The ISMP Medication Errors Reporting Program (MERP) is operated by the Institute for Safe Medication Practices. It's a confidential national voluntary reporting program that provides expert analysis of the causes of medication errors and offers recommendations for error prevention to regulatory agencies and manufacturers.

Without reporting, such events may go unrecognized. Errors include — but are not limited to — administering the wrong drug, strength, or dose of medications; confusing drugs with similar names or labels; misuse of medical equipment; and errors in prescribing, dispensing, and monitoring medications.

Consumers can submit reports and associated materials in confidence. With your permission, the report will be forwarded to the Food and Drug Administration, and the manufacturer to inform them about improper pharmaceutical labeling, packaging, and other issues that may cause errors. The reporter is never identified in case studies and ISMP always respects reporters' wishes as to the level of detail included in publications.

Please do not submit any patient identifiable information within the form such as your name, social security number, or address when forwarding medication error reports to ISMP.

The electronic report form on this page is easy to complete. Once you finish and submit the report it will be housed in a secure database. ISMP nurse and pharmacist analysts will be notified within 24-48 hours of your submission. They'll review the form and, if you provide your e-mail address or telephone number, will call for any necessary follow up information.

Report Medication Errors

Thank you for reporting your error or medication safety concern to ISMP. Please answer the questions as completely and accurately as possible. Your answers will help us to better understand the type of errors that are happening, where and why they are happening, and how to help those people being affected.

WHAT SHOULD BE REPORTED?

We're interested in learning about medication errors, near misses, hazardous situations or bad drug reactions experienced by you or a loved one. These problems may be related to:

Issues with prescriptions
Pharmacy or hospital procedures, staff, and systems
Inadequate medication instructions
Poor communication of information from a health care professional
Medicine labels and packaging
Names of medications
The preparation and/or mixing of medications
The way in which you order medication (Internet, telephone, mail, etc.)
Unexpected reactions to a drug

WHAT TYPES OF ERRORS AND OTHER EVENTS SHOULD BE REPORTED?

Medication errors, near misses, or hazardous situations that should be reported include, as well as bad reactions, but are not limited to:

Receiving the wrong drug, strength, or dose of medication that was ordered for you
Being prescribed a drug to which you were allergic
Having an unexpected reaction to a drug because you were taking another drug or food that shouldn't be eaten while taking the drug
Taking a drug incorrectly because you did not understand how or when to take it
Developing an already known but unexpected side effect because the provider did not give clear or full instructions on how to properly take the drug. For example, if you got an upset stomach because you were not told to drink a full glass of water when taking your medicine or getting sunburned because you were not counseled that the drug requires you to stay out of sunlight.
A problem with equipment used to give the medication such as with IV (intravenous) pumps, PCA (patient controlled analgesic) pumps, and insulin pens, etc.

Required information:

Please describe what happened or what could happen due to your safety concern or error. View a description of the types of information that would be helpful to understand the error.

Describe the error or adverse drug reaction. What went wrong?
Was this an actual medication error that happened to you or a loved one, or are you expressing concern about a potential error that was discovered before it reached the patient?
Type of practice site (hospital, private office, retail pharmacy, long-term care facility, etc).
The name of all drugs and/or medical products related to the error.
If known, the dosage form (capsule, tablet, injection, etc), concentration or strength, etc.

Error description:
(Be sure to include the names of all drugs involved):

Please include any product photographs, scans of doctor's prescriptions, associated records, etc. that might help us understand your report. Be sure not to include any personally identifiable information such as your name, social security number, etc.

Image 1:

Image 2:

Image 3:

Approximate date of the error or event or discovery of the medication safety concern:

How was the error/concern discovered?

What was the final outcome to the person/patient involved in the error?

If an error or event happened, what was the age of the person affected at the time of the error/event?

What do you think should have been done to avoid this type of mistake or your safety concern?

Is this the first time you have reported an error, event, or concern on this website?

Yes No

If an error or event happened...

Optional Information

Did any of the following happen to the person because of the error (check all that apply):

Had you, the person involved in the error, or their caregiver been provided with specific instructions regarding how to take the medicine?

Yes No

If yes, who provided this information?

	Pharmacist
	Nurse
	Doctor
	Other person

If yes, how were the instructions administered?

If yes, were the instructions easy to understand?

Yes No

Who discovered the event?

Were you or the person affected by the error or bad reaction told about it by a healthcare provider?

Yes No

Did you or the person affected by the error receive an apology from the healthcare provider(s) for the error?

Yes No

Optional Personal Information

All communications are strictly confidential. ISMP will not disclose your identity to any individuals or outside organizations without your expressed permission. However, we need to be able to communicate with you in case we have follow-up questions. Also, you will only receive an email confirmation of this report if you provide an email address below. If you do not provide any identifying information, please print the final report page for your records.

Name of person submitting report:

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

Email:

Important!

Our organization shares information with the FDA, in confidence, when we receive a report. Both organizations (ISMP, FDA) utilize these reports to identify and address drug-related problems by working with drug manufacturers, scientists and others. Please indicate which of the following organizations we may not share your report with (your information will be handled 100% securely and confidentially):

US Food and Drug Administration (FDA MedWatch Program)

The manufacturer, distributor or labeler of the product indicated in the report (if applicable). (Manufacturer includes drug or medical device manufacturer)

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