High Alert Medications

[NRSKarenRN, BSN, RN]

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 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