Transcript Diabetes Today: An Epidemic

Managing Hospital Safety:
Common Safety Concerns
(Hospital-focused presentation)
Part 3 of 4
Managing Patient Safety:
High-Risk Medications
in the Hospital Setting
High-Alert Medications:
A Cause for Concern
Why Are High-Alert Medications
a Cause For Concern?
More likely to be
associated with
harm than other
medications
Harm leads to
poor outcomes
for patients and
increased patient
care costs
Cause harm more
commonly and the
harm produced is
likely more
serious
Institute for Healthcare Improvement (IHI). Getting started kit: prevent harm from high-alert medications.
http://www.ihi.org. Accessed January 29, 2009.
Medications Associated With the Highest
Risk of Injury When Misused Are Known
as High-Alert Medications1
High-alert medications identified by key US safety organizations
ISMP1
IHI2
Joint Commission3
Parenteral chemotherapy
Anticoagulants
Insulin
IV insulin
Narcotics and opiates
Opiates and narcotics
Potassium chloride
Insulin
Injectable potassium
chloride or phosphate
concentrate
IV unfractionated heparin
Sedatives
IV anticoagulants
Epidural/intrathecal drugs
Sodium chloride solutions
>0.9%
1. The Institute for Safe Medication Practices. ISMP 2007 survey on high-alert medications: differences between nursing and
pharmacy perspectives still prevalent. http://www.ismp.org/Newsletters/acutecare/articles/20070517.asp. Published May 17,
2007. Accessed January 29, 2009.
2. Institute for Healthcare Improvement. 5 million lives campaign. Getting started kit: Prevent harm from high-alert medications.
Cambridge, MA: 2008.
3. The Joint Commission. High-alert medications and patient safety. Sentinel Event Alert.
http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_11.htm. Published November 19, 1999. Accessed
January 29, 2009.
Categories of High-Alert Medications
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Adrenergic agents
Anesthetic agents
Antiarrhythmics, IV
Antithrombotic agents
Cardioplegic solutions
Chemotherapeutic agents
Dextrose, hypertonic, ≥20%
Dialysis solutions,
peritoneal and hemodialysis
• Epidural or intrathecal
medications
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Hypoglycemics, oral
Inotropic medications, IV
Liposomal forms of drugs
Moderate sedation agents, IV
Narcotics/opiates
Neuromuscular blocking
agents
• Radiocontrast agents, IV
• Total parenteral nutrition
solutions
Institute for Safe Medication Practices (ISMP). ISMP’s list of high-alert medications.
http://www.ismp.org/Tools/highalertmedications.pdf. Accessed January 29, 2009.
Examples of ISMP Medication Safety
Recommendations for Hospitals
• Many recommendations address the common risk factors for
high-alert medications:
– Process1
• Hospital formulary should contain minimal duplication of
therapeutically equivalent products
• Make current protocols, dosing scales, and/or checklists for high-alert
drugs easily accessible to prescribers, pharmacists, and nurses
• All inpatient drug orders should be entered into a computer and
screened electronically against the patient’s current clinical profile
for contraindications, interactions, and appropriateness of doses
before drug administration
• Nurses and pharmacists should establish a clear, effective process
for resolving conflicts about safety issues with prescribers
and/or supervisors
Adapted from the Institute for Safe Medication Practices 2004.1
1. The Institute for Safe Medication Practices. 2004 ISMP Medication Safety Self Assessment ® for Hospitals.
http://www.ismp.org/selfassessments/Hospital/2004Hospsm.pdf. Accessed January 29, 2009.
Examples of ISMP Medication Safety
Recommendations for Hospitals (cont’d)
• Many recommendations address the common risk factors for
high-alert medications:
– Medication administration1
• Labels for IV admixture containers should be visible, positioned correctly,
and list the total volume of solution, the base solution, and the
concentration or total amount of each drug additive contained
• Manufacturers’ prefilled syringes should be used for at least
90% of injectable products, rather than vials
• Readable labels that clearly identify drugs should be on all drug
containers; drugs should remain labeled up to the point of administration
• All drug containers taken to the patient’s bedside should be labeled with
drug name, strength, and dose
• All medications should be dispensed to patient-care units in labeled,
ready-to-use UNIT-DOSES or in labeled UNIT-OF-USE containers
Adapted from the Institute for Safe Medication Practices 2004.1
1. The Institute for Safe Medication Practices. 2004 ISMP Medication Safety Self Assessment ® for Hospitals.
http://www.ismp.org/selfassessments/Hospital/2004Hospsm.pdf. Accessed January 29, 2009.
Please refer to the following Web link for ISMP Medication Safety Self Assessment ® for Hospitals and for additional
recommendations: www.ismp.org/selfassessments/default.asp.
Examples of ISMP Medication Safety
Recommendations for Hospitals (cont’d)
• Medication administration1
(cont’d)
– Concentrations for infusions of high-alert drugs should be
standardized to a single concentration that is used in at least
90% of cases
– With each new bag/bottle or change in the rate of infusion of
selected high-alert drugs, one practitioner should prepare the
solution for administration and a second practitioner should
independently verify that the correct drug, drug concentration,
rate of infusion, patient, channel selection, and line attachment
have been selected prior to infusion
– Machine-readable coding (eg, bar coding) should be used to verify
drug selection prior to dispensing and before administration
Adapted from the Institute for Safe Medication Practices 2004.1
1. The Institute for Safe Medication Practices. 2004 ISMP Medication Safety Self Assessment ® for Hospitals.
http://www.ismp.org/selfassessments/Hospital/2004Hospsm.pdf. Accessed January 29, 2009.
Please refer to the following Web link for ISMP Medication Safety Self Assessment ® for Hospitals and for additional
recommendations: www.ismp.org/selfassessments/default.asp.
Managing Hospital Safety:
Focus on Insulin
Increased Hospital Safety Concerns1-3
High-Alert Medications (JCAHO)1
1. Insulin
2. Opiates and narcotics
3. Injectable potassium chloride or
phosphate concentration
4. IV anticoagulants
5. Sodium chloride solutions >0.9%
1. The Joint Commission. http://www.jointcommission.org. Accessed January 29, 2009.
2. The Institute for Safe Medication Practices (ISMP). http://www.ismp.org. Accessed January 29, 2009.
3. New Tech Media. Senior Journal. http://seniorjournal.com/NEWS/Medicare/2008/20080804-CMSMoving.htm.
Accessed January 29, 2009.
Insulin Errors Directly
Affect Inpatient Care
• Insulin is a major contributor of injury-induced
medication errors within the hospital setting1
• Per Institute for Safe Medication Practices (ISMP),
11% of serious medication errors were associated
with incorrect insulin administration2
• Insulin may be twice as likely to cause patient harm
vs other reported medications based on MEDMARX
data compiled by United States Pharmacopeia3
1. Hellman R. Endocr Pract. 2004;10(suppl 2):100-108.
2. Grissinger M. P&T. 2003;28(10):628.
3. US Pharmacopeia Center for the Advancement of Patient Safety. USP patient safety CAPSLink. July 2003.
http://www.usp.org/pdf/EN/patientSafety/capsLink2003-07-01.pdf. Accessed January 29, 2009.