Anonymous Reporting

Please read the ‘Information’ section prior to completing a report. Reporting an incident via the Online Anonymous Incident Reporting System ensures anonymity. To preserve this, please do not include any information that allows identification of patients or pharmacy staff. SPPG reserves the right to edit/remove information received eg inclusion of person-identifiable information.

Questions marked with asterisk * must be completed

Date of Incident*
Approximate date if exact unknown
DD slash MM slash YYYY
Age of Patient involved in incident
Approximate age if exact unknown
Summary of incident*
(Must not include information that will identify patients or staff)
Please provide a complete description of the incident. Include the name, form, dose and quantity of medication(s) prescribed and dispensed (if different). Indicate if the patient actually received or consumed the medication. For product-specific concerns (e.g labelling and packaging risks), please include the manufacturer name and product batch number.
Was any harm caused?*
Where an incident has caused harm, it is encouraged that this is discussed with a Pharmacy Adviser at your local SPPG office.
- No
- Yes
Please provide details of any harm caused and if any follow up was required eg increased monitoring.*
Possible causes or contributory factors*
Action taken by pharmacy with regard to this incident*
Action taken by pharmacy to prevent a re-occurrence*
Further recommendations/suggestions that may help prevent a re-occurrence
Yellow Card Report
Please tick if a Yellow Card report has been made.
Thank you for reporting your incident to the SPPG Anonymous Incident Reporting System. The information that you have provided will be used by the SPPG to share learning with healthcare professionals across Northern Ireland or with suppliers/other health organisations where this will contribute to the safer use of medicines.

If you wish to print or save a copy of your report for your records, please do so BEFORE submitting. The report will not be accessible to pharmacy staff to print once submitted.
Phone
This field is for validation purposes and should be left unchanged.

Anonymous Reporting

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