.

Development and Interrater Agreement of a Novel Classification System Combining Medical and Surgical Adverse Event Reporting

Categorization systems for adverse events are not standardized across care settings and specialties and do not always include near miss events (events where there was potential for patient harm, but where no actual harm occurred), making it difficult to effectively assess patient safety for quality improvement. To develop and assess interrater agreement on a classification system for adverse events reporting that incorporates events in both inpatient and outpatient settings across medical and surgical subspecialties including near miss events. A cross-sectional study in a tertiary care center including 174 patient cases occurring from 2018 to 2020 was carried out. Data were abstracted from a Department of Otorhinolaryngology-Head and Neck Surgery Quality Assurance database. The cases were comprised of near miss and adverse events occurring in adult and pediatric patients in inpatient, outpatient, and emergency department settings. The ratings took place in March and April of 2022. Four raters (2 attending physicians and 2 senior resident physicians) were recruited to classify these cases according to 3 classification systems: the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP), Clavien-Dindo, and our novel Quality Improvement Classification System (QICS). The primary outcome was overall interrater agreements using Fleiss κ. Across all 4 raters grading 174 cases, the NCC-MERP, Clavien-Dindo, and QICS received a κ score. Fair-to-moderate interrater reliability was observed between the resident and attending physician groups across the 3 classification systems: NCC-MERP (κ = 0.33; 95% CI, 0.30-0.35), Clavien-Dindo (κ = 0.47; 95% CI, 0.43-0.50), and QICS (κ = 0.42; 95% CI, 0.39-0.44). Strong interrater concordance was observed for complications across all scenarios. This cross-sectional study found that the new QICS classification scheme was applicable to wide-ranging clinical scenarios with a focus on patient-centered outcomes including near miss events. In addition, QICS allowed for the comparison of patient outcome data in a multitude of settings.

Types, trends, and patterns of the reported antimicrobial errors to the eastern region’s medical centers in Saudi Arabia: A cross-sectional study

IntroductionMedication errors (MEs) are a huge burden on any healthcare system and have been associated with significant morbidity and mortality. The medical literature reported heavily on MEs but lacked focus on analyzing high-risk medications such as antimicrobials. Research design and methodsThis was a retrospective analysis of the MEs database reported by the eastern region’s medical centers in Saudi Arabia from January 1, 2019 to December 31, 2019. We used descriptive analysis to identify most common antimicrobials with errors, the stage of antimicrobial errors, type of the errors, contributing factors to the errors, and categories of errors based on the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) classification of errors. ResultsA total of 1422 (22.1%) antimicrobial errors were identified out of 6412 MEs. Amoxicillin/Clavulanate (18%) was the most common antimicrobial reported in the database. Most errors occurred in the prescribing phase (87.6%) and included mainly incorrect doses (32.1%) and duplicate therapy (20.5%). In addition, most errors were identified as category B (72.5%). Finally, inexperienced personnel (57.9%) was the most cited contributing factor. ConclusionThis study revealed that antimicrobial errors occur primarily during prescription and that policy gaps and inexperienced staff were contributory factors. To improve, the focus should shift to physician education, clear dosing guidelines, efficient workload management, and implementing antimicrobial stewardship programs to promote appropriate antimicrobial use.

The Identification and Analysis of Adverse Events in Elderly Female Breast Cancer Patients Using Anthracycline-Based Regimens at Dharmais Cancer Hospital

Background: Anthracycline is the first-choice chemotherapy for the treatment of breast cancer, particularly in elderly patients. However, several studies reported adverse events in the treatment of using anthracyclines. This study aims to identify adverse events. It is also to find out more about how independent variables are related to adverse events. Method: An observational retrospective study of elderly patients (≥ 60 years old) was conducted in a tertiary cancer hospital in Jakarta. Data were collected from January 2018 to December 2020. We used an oncology-specific trigger tool to identify adverse events during anthracycline-based regimens. Independent variables were evaluated in univariate analysis: age, weight loss, marital status, total cumulative dose, polypharmacy, types of anthracyclines, and metastatic status. Bivariate and multivariate analyses were conducted to find out the relationship between the independent variables and adverse events.Results: In total, 107 subject records were collected and reviewed. Triggers were identified 122 times in 86 medical records. Blood transfusion, the most common trigger, was found in 35% of subjects. We found the number of triggers and adverse events more commonly identified in the first and second cycles of chemotherapy. The prevalence of adverse events is detected in 80% of subjects. Of these 86 subjects, 74% were detected in doxorubicin and 26% were detected in epirubicin. All the adverse events were categorized as The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) harm category E.Conclusion: Trigger tools specific for cancer patients can be used to identify adverse events. Blood transfusion was the common trigger to detect adverse events in our study. Adverse events with category E were identified in all the subjects. Neutropenia and anemia were the most common adverse events in all cycles of chemotherapy. Weight loss was the independent variable related to adverse events in elderly breast cancer patients (p <0.003).

