4 High Alert Medication Final

High alert
medications
By Athirah
Definition
compared to other medications
About 15 years ago, the

Institute for Safe Medication
Prctices (ISMP) in the United
States has conducted a research
to determine the medications and
conditions
which
was
most
tendency to harm patients. The

study gathered the results of data
submitted by an approximate of
161 health care organisation on
serious errors that had taken
place during this period. The
outcomes of the study showed
that a majority of the medication
errors resulting in death or
serious injury involved a small
they cause harm more commonly

and the harm they yielded are
likely to be more severe. The
harm leads not only to patient
suffering but also to increment of
costs associated with the care of
these patients. The consequences
associated
can
be
especially
serious and studies suggest this

applies across the board2. In a
study done by Budnitz D.S., et al.,
(54.9%) occurred with central

nervous system, antineoplastic
and
cardiovascular
drug
products5. The top five drugs

cited for overall incident records,
medication
errors
reaching
patinets without causing harm, or

errors resulting in patient harm,
were high alert medications such
as insulin, morphine, heparin,
potassium
chloride
and
warfarin6.
insulin, warfarin and digoxin

were implicated in one of every
HAM Categories
three estimated ADEs treated for

the
elderly,
department3.
in
Edgar
The
emergency
et
al.
American
Pharmaceutical Association has
reviewed medical event reports
listed
in a US national database and
cardiovascular
drugs,
reported that heparin, xylocaine,
chemotherapeutic
drugs,
adrenaline
potassium
narcotics, opiates, anticoagulants,
chloride were the drugs most
benzodiazepines, neuromuscular
commonly involved in critical
blocking agents and electrolytes5.
incidents4.
al.
The ISMP has 19 categories and
Medications
examined 469 fatal medication
13 specific medications in its list
are medications which are more
error reports and indicated that
of HAM (Table 1).
likely to be associated with harm
the largest number of deaths
number of specific medications.

The ISMP has termed these
medications that have the highest
risk of causing injury when
misused
as
Medications or
High-Alert
HAM1.
High-Alert
and
Phillips
et
eight
HAM
categories:
Page 7
Lorem Ipsum
Aenean sem nulla, blandit

vitae feugiat id, congue eget.
Table 1. List of Classes of Medications categorised under High Alert Medications
Common Risk Factors
Strategies in Preventing Errors Involving
The common risk factors for

errors associated with High-Alert
Procurement
1. Limit the drugs strengths available In health

center formulary.
Medications include poorly written

medication orders and incorrect
2. Avoid frequent changes of brand. Notify the end
dilution
user whenever there are changes.
procedures.
Confusion
between IM, IV, Intrathecal, Epidural

preparations and confusion between
different strengths of the same
medications such as sodium chloride
Storage
1. All HAM should be kept in individual labelled

containers. Whenever possible avoid look-alike
and sound-alike drugs or different strengths of the
same drug from being stored side by side.
3% and sodium chloride 0.9% may

predispose errors in handing HAM.
2.
Ambiguous
differences In medication names (e.g DOPamine
labeling
on
concentration and total volume of

medications also increases the risk
for errors in prescribing drugs listed
Use TALL-man lettering to emphasize
and DOBUtamine).
3. Label all containers used for storing HAM in red
as "HIGH ALERT".
as HAM, apart from look alike or

sound alike product or similar
packaging2.
Page 8
Ordering
1.
Use standardized forms for cytotoxic drugs and
parenteral nutritions.
2. Do not use abbreviations when prescribing HAM.
3. Specify the strength of dilution and rate of infusion for
HAM prescribed. (e.g. Noradrenaline 4mg in 50ml NS,
run at 5ml/hr)
Rerences:
4. Do not use trailing zero when prescribing. (e.g. 5.0mg
can be mistaken as 50mg)
Preparation
1. Establish a counterchecking system for all

preparations involving HAM.
References:
1.
Institue
for
Safe
Medication
Practices (ISMP): Part IIHow to

pre- vent errorsSafety issues
1. All HAM containers issued to wards/units must be

Dispensing/
Supply
labeled as "HIGH ALERT".
with patient-controlled analgesia.

