Potential clinical consequences and details of medication process problems.

Table 1: Potential clinical consequences and details of medication process problems.

Potential clinical consequence	Medication process problems n (%)	Examples of medication process problems
Class 1^a	129 (41.8)	Calmurid cream for daily use has been prescribed but is not listed on the MARL (medication discrepancy).
		Triamcinolonacetonide 0.1% ear drops have been stopped by the prescriber; however, ear drops are still listed on the MARL (medication discrepancy).
		No medication list has been delivered with the prescription order: Hydrocortisone Vaseline cream 1% (undelivered MARL).
Class 2^b	116 (37.5)	Lactulose (oral solution, dose 15 ml, twice a day) is not listed on the MARL (medication discrepancy).
		An ophthalmologist prescribed Artelac eye drops (four times per day); however, the prescription is not listed on the MARL (medication discrepancy).
		The Vidisic eye drop has not been delivered (undelivered medication).
Class 3^c	64 (20.7)	The medication list with the prescription of Insulin is not delivered (undelivered MARL).
		No Isosorbide Mononitrate Retard 60 mg delivered (undelivered medication).
		The dose of Lantus has been changed from 18 IE to 10 IE once a day; however, the MARL still lists 18 IE once a day (medication discrepancy).

^aProblem was unlikely to result in discomfort or clinical deterioration; ^bProblem had the potential to result in moderate discomfort or clinical deterioration; ^cProblem had the potential to result in severe discomfort or clinical deterioration.