Medication Prescription Errors in the Intensive Care Unit: Prospective Observational Study.

IntroductionThe WHO launched a 5-year global initiative to address the problem of medication errors on March 29, 2017, targeting a decrease in severe and avoidable medication-related harm by 50% in all the countries. Since prescription errors are preventable, this study was conducted to determine incidence and severity of medication prescription errors (MPEs).Settings and designIntensive care unit of a tertiary care academic hospital, prospective observational study.Methods and materialsFor all patients admitted in a medical ICU, baseline data (demographic, APACHE II, length of ICU stay, and days of mechanical ventilation) were noted. Treatment charts were reviewed daily, and each prescription was compared against a master chart prepared using standardized references to study the incidence of prescription errors. Severity classification was done using National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) classification. Mean and median, along with standard deviation and interquartile range, were calculated for all quantitative variables. Multivariate linear regression analysis model was used.ResultsOut of the total 24,572 medication orders, 2,624 had prescription errors, an error rate of 10.7% (95% CI, 10.3–11.1). When analyzed for severity, 1,757 (7.15%) (95% CI, 6.8–7.5) MPEs did not result in patient harm and 867 (3.52%) (95% CI, 3.3–3.8) MPEs required interventions and/or resulted in patient harm. Patients with deranged creatinine (p <0.001) and INR (p = 0.024) had higher number of severe MPEs.ConclusionThe incidence of MPEs in the medical ICU at the tertiary care hospital was 10.7%, 3.52% being severe errors.How to cite this articleKumar M, Sahni N, Shafiq N, Yaddanapudi LN. Medication Prescription Errors in the Intensive Care Unit: Prospective Observational Study. Indian J Crit Care Med 2022;26(5):555–559.

Identification and solution of drug-related problems in the neurology unit of a tertiary hospital in China

BackgroundThe prevalence and characteristics of drug-related problems (DRPs) and factors associated with the occurrence of DRPs in the neurology unit in China remain unknown. This study aimed to determine the prevalence, characteristics and severity ratings of DRPs and identify factors associated with the occurrence of DRPs in the neurology unit of a tertiary care and academic teaching hospital in China.MethodsA retrospective study of DRPs and pharmacists’ interventions for neurology patients was performed during a non-consecutive 24-month study period. Patient demographics and clinical characteristics, and pharmacist’s intervention records were collected. The characteristics and severity ratings of DRPs were categorized using the Pharmaceutical Care Network Europe (PCNE) DRP classification tool V9.00 and the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) classification respectively.ResultsA total of 242 DRPs were detected for 974 admitted patients, an average of 0.25 DRPs per patient. Treatment safety was the major type of DRPs (106;43.8%) followed by treatment effectiveness (78;32.2%). The primary causes of DRPs were drug selection (124;44.1%) and dose selection (92;32.7%). Clinical pharmacists provided 525 interventions, and most interventions occurred at the prescriber level (241;45.9%). A total of 91.4% of these interventions were accepted, contributing to solving 93.0% of the identified problems. The majority of DRPs (210;86.8%) were rated at severity categories B to D (causing no patient harm). Multiple logistic regression showed that creatinine clearance, number of medications used, nasogastric feeding, diabetes, and infectious diseases were associated with more frequent DRPs (p < 0.05).ConclusionsDRPs are relatively common in the neurology unit in China, with primary causes of drug and dose selection, and clinical pharmacists can effectively reduce and prevent DRPs to optimize medication therapy.

Pharmacist intervention on prescribing errors: Use of a standardized approach in the inpatient setting.

