High Alert Medications during Transport

Here.I.Stand, BSN, RN · Feb 29, 2016

Hmm I haven't come across that, but then narcotics/benzos are not on our high alert list.

Our list includes IV heparin, insulins (IV or SQ), vasoactive gtts at initiation (but not for adjustments), paralytics, and MgSO4 gtts (since we have to do med math for titrations, e.g. decrease by 25%.) TPN also requires a dual sign.

None of those things would be given/adjusted while in the MRI scanner unless the pt codes and is needed emergently.

CRNAs draw up and give RSI drugs.

Penelope_Pitstop, BSN, RN · Feb 29, 2016

"manual independent double-checksare not always the optimal error-reduction strategy and may not bepractical for all of the medications on the list."

Got that from ISMP's list, which I got to from IHI's website.

KatieMI, BSN, MSN, RN · Mar 1, 2016

We get the meds (sometimes pre-drawn) with another RN and then during the process I just administer what is needed, noting dose and time. We have pre-printed labels for syringes so not to mix them. If there is a drip, I just change the bag.

Unfortunately, MRI and other such areas commonly do not have even flushes, leaving alone another RN. CRNA will push RSI sequence meds but they only around if something that serious is planned and most of my patients are trached anyway. If the patient suddenly got panic attack in MRI tube with BP hitting the ceiling, I am on my own for at least 5 min and probably longer, so I'll just push hydralazine or whatever is ordered for hypertensive emergency.

calivianya, BSN, RN · Mar 1, 2016

I've never worked anywhere that considered narcotics or benzos to be high alert medications, so this is not a problem I've ever run into. High alert medications that require a dual sign off include IV insulin, digoxin, tPA, IV heparin - and those are, generally speaking, not things that I'd have to give emergently while the patient is MRI.

Maybe you could suggest your facility take another look at what drugs are considered critical drugs.

bobbi_marieda · Mar 2, 2016

It's interesting that your institution doesn't consider IV narcotics or opiates to be high alert medications. They are definitely categorized as high alerts by ISMP.

bobbi_marieda · Mar 2, 2016

This is similar to what is done now at our facility. We just never technically have a 2nd RN verifying the dose at the time of administration if we are on a transport. There may not be a perfect solution, I was just curious if another institution had a better way.

Penelope_Pitstop, BSN, RN · Mar 2, 2016

It's interesting that your institution doesn't consider IV narcotics or opiates to be high alert medications. They are definitely categorized as high alerts by ISMP.

So is Metoprolol.

How long would an AM med pass take on a MedSurg floor if every beta blocker had to be double-checked?

And how far is this taken - does every titration of a vasoactive gtt need a second nurse?

Not jumping on you, bobbi. Obviously this is what you know. But I really don't see how it's realistic. Every med has the potential for danger. That's why we do our checks and observe the rights of administration.

MunoRN, RN · Mar 2, 2016

It's interesting that your institution doesn't consider IV narcotics or opiates to be high alert medications. They are definitely categorized as high alerts by ISMP.

You've misunderstood ISMP's recommendations, and actually have them backwards. ISMP specifically recommends not doing double checks on all high alert medications, such as opiates, benzos, SQ insulin, etc. They've found that overuse of double checks negates their effectiveness.

https://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=51

bobbi_marieda · Mar 2, 2016

Fair point well made. :-)

Although maybe the key piece I was missing is that I work in pediatrics, always have. IV opiates have always been considered a HAM requiring an independent RN double check where I've worked. Sometimes I forget that there's adults in the world, lol. I'm assuming that's where discrepancy lies.