Published Apr 24, 2010
NRSKarenRN, BSN, RN
10 Articles; 18,926 Posts
ismp issues list of high-alert medications
high-alert medications are drugs that pose a heightened risk of causing significant patient harm when they are used in error. although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. based on error reports submitted to the usp-ismp medication errorsreporting program and reports of harmful errors in the literature, ismp has created a list of potential high-alert medications. during august and september of 2003, more than 350 practitioners responded to an ismp survey designed to identify which of these medications were most frequently considered high alert by individuals and organizations.further, to assure relevance and completeness, the clinical staff at ismp, membersof our advisory board, and safety experts throughout the us were asked to reviewthe potential list. the following list of 33 drugs and drug categories reflects the collective thinking of all who provided input. we hope you will use this list to determine the medications that require special safeguards to reduce the risk of errors. this may include strategies like limiting access; using auxiliary labels and automated alerts; standardizing the ordering,concentrations, preparation, and administration of these products; using premixed solutions; and employing automated or independent double-checks when necessary.(note: manual double-checks are not always the optimal error reduction strategy and may not be practical for a few of the medications on the list.) during 2004, we plan to issue a series of surveys to learn more about the special precautions healthcare organizations have in place for several of these medications. [color=white]class/category of medications drug categories: adrenergic agonists, iv (e.g., epinephrine)adrenergic antagonists, iv (e.g., propranolol) anesthetic agents, general, inhaled and iv (e.g., propofol) cardioplegic solutions (used to induce cardiac arrest in open heart surgery) chemotherapeutic agents, parenteral and oral dextrose, hypertonic, 20% or greater dialysis solutions, peritoneal and hemodialysisepidural or intrathecal medicationsglycoprotein iib/iiia inhibitors (e.g., eptifibatide)hypoglycemics, oral (e.g., glyburide)inotropic medications, iv (e.g., digoxin, milrinone)liposomal forms of drugs (e.g., liposomal amphotericin b)moderate sedation agents, iv (e.g., midazolam)moderate sedation agents, oral, for children (e.g., chloral hydrate)narcotics/opiates, iv and oral liquid concentrates (immediate- and sustained-release)neuromuscular blocking agents (e.g., vecuronium)radiocontrast agents, ivthrombolytics/fibrinolytics, iv (e.g., tenecteplase)total parenteral nutrition solutions drugs:amiodarone, ivcolchicine injectionheparin, low molecular weight, injectionheparin, unfractionated, ivinsulin, subcutaneous and ivlidocaine, ivmagnesium sulfate injectionmethotrexate, oral, non-oncologic usenesiritide, ivnitroprusside, sodium, for injectionpotassium chloride for injectionconcentratepotassium phosphates injectionsodium chloride injection, hypertonic (more than 0.9% concentration)warfarin http://www.ismp.org/tools/highalertmedications.pdf
high-alert medications are drugs that pose a heightened risk of causing significant
patient harm when they are used in error. although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. based on error reports submitted to the usp-ismp medication errors
reporting program and reports of harmful errors in the literature, ismp has created a list of potential high-alert medications. during august and september of 2003, more than 350 practitioners responded to an ismp survey designed to identify which of these medications were most frequently considered high alert by individuals and organizations.
further, to assure relevance and completeness, the clinical staff at ismp, members
of our advisory board, and safety experts throughout the us were asked to review
the potential list.
the following list of 33 drugs and drug categories reflects the collective thinking of all who provided input. we hope you will use this list to determine the medications that require special safeguards to reduce the risk of errors. this may include strategies like limiting access; using auxiliary labels and automated alerts; standardizing the ordering,concentrations, preparation, and administration of these products; using premixed solutions; and employing automated or independent double-checks when necessary.
(note: manual double-checks are not always the optimal error reduction strategy and may not be practical for a few of the medications on the list.) during 2004, we plan to issue a series of surveys to learn more about the special precautions healthcare organizations have in place for several of these medications.
[color=white]class/category of medications
drug categories:
adrenergic agonists, iv (e.g., epinephrine)
adrenergic antagonists, iv (e.g., propranolol)
anesthetic agents, general, inhaled and iv (e.g., propofol)
cardioplegic solutions (used to induce cardiac arrest in open heart surgery)
chemotherapeutic agents, parenteral and oral
dextrose, hypertonic, 20% or greater
dialysis solutions, peritoneal and hemodialysis
epidural or intrathecal medications
glycoprotein iib/iiia inhibitors (e.g., eptifibatide)
hypoglycemics, oral (e.g., glyburide)
inotropic medications, iv (e.g., digoxin, milrinone)
liposomal forms of drugs (e.g., liposomal amphotericin b)
moderate sedation agents, iv (e.g., midazolam)
moderate sedation agents, oral, for children (e.g., chloral hydrate)
narcotics/opiates, iv and oral liquid concentrates (immediate- and sustained-release)
neuromuscular blocking agents (e.g., vecuronium)
radiocontrast agents, iv
thrombolytics/fibrinolytics, iv (e.g., tenecteplase)
total parenteral nutrition solutions
drugs:
amiodarone, iv
colchicine injection
heparin, low molecular weight, injection
heparin, unfractionated, iv
insulin, subcutaneous and iv
lidocaine, iv
magnesium sulfate injection
methotrexate, oral, non-oncologic use
nesiritide, iv
nitroprusside, sodium, for injection
potassium chloride for injection
concentrate
potassium phosphates injection
sodium chloride injection, hypertonic
(more than 0.9% concentration)
warfarin
http://www.ismp.org/tools/highalertmedications.pdf