PurposeThe objective of this study was to implement a standardized process across health systems to determine the prevalence and clinical relevance of prescribing errors intercepted by pharmacists.MethodsThis prospective, multicenter, observational study was conducted across 11 hospitals. Pharmacist-intercepted prescribing errors were collected during inpatient order verification over 6 consecutive weeks utilizing a standardized documentation process. The potential harm of each error was evaluated using a modified National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) index with physician validation, and errors were stratified into those with potentially low, serious, or life-threatening harm. Endpoints included the median error rate per 1,000 patient days, error type, and potential harm with correlating cost avoidance.ResultsPharmacists intervened on 7,187 errors, resulting in a mean error rate of 39 errors per 1,000 patient days. Among the errors, 46.6% (n = 3,349) were determined to have potentially serious consequences and 2.4% (n = 175) could have been life-threatening if not intercepted. This equates to $874,000 in avoided cost. The top 3 error types occurring with the highest frequency were “wrong dose/rate/frequency” (n = 2,298, 32.0%), “duplicate therapy” (n = 1,431, 19.9%), and “wrong timing” (n = 960, 13.4%). “Wrong dose/rate/frequency” (n = 49, 28%), “duplicate therapy” (n = 26, 14.9%), and “drug-disease interaction” (n = 24, 13.7%) errors occurred with the highest frequency among errors with potential for life-threatening harm. “Wrong dose/rate/frequency” (n = 1,028, 30.7%), “wrong timing” (n = 573, 17.1%), and “duplicate therapy” (n = 482, 14.4%) errors occurred with the highest frequency among errors with potentially serious harm.ConclusionDocumentation of pharmacist intervention on prescribing errors via a standardized process creates a platform for multicenter analysis of prescribing error trends and an opportunity for development of system-wide solutions to reduce potential harm from prescribing errors.

Paediatric Focused Triggering Tool (PFTT) To Assess the Harm and its Utilization to Minimize the Levels of Harm among Children at a Tertiary Care Hospital

Abstract: Objectives: Very few paediatric trigger tools have been developed to assess harm in children. Hence, a Paediatric-focused trigger tool has been developed, assess its utility to measure the levels of harm, categorize and minimize them further. Methodology: The final 40 trigger tool developed by modifying IHI-GTT adult care, was prospectively tested for structural review of records (n=520) of paediatric population of a tertiary care hospital for incidence of adverse events (AE’s) with associated harm and categorized using modified NCCMERP (National Coordinating Council for Medication Error Reporting and Prevention) index from E-I. Results: Among 292 male and 228 female children, the incidence of AEs was 35%, more in the category of 1-5 years of age with harm assessment events. Out of 182 AEs identified, 107(58.80%) were found to be of E-category, 43(23.62%) were of category F, 22(12.08%) with category G, 9(4.95%) with category H and 1(0.55%) was category I. Two third of the paediatric population of category E and F (82.4%) had temporary harm and remaining (17.6%) were of non- preventable harm, category G-I. One example of AE identified with harm was, decrease in 25% in Haemoglobin or Haematocrit and number of blood transfusions. Further action was taken to strictly monitor and minimize further harm. Conclusion: The present study highlights on the harm assessment among the paediatric population with the help of developed Paediatric-Focused Trigger Tool (PFTT) modified by using IHI-GTT adult trigger tool. This helps paediatric set ups to assess its usefulness and further develop strategies to mitigate the harm. Key words: Paediatric, Trigger tool, AEs, NCCMERP Index, Harm.

Identifying Medication Errors in a Tertiary Care Teaching Hospital: A Prospective Observational Study

Background: Medication error is defined as any avertable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient and consumer. Medication errors may occur at any stage of the medication use process including ordering, transcription, dispensing, administering and monitoring. &#x0D; Objective: The objective of the study is to assess the medication errors in a tertiary care hospital and to categorize them based on their nature and type.&#x0D; Methodology: A prospective observational study was conducted over a period of 3 months in a tertiary care teaching hospital. This study was carried out among 240 inpatients, admitted in General Medicine department of the hospital, who were selected randomly. During the study, inpatients case records were reviewed, which includes patient’s case history, diagnosis, medication order sheets, progress chart, laboratory investigations. The data collected were analyzed for identifying medication errors such as prescribing errors and administration errors. Each reported medication error was assessed using the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) proposed index for categorizing medication errors.&#x0D; Results: A total number of 240 inpatients were enrolled in the study, out of which 82 patients have developed medication errors. The overall percentage of observed medication error was 34.16%. In our study medication errors were found more in males (70.7%) than in the females (29.3%). Prescribing errors (62.19%) were the most frequently occurring type of error, which was followed by administration errors (37.8%). In our study, we found that medication errors were more with antibiotics (37) followed by NSAIDs (19). 96 prescriptions were found having drug interactions. Conclusion: This study concludes that the overall incidence of medication error was found to be 34.16%. Most of the medication errors are clinically significant and it can prevent by working together in a health care team.&#x0D;

Potential Medication Errors in Electronic Prescribing in A Primary Health Care

An effort to reduce medication errors is to use drugs prescription electronically[1,2,4]. However, there needs to be an evaluation of this system, because this system is not free from errors in medication. This study aimed to find out the description of prescribing flow, to examine electronic prescription completeness, and find out the potential medication errors that occur in the prescribing phase of electronic prescription using prescribing indicators[1,5,9,10]. This study used observational method by taking general practice outpatient prescription data of March 2018 in a company health service located in Bandung and analyzed descriptively[6,7,8]. Electronic prescription of medicines at this health care was made and inputted by doctors. When an error occured on a computer system, the doctor would prescribe it manually so that the patient can still be served. Incompleteness of the most common recipe was on administrative requirements where all prescriptions did not listed the doctor's practice permit, patient's gender, patient's weight, telephone number of the place of practice, and patient's contact number. Medication errors had the most potential for the occurrence of prescription writing with two or more drugs interacting and this error was classified as category D according to The National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP).&#x0D;

Identify and categorize drug-related problems in hospitalized surgical patients in China.