ISMP
Medication
Acute
2. All HAM must be counter-checked before dispensing.
Care,
Safety
Jul.
24,
Alert:
2003.
http://www.ismp.org/
newsletters/acutecare/articles/20
030724.asp?ptr=y (last accessed
Jul 2011).
2.
McCannon C.J., Hackbarth A.D.,

Giffin
F.A.:
Miles
to
go:
An
introduction to the 5 Million Lives

Campaign. Jt Comm J Qual Patient
Saf 33:477484, Aug. 2007.
3.
Leape L.L., et al.: The nature of

adverse events in
hospitalized
patients. Results of the Harvard

Medical Practice Study II. N Engl J
Med 324:377384, Feb. 7, 1999.
4.
Leape L.L., et al.: The nature of

adverse events in
Conclusion
hospitalized
patients. Results of the Harvard

Medical Practice Study II. N Engl J
As the conclusion, High-Alert Medications posses high risk for

errors and the impact on patients safety is a system problem, which
Med 324:377384, Feb. 7, 1991.

5.
T.:
improve
will therefore require a joint effort from all health care participants
including doctors, pharmacists and nurses to improve patients safety
Nolan
System
patient
changes
safety.
to
BMJ
320:771773, Mar. 18, 2000.

6.
Rozich J.D., et al.: Standardization
with respect to minimising the errors and ultimately, their
as a mechanism to improve safety
consequences.
in health care. Jt Comm J Qual

Patient Saf 30:514, Jan. 2004.
Page 9

4 High Alert Medication Final

Uploaded by

Copyright:

Available Formats

4 High Alert Medication Final

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

4 High Alert Medication Final

Uploaded by

Copyright:

Available Formats

High alert

compared to other medications

About 15 years ago, the

tendency to harm patients. The

they cause harm more commonly

serious and studies suggest this

(54.9%) occurred with central

products5. The top five drugs

patinets without causing harm, or

insulin, warfarin and digoxin

three estimated ADEs treated for

Pharmaceutical Association has

reviewed medical event reports

in a US national database and

reported that heparin, xylocaine,

narcotics, opiates, anticoagulants,

chloride were the drugs most

commonly involved in critical

blocking agents and electrolytes5.

The ISMP has 19 categories and

examined 469 fatal medication

13 specific medications in its list

are medications which are more

error reports and indicated that

of HAM (Table 1).

likely to be associated with harm

the largest number of deaths

number of specific medications.

Aenean sem nulla, blandit

Strategies in Preventing Errors Involving

The common risk factors for

1. Limit the drugs strengths available In health

Medications include poorly written

2. Avoid frequent changes of brand. Notify the end

user whenever there are changes.

between IM, IV, Intrathecal, Epidural

1. All HAM should be kept in individual labelled

3% and sodium chloride 0.9% may

differences In medication names (e.g DOPamine

concentration and total volume of

Use TALL-man lettering to emphasize

as HAM, apart from look alike or

Use standardized forms for cytotoxic drugs and

1. Establish a counterchecking system for all

Practices (ISMP): Part IIHow to

1. All HAM containers issued to wards/units must be

with patient-controlled analgesia.

2. All HAM must be counter-checked before dispensing.

McCannon C.J., Hackbarth A.D.,

introduction to the 5 Million Lives

Leape L.L., et al.: The nature of

patients. Results of the Harvard

Leape L.L., et al.: The nature of

patients. Results of the Harvard

As the conclusion, High-Alert Medications posses high risk for

Med 324:377384, Feb. 7, 1991.

320:771773, Mar. 18, 2000.

Rozich J.D., et al.: Standardization

with respect to minimising the errors and ultimately, their