"High Alert Medications"--How are you dealing with them?

[PICC ACE]

The ISMP recently put out an updated list of what they have determined to be "high-alert" medications. That is,medication which have a "heightened risk of causing significant patient harm when they are used in error". The list is a long one and pretty much includes everything given in an ICU from paralytics to pressors to even KCl. One of the recommended strategies for improving safe administration of these meds includes a redundant manual double-check. (If you want to see the list,go to : http://www.ismp.org/ and find the high-alert medication list.)

My hospital's powers-that-be decided to make our jobs even more infernal by requiring us to have a second person not only sign off on the med but go to the room and actually witness the med be hung,the pump programmed,follow the tubing to the patient,etc. Made for an awful lot of ticked off nurses,as you might guess.

We are trying to overturn this policy change,but not look like we are ignoring the need for patient safety. I would like to hear from others what their hospitals have done about these medications.

Thanks,

Z.

[meandragonbrett]

The only thing we double check is controlled substance gtts/PCA. We do not double check pressors, insulin, or heparin.

[stressgal, RN]

We are required to double check insulin, PCA pumps, and any heparin product. This includes TPN/PVN which contains heparin/insulin. Yes we were crabby at first (still are at times). We use a computerized MAR and must scan our bar code, found on our name badge, along with a second nurses initials and bar code. Time consuming.....yes! In all of my checks I have never come across an error. Pressors do not require double check at this time, however if I am utilizing a concentrated dose that is not programmed into our "smart pumps" I have a second RN check my entry/rate. Actually the only error I have ever experienced was when a POCT reported a lunchtime fingerstick glucose aroud 350, which I covered and then saw the lab result cross over the computer as 120. Turns out she had swapped the glucose check number for the foley output. The patient was provided with a really good lunch and no bad outcome but I did have and reported a med error. Needless to say I now wait until I see confirmation on our computer system prior to administering coverage. Live and learn.

[NickiLaughs, ADN, BSN, RN]

I think it's funny because we have to double check when we're giving SQ insulin but not when our patient is on an insulin gtt.....

[fiveofpeep]

it seems like most nurses just "cosign" after the med was given anyways because they forgot or were too busy