Background Data is lacking on types and severities of drug-related problems (DRPs) in hospitalized surgical patients in China. Objective To identify and categorize types and causes of DRPs, and to assess severities of these DRPs. Setting An academic teaching hospital in Chongqing, China. Method We retrospectively reviewed all medication orders for patients in six surgical departments during a six-month period. DRPs were classified using the Pharmaceutical Care Network Europe(PCNE) classification, and the severity ratings of these DRPs were based on the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP)classification. Main outcome measure The number, types, causes and severities of the DRPs. Results A total of 291,944 medication orders in 10,643 patients were reviewed, and 3548 DRPs were identified. The average DRP number per patient was 0.3. The most common problem was treatment effectiveness (39.9%) and the major cause of the problems was dose selection (47.0%). Total 80.1% of the DRPs were rated at severity categories B to D (causing no or potential harm), whereas 19.9% were rated as categories E to H (causing actual harm). Conclusion DRPs are common in surgical patients, and prospective pharmacist medication order review services are needed to improve patients' pharmaceutical care.

Learning from error: identification and analysis of causative factors leading to medication error in an inpatient hospital setting

Background: Medication errors are preventable causes of medical error. These errors may happen at various steps of medication process. This study tries to find common errors during four stages i.e. prescribing, transcribing, dispensing and administration. Methods: It was a cross sectional study in a tertiary care teaching hospital in north India. Five hundred patients were randomly selected for the study. Medication error was checked at different level by a medication audit tool. Direct observation, chart reviews and personal communication with patients, nurses and pharmacist were done to complete the details of tool. Root cause analysis was done after discussing with concerned professionals. Severity of the medication errors were assessed using national coordinating council for medication error reporting and prevention (NCCMERP) proposed medication error index. Results: Medication error rate was found to be around 50%. i.e. every one of two patients received some form of error. Prescribing error were most common cause of error followed by administration error and transcription error. Dispensing error was least common. Root cause analysis indicated casual attitude, inadequate knowledge and training as the main causes. Conclusions: This study was an initial step in recognising error prone areas of medication management. It can be used to develop standard procedures and formulating guidelines for prevention of such errors.

Health professionals’ beliefs, attitudes and experiences of medication error reporting: a systematic review protocol

REVIEW OBJECTIVE The objective of this review is to critically appraise, synthesize and present the available evidence on health professionals’ beliefs, attitudes and experiences of medication error reporting. Review questions More specifically, this review seeks to answer the following questions. In relation to health professionals (i.e. doctors, nurses and pharmacists): 1.What are their beliefs and attitudes towards medication error reporting? 2. What are their experiences of medication error reporting? (E.g. nature of feedback obtained, any subsequent changes in their practice, ease of use of the reporting system, any improvements required to optimize medication error reporting.) 3. What are the reasons given or factors which are associated with under-reporting of medication errors? (E.g. lack of awareness or understanding of the reporting system, fear of possible consequences of reporting, and forgetting to report.) INCLUSION CRITERIA Types of participants This review will only consider studies that include doctors, nurses and pharmacists, as these are the health professionals involved in the patient medication journey and specifically in the processes of prescribing of medicines (doctors, nurses and pharmacists all have prescribing rights in certain countries, e.g. the United Kingdom), administering (all are involved) and dispensing (all may be involved to some extent in different countries). Phenomena of interest While there is no intervention (as would be the case in reviews of effectiveness or cost-effectiveness), the qualitative component of this review will consider studies that investigate the phenomenon of medication error reporting from a number of different perspectives (e.g. doctors, nurses, pharmacists). TRUNCATED AT 250 WORDS

Medicine reconciliation on admission in a paediatric hospital setting

BackgroundMedication reconciliation is an organisational practice designed to ensure patients' pre-admission medicines are prescribed correctly upon admission to hospital. Multiple sources of information are needed to do this. This is...

