amanda.woltz@iowa.gov
6200 Park Ave., Ste. 100 Des Moines, IA 50321
515-281-6674
Iowa Board of Pharmacy 6200 Park Ave., Ste. 100 Des Moines, IA 50321 515-281-5944
Each quarterly report shall be maintained in the pharmacy.
Reporting Date
Quarter
Pharmacy Address
Supervising RPh
Checking technician participating in TPV
Report the following errors on this report:
Include: wrong drug, wrong strength, incorrect storage, non-safety cap without patient authorization, other product filling errors which could impact patient safety.
Do not include: data entry/typing errors, safety cap when non-safety cap is authorized, wrong quantity or other errors that are not directly related to the verification station.
*Calculate % error rate by dividing total errors by # double checked by RPh
Month
The following errors must be documented into your Continuous Quality Improvement (CQI) system.
Include: wrong drug, wrong strength, incorrect storage, non-safety cap without patient authorization, other product filling errors which could impact patient safty that were caught by the checking technician during product verification.
Do not include: data entry/typing errors, safety cap when non-safety cap is authorized, wrong quantity or other errors not related to the filling of the drug product.
Compliance officers may request to view this information upon inspection or site visit.
Errors that were detected after verification, that were discovered outside of the pharmacist double checks must be documented into your CQI system.
Pharmacist Hours Worked
Which clinical services do you currently provide at your pharmacy?
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