When the nurse writes in the chart and discovers an error has been made which is the best approach

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Detection methods used to investigate medication errors and adverse events

Method	Advantages	Limitations	Efficacy	Costs
Chart review	Retroactive; disposable data; commonly used; standardized criteria; poor at capturing latent failures	Difficult; time-consuming; labour intensive; planning criteria/indicators necessary	Gold standard to detect adverse events; less medication errors detected; reviews, papers	Reviewers' training and time (nurses, pharmacists, students, physicians)
Claims data	Local data; captures latent failures	Litigation based; legal implications	Adverse events detected	Reviewers' training and time
Incident reporting (sentinel events)	High-quality data; root cause analysis due; captures active and latent failures	Only detects severe, unexplained events/deaths; underestimated rates (blame and fear of punishment)	Reports and alerts; detects adverse events; less medication errors detected	Root cause analysis
Voluntary reporting	Variety of sources; structured simple form; Captures active and latent failures; promotes a culture of safety	Variable quality; underreporting; blame culture; problem of data integration	Reports and alerts; feedback and corrective actions; medication errors detected	Time for feedback and analysis
Administrative data examination	Disposable and retroactive data; easy; standardized	Absence of clinical data	Statistical	Routine evaluation
Computer monitoring	Multidata source integration; real time; adverse events prevention	Inserted errors; poor software; poor triggers; undetermined future risks	Prescribing faults, prescription errors, and dispensing errors (CPOE)	High costs for software and implementation
Direct care observation	Accurate; captures active errors	Time-consuming; training difficult;	Good quality data about administration errors	Nurse training
Patient monitoring	Data from outpatients; wide impact	Not standardized tools (interviews, questionnaires, focus groups, etc)	Future development	Nurse training