1. ANALYSIS PATIENT SAFETY REPORT Pharmacy name Month / Year
Near miss error % for month / year
Total no of near misses for month/ year
Total no of incidents for month/ year
Total no of CD incidents for month/ year
No of patient safety alerts received/ actioned for month / year
No of CPPQ responses received for month / year
No of pharmacy complaints for month / year
ANALYSIS
Complete the next section after your team has discussed and identified the key contributing factors and root causes for each of the following
Near Misses
Issue identified
Cause / contributing factor
Dispensing Incidents
Issue identified
Cause / contributing factor
Pharmacy Complaints
Issue identified
Cause / contributing factor
Other Issues e.g. CPPQ
Issue identified
Cause / contributing factor

2. KEY ACTIONS: PHARMACY Description Action Owner To complete by Outcome
Team briefed
Action 1
Reason
Action 2
Action 3
Date Agreed
Date Reviewed
Pharmacist Lead