Free Administration Record Correction Form Template
Administration Record Correction Form
This form is utilized to document corrections made to the medication administration record (MAR) for accuracy and patient safety. Please complete all sections accurately, providing details of the error, correction, and staff involved. Sign and date upon completion. Thank you for your attention to detail.
Patient Information
|
Patient Name: |
[Your Name] |
|---|---|
|
Patient ID/DOB: |
JS166172 / [Month Day, Year] |
|
Date of Correction: |
[Month Day, Year] |
|
Location/Unit: |
Medical Ward, Room 203 |
Medication Information
|
Medication Name: |
Ibuprofen |
|---|---|
|
Prescription/Order Number: |
RX789012 |
|
Dosage/Strength: |
200 mg |
|
Route of Administration: |
Oral |
|
Frequency: |
Every 6 hours |
|
Date/Time of Administration Error: |
[Month Day, Year], 10:00 AM |
Nature of Error
Description of Error: The medication administration record (MAR) incorrectly documented the administration of Ibuprofen at 10:00 AM. However, upon review of nursing notes and patient assessment, it was discovered that the medication was administered at 11:00 AM.
Explanation of How Error Occurred: The error likely occurred due to a documentation oversight during a busy medication administration round.
Correction Details
|
Corrected Dosage/Strength: |
200 mg |
|---|---|
|
Corrected Date/Time of Administration: |
[Month Day, Year], 11:00 AM |
|
Corrected Route of Administration: |
Oral |
|
Corrected Frequency: |
Every 6 hours |
Reason for Correction
Reason for Error (if known): Documentation oversight during medication administration round.
Preventive Measures to Avoid Future Errors: Reinforcing the importance of accurate documentation during medication administration rounds. Encouraging staff to double-check and verify administration times.
Staff Information
|
Name of Staff Member Identifying Error: |
[Name] |
|---|---|
|
Staff Member Role/Position: |
Registered Nurse |
|
Signature: |
|
|
Date: |
[Month Day, Year] |
Additional Comments/Notes
|
None. |
Approval
Approval of Correction
Supervisory approval is required. Please ensure a supervisor reviews and signs this section before final submission.
[Name of Supervisor Reviewing Correction]
Head Nurse
[Month Day, Year]
