Change register form

If you have any recommendations for change of the NIMC, please complete the form provided. Please note that your recommendation for change must be evidence based, with the primary objective of improving patient safety. All recommendations will be considered and outcomes provided on the form accordingly. It should be noted that any significant changes to the form have to be agreed nationally.

Date:
Hospital:
Section of Chart:
Proposal/ Issue/ Risk:

Evidence for Change:

If you would like feedback on this issue, please provide us with your contact details:
Name:
Email Address:

Did this factor result in a medical error? If Yes, please report the error.
Medication error resulting from NIMC If you have experienced any medication errors which you believe are a direct result of the implementation / design of the NIMC, please complete an AIMS form, including the phrase ‘National Medication Chart’ or 'NIMC' in the 'Describe the actual or potential incident’ or ‘Contributing factors’ section of the AIMS form. AIMS forms are available on your Ward / Unit.

Change register form

Medication error resulting from NIMC