Transcript High Alert Medication

HIGH ALERT MEDICATION
Definition:
 medication that have a higher likelihood of
causing injury if they are misused. Errors with
these medications are not necessarily more
frequent- just their consequences may be
more devastating. Some high alert
medications also have high volume use.
TOP FIVE HIGH ALERT
MEDICATIONS
 Insulin
 Opiates and narcotics
 Injectable potassium chloride or phosphate
concentrate
 Intravenous anticoagulants (heparin)
 Sodium chloride solutions above 0.9 percent.
Ref. ISMP 2007 Survey on High-Alert Medications
INSULIN
Common risk factor:
 Lack of dose check systems
 Insulin & heparin vials kept in close proximity
to each other on a nursing units, leading to
mix-ups
 Use of “U” or “IU”
 Incorrect rates being programmed into an
infusion pump
Suggested Strategies:
 Establish a check system whereby one nurse
prepares the dose and another nurse reviews
it.
 Do not store insulin and heparin near each
other.
 Spell out the word “units” instead of “U”
 Build in an independent check system for
infusion pump rates and concentration
settings.
OPIATES AND NARCOTICS
Common risk factors:
 Narcotics kept as floor stock
 Confusion between morphine and
hydropmorphone
 PCA ( patient controlled analgesia)
errors regarding rate and
concentrations.
Suggested Strategies:
 Limit opiates and narcotics in Floor stock
 Education (sound-alike, hydromorph.)
 Implement PCA protocols
 Double-check drug and pump settings
 Prepare infusion in Pharmacy
INJECTABLE POTASSIUM
CHLORIDE OR PHOSPHATE
CONCENTRATE
Common risk factor:
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Mixing pot. chloride/ phosphate
Request for unusual concentrations
Unclear labels
Storing concentrated potassium
chloride/phosphate outside the pharmacy
Suggested strategies
 Remove Pot. Chloride/ phosphate from wards
 Use commercially available premixes
 Standardize and limit concentrations
 Prepare, double-check in pharmacy
INTRAVENOUS
ANTICOAGULANTS
(HEPARIN)
Common risk factor:
 Unclear labelling regarding concentration
and total volume
 Multidose-containers
 Confusion between heparin and insulin due
to similar measurement units and proximity.
Suggested strategies:
 Standardized concentrations and use
premixed solutions.
 Use only single-dose containers.
 Separate heparin and insulin.
SODIUM CHLORIDE SOLUTIONS
ABOVE 0.9 PERCENT
Common risk factor:
 Storing sodium chloride solutions above 0.9
percent on nursing units.
 Large number of concentrations/formulations
available.
 No double check system in place.
Suggested strategies:
 Limit access of sodium chloride solutions
above 0.9 percent and remove from nursing
units.
 Standardize and limit drug concentrations.
 Double check pump rate, drug, concentration
and line attachments.
ACTIONS THAT CAN BE TAKEN IN
CLINICAL AREAS
 Risk awareness- be aware of high alert products in
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your area.
Review floor stock to reduce availability of items, as
well as, quantities.
Use of shelf labelling which incorporates TALLman
lettering.
Separate storage for easily mistaken medicines.
Additional product labels.
Read the labels three times (RL3).
Insure proper and correct programming of infusion
pumps.
 Independent double checking system
( example: IV medication and infusion
pumps).
 Standardize the prescribing / order entry/IV
infusion labelling/pump settings.
 Know the medications that you administer
example dose, route, frequency, effect,
common adverse effects, and monitoring
( laboratory
PRINCIPLES FOR IMPROVED
SAFETY OF HIGH ALERT
MEDICATIONS
1. ELIMINATE THE POSSIBILITY
OF ERROR
 Reducing the number of medications in the
formulary.
 Reducing the number of concentrations and
volumes to those clinically appropriate for
most.
 Remove / minimize high alert medications
from clinical areas, where possible.
2. MAKE ERRORS VISIBLE
 Have two individuals independently check
the product or setting.
Examples: IV pumps and epidural
medications, insulin doses drawn up in
syringe, and chemotherapy and TPN
production.
3. MINIMIZE THE CONSEQUENCES
OF ERROR.
 Minimize the size of vials or ampules in the
patient care area to the dose comonly needed
( example: heparin in single dose vial versus
10 ml vials
 Reduce the total dose of High Alert
Medications in continous IV drip
bags(example: 12,500 units of heparin in 250
ml vs 25,000 units in 500 ml) to reduce risk
when it runs away, because it will.
Thank You