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Table 2 Worksheet used to assess the potential clinical consequences due to anticancer medication errors

From: Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs

Error number:
Check the appropriate boxes
Physician assessment number: 1 or 2  
Potential severity according to the Medication Error Index (3)   
No consequences for the patient   
An error avoided that would not cause patient harm   
An error avoided that would require monitoring to confirm that it did not result in patient harm   
Temporary damage Potential clinical consequences Potential hospitalisation and treatment*
An error avoided that could have contributed to temporary harm to the patient, requiring intervention Acute renal failure Hospitalisation
  Cardiac toxicity Prolongation of the initial hospitalisation
  Skin toxicity New hospitalisation
An error avoided that could have contributed to temporary harm to the patient, requiring initial or prolonged hospitalisation Neutropenia Type of ward
  Thrombopenia Standard hospitalisation unit
  Anemia Day-care unit
  Febrile neutropenia Intensive care unit
  Neurotoxicity Number of additional days of hospitalisation
Permanent damage Hepatic cytolysis Treatments
An error avoided that could have contributed to permanent patient harm Hepatic cholestasis Platelet transfusions
Compromised vital prognosis Diarrhea Erythrocyte transfusions
An error avoided that could have required intervention necessary to sustain life Vomiting Granulocyte Colony Stimulating Factor
Patient death Other: Parenteral nutrition
  Other:  
An error avoided that could have contributed to the patient's death   
  1. * Only drugs funded in addition to the diagnosis-related groups costs