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Reporting a Medication Error

What Do We Do With Your Report?

At ISMP, we review incident reports submitted by consumers and healthcare professionals and look for ways to prevent harmful errors. For example, we may approach a manufacturer to suggest that the label of a product be changed, we may suggest safer ways for healthcare professionals to handle medications, or we may remind consumers of things they can do to avoid making mistakes with medications.

ISMP will:

  • Review your report
  • Look for system problems that could cause errors to happen
  • Prepare recommendations that are designed to prevent mistakes with medication
  • Send recommendations about medication safety to healthcare professionals and consumers
  • Notify the manufacturer if it is a product issue
  • Advocate throughout the healthcare system to promote changes to improve medication safety
  • Provide consumer-focused information and tips about medication safety on the ConsumerMedSafety.org website
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ISMP will not:

  • Investigate a complaint on your behalf with an organization or healthcare professional that is responsible for an error
  • Investigate the actions of individual practitioners
  • Report (for disciplinary purposes) the incident to professional authorities responsible for regulating the practice of healthcare professionals
  • Release or publish any information that could identify the reporter of an incident, a patient, a healthcare professional, or an organization involved in an incident

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More Safety Articles

CDC Message: Practice Safe Medicine Storage Habits While Preparing for This Fall and Winter Virus Season

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One Nostril or Two?

Some medicines come as a nasal spray. While a spray in each nostril is the typical way to take a single dose, there are some exceptions. Some medicines are meant to be given as a single spray into one nostril for each dose. One prime example is calcitonin salmon (Fortical or Micalcin), a medicine used to treat women with osteoporosis (bone thinning) after menopause.

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Definitely Not a Band-Aid!

A kindergarten student was wearing a Daytrana (methylphenidate) patch on his skin when he arrived at school. Daytrana is a medicine used to treat Attention Deficit Hyperactivity Disorder (ADHD), a condition that makes it hard for children to control their behavior and/or pay attention.

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Replace Bottle Adapter with Childproof Cap after Using Liquid Medicine

Liquid medicines, especially those required for small children and pets, are often measured using oral syringes. Sometimes, there is a device that comes with the syringe called an adapter. This allows the oral syringe to directly attach to the bottle, eliminating the step of pouring the liquid into a cup for withdrawal by an oral syringe.Using a syringe adapter is a convenient way to accurately measure and administer liquids. However, depending on the actual product, parents should be aware they are not always childproof.

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