CPC-108 Pharmacy Interventions Undertaken in an Intensive Care Unit Specialising in Women’s Health

BackgroundPharmaceutical interventions can prevent drug-related problems and possible prescription errors. They thus contribute to the optimization of pharmacotherapy and to prioritising safety in an Intensive Care Unit (ICU).Purpose To identify...

Tool Helps Track Adverse Drug Events

Tool Helps Track Adverse Drug Events

ARV Medication Errors: Experience of a Community-Based HIV Specialty Clinic and Review of the Literature

ObjectiveTo describe antiretroviral (ARV) medication errors reported within a community Human Immunodeficiency Virus (HIV) clinic, identify potential strategies to prevent errors, and review the literature pertaining to ARV medication errors.DesignReview of voluntarily reported ARV errors. Errors were classified using the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) Index. The clinic's medication distribution process was also analyzed.SettingCommunity-based clinic with HIV-experienced clinicians in an urban setting.ResultsThirty-seven errors were reported over 3 years; 81.1% of these were classified as NCC-MERP category C. Most errors resulted from lapses in clinic and pharmacy systems of care (n = 21). Pharmacy and clinic prescribing errors were less (n = 11).ConclusionARV medication errors were notable. Changes in drug distribution and prescribing processes may reduce future ARV medication errors.

L'informatique clinique

The positive impact of computerized physician order entry (CPOE) systems on prescription safety must be considered in light of the persistence of certain types of medication-prescription errors. We performed a systematic review, based on the PRISMA statement, to analyze the prevalence of prescription errors related to the use of CPOE systems.We searched MEDLINE, EMBASE, CENTRAL, DBLP, the International Clinical Trials Registry, the ISI Web of Science, and reference lists of relevant articles from March 1982 to August 2017. We included original peer-reviewed studies which quantitatively reported medication-prescription errors related to CPOE. We analyzed the prevalence of medication-prescription errors according to an adapted version of the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) taxonomy and assessed the mechanisms responsible for each type of prescription error due to CPOE.Fourteen studies were included. The prevalence of CPOE systems-related medication errors relative to all prescription medication errors ranged from 6.1 to 77.7% (median = 26.1% [IQR:17.6–42,1]) and was less than 6.3% relative to the number of prescriptions reviewed. All studies reported “wrong dose” and “wrong drug” errors. The “wrong dose” error was the most frequently reported (from 7 to 67.4%, median = 31.5% [IQR:20.5–44.5]). We report the associated mechanism for each type of medication described (those due to CPOE or those occurring despite CPOE).We observed very heterogeneous results, probably due to the definition of error, the type of health information system used for the study, and the data collection method used. Each data collection method provides valuable and useful information concerning the prevalence and specific types of errors related to CPOE systems.The reporting of prescription errors should be continued because the weaknesses of CPOE systems are potential sources of error. Analysis of the mechanisms behind CPOE errors can reveal areas for improvement.

Preventing medication errors in the home.

Medication errors are a major problem in all settings of health care, including the home environment. The National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) defines a medication error as any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use. 1 This definition is important for the nurse working in the home health environment because it contains elements inherent in the nurse’s role. According to Cowley, 2 the most frequent type of medication error in the home is improper dosing. Other types of medication errors the nurse will see include documentation or transcription errors, polypharmacy, medication miscalculation, and deficient practitioner and patient knowledge. This article will address the steps the home health nurse can take to ensure the patient receives medications safely and effectively and errors are avoided. ACCURATE DOCUMENTATION Accountable and concise nursing care delivery calls for each nurse to examine the patient’s record, particularly the physician order sheet and medication record, before going into the home. This review is done whether the nurse has to administer medication or assess whether the patient or family is administering medications correctly. The patient’s medical record must be complete and the medication list updated as needed. The patient and family often are asked to document medications the former receives. For example, if the patient has a diagnosis of congestive heart failure but has gained weight since the last in-home nurse visit, the nurse can check the medication record and question the patient or family about compliance with diuretic and cardiac glycoside therapy. If the nurse has reason to question their responses, he or she should contact the physician to order possible laboratory work that will indicate the patient’s serum drug levels and help determine if the patient is receiving or taking medication as ordered. It is important for the nurse to document medication compliance or a lack thereof in the nurse’s notes. Documenting in the medical record all over-thecounter medications or herbal (nutritional) supplements the patient may be taking is also important because serious drug interactions can occur. An herbal supplement may have some of the same properties as a prescribed medication that in actuality can cause a double dose effect or have an antagonistic effect toward the prescribed medication. It becomes terribly important that the nurse knows not only the effects of prescribed medications but also those of any supplements. The nurse can use accurate medication documentation both in the patient’s medical record and the list maintained in the home to ensure the patient receives the correct medication.