Unit 5 – Prescribing in Practice

Identifying and Reporting ADRs and Near Misses

Refer Back

Link to Unit 2. Clinical Pharmacology, including the Effects of Co-morbidity.

Link to Unit 4. Prescribing Partnerships.

It is crucial to foster and support a no-blame culture with regard to identifying adverse drug reactions (ADR) and reporting them. This is to ensure that individuals can give an honest account of why an ADR occurred.

An ADR may occur as a result of a hurried consultation or be due to inadequate information being recorded in the patient's notes. Ensuring that all the information regarding a consultation, such as the quality of the patient's notes and the length of consultation, is documented may assist in preventing other ADRs.

Recording so-called near misses is also important, to prevent future such occurrences — the next time it may not be near miss and could lead to a patient suffering an ADR. Again, documentation is important to help identify whether a system may need to be put in place or a current one improved to ensure a near miss does not occur in a similar situation.

An ADR may be reported via the Yellow Card scheme, if appropriate, and/or may be reported in your area of practice.

Make Notes

Make notes on any systems that you are aware of for reporting ADRs or near misses within your practice area.

If you are unaware of any such systems, investigate whether there is one in place and, if not, why not? Could it be that people are afraid of being honest? How would you feel about reporting that you had made an error that resulted in an ADR?
Maybe this would be a good time to suggest implementing such a system, or even write a proposal for one yourself.

Further information about the Yellow Card scheme is available at:



British National Formulary (BNF)

Go to section entitled Guidance on Prescribing and read subsection 'Adverse Reactions to Drugs'.

Make Notes
  • Consider and write down whom you would need to inform of a suspected ADR
  • Consider and write down where you would need to document this incident (such in a patient's notes, the Yellow Card scheme and so on)
  • What other actions would you need to take?
  • Ensure you are aware of what to report with regards to 'black triangle' drugs and the difference between a serious and a severe reaction
  • Consider issues regarding, adverse reactions in children and older people, delayed drug effects, congenital abnormalities and herbal remedies.
Refer Back

Link to 'Contraindications to immunisation' in Unit 3. Prescribing and the Wider Healthcare Context.

Further Reading

Further reading

Griffith, R. (2006) Adverse drug reactions and non-compliance with prescribed medication. Nurse Prescribing, 4 (2) 69-72.

Cossey, M. (2004) Applied pharmacology in Courtenay, M. and Griffiths, M. Independent and Supplementary Prescribing: An Essential Guide. London: Greenwich Medical Media. Chapter 7. Adverse Drug Reactions, 93-95.

Wong, I. (1999) Pharmacovigilance resources in the United Kingdom. Pharmaceutical Journal 263: 7059, 285-288.

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