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High-Alert Medications
Defined as drugs having a higher
likelihood of causing injury if misused Are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Some high-alert medications also have a high volume of use, increasing the likelihood that a patient might suffer inadvertent harm. MEDICATIONS are deemed high alert not because they are more prone to errors than other medications but because of the serious harm that can result from administering the drug error. In 1993, certain medications were tagged as todays poisons. JCHO has made one high-alert medication a priority by including it in one of its patient-safety goals Some of the measures implemented to prevent problems with high-alert medications are: Limit availability of medication Utilize double checks; it can occur at the dispensing or administering point of the medication-use process. Utilize caution labels Review storage practices for those items that must remain available for use Standardize ordering procedures; use pre-printed orders when possible
Some of the measures implemented to prevent problems with high-alert medications are: Require double check calculations Use only pumps that are protected from free flow Implement maximum dosing alerts in pharmacy computer systems Develop standards for monitoring of some high-alert medications Prohibit bolus doses from infusion bags. (3) Principles to improve high-alert medication administration and distribution:
1.) Eliminate the Possibility of Error
2.) Make Errors Visible
3.) Minimize the Consequence of Error
1. Eliminate the Possibility of Error Reduce the number of drugs on a facilitys formulary. Reduce the number of concentrations and volumes Remove high-alert drugs from critical areas
2. Make Errors Visible Have two individuals independently check the product to ensure it is correct, particularly when received in bulk. Have two individuals independently check equipment settings, as applicable, since some drugs are administered IV. 3. Minimize the Consequence of Error Minimize the size of vials or ampules in the patient-care area to be able to give the dose commonly needed. Reduce the total dose of high-alert drugs in continious IV drip bags. Reduce the concentration of the drugs when possible. Based on these principles, fostering change in the way high-alert drugs are managed includes things such as: Encouraging standardized dosing procedures; Carefully screening new products; and Creating system redundancies, commonly known as double checks
The US FDA defines a drug product as having a narrow therapeutic ratio as follows: A. There is less than a 2-fold difference in median lethal dose and median effective dose values. B. There is less than 2-fold difference in the minimum toxic concentration and minimun effective concentrations in the blood. C. Safe and Effective use of the drug products requires careful titration and patient monitoring. QUESTION: 1. What are the reasons why certain medications are deemed high alert?
Answer: High-alert (or high-hazard) medications are medications that are most likely to cause significant harm to the patient, even when used as intended. Although any medication used improperly can cause harm, high-alert medications cause harm more commonly and the harm they produce is likely to be more serious and leads to patient suffering and additional costs associated with care of the patients.
QUESTION: 2. What are the methods of preventing errors in the administration of the high-alert medications and narrow therapeutic index drugs?
Answer: Health information technology has been identified as method to reduce medication errors as well as improve the efficiency and quality of care. Computerized physician order entry and clinical decision support systems can play a crucial role in decreasing errors in the ordering stage of the medication
QUESTION: 3. What are the technologies used to minimize high alert medication errors?
Answer: Bar code technology, intravenous infusion safety systems, and electronic medication administration records can target prevention of errors in medication dispensing and administration
QUESTION: 4. What are the other agents considered as High Alert Medications?
Answer: top high-alert medications to be insulin, opioids, injectable potassium chloride (or phosphate), intravenous anticoagulants (heparin), and sodium chloride solutions Other high-alert medications include chemotherapeutic agents and sedatives.
QUESTION: 5. What are the organizations offering safe medication practices?
Answer: American Society of Health-System Pharmacists They have offer an extensive information for patients page which offers tips and tools for safe medication practices and step-by-step instructions on how to administer the different forms of medication. Be MedWise On this website, patients can find educational resources for successfully managing and understanding their medications.
Drug Digest DrugDigest is a noncommercial, evidence-based, consumer health and drug information site dedicated to empowering consumers to make informed choices about drugs and treatment options. US Pharmacopoeia (USP) USP Offers: definitions of medical and drug terminology articles on medication errors in various settings, medication safety initiatives, and the impact of practitioner experience on official drug standards-tools such as USPs Drug Error Finder, a free tool for accessing lookalike/soundalike drug names
alerts on specific drug products based on medication error reports patient safety newsletters (USP Drug Safety Review,USP Medication Safety Review, Error Watch, USP Quality Review)
HIGH-ALERT MEDICATION DRUGS 1. Adrenergic Agonist EPINEPHRINE Availability: 10 mL saline. Maintenance: 500mcg/dose 6 times a day Pharmacologic Category: Cardiac Stimulant
What are narrow therapeutic drugs? Narrow therapeutic index (NTI) drugs are agents for which small changes in systemic concentration can lead to significant changes in pharmacodynamic response What are the concerns for drugs with narrow therapeutic indices? By definition, approved drugs with narrow therapeutic indices exhibit small intrasubject variability.
If this were not true, patients would routinely experience cycles of toxicity and lack of efficacy, and therapeutic monitoring would be useless.
ACTIVITY Narrow Therapeutic Drugs 1. Digoxin Availability & Dose: 250 mcg >10 year old Rapid oral loading dose 750-1500 mcg as single dose Slow oral loading dose 250-750 mcg daily for one week followed by an maintenance dose Maintenance dose: Usually 125-250 mcg/day Pharmacologic Category: Cardiac drug 2. Heparin Availability & Dose: 1000 IU/mL Treatment of venous thromboembolism IV loading dose of 5000-10,000 u 12hrly Children Lower loading dose then maintenance with continuous infusion of 15-25u/kg Pharmacologic Category: Treatment and prophylaxis of thromboembolism Availability & Dose: 100mg,50mg/mL Adult Initially 100mg tid Children Initially 100mg tid, adjusted Status Epilepticus 10-15mg/kg slow IV Maintenance: 100mg orally or IV 6- 8hrly Cardiac Arrhythmia 3.5-5mg/kg once Pharmacologic Category: Anticonvulsant Availability & Dose: 130mg Adult 1 tab tiq-qid Children 7-12 yr tab tid- qid Pharmacologic Category: Antiasthma Availability & Dose: 1mg, 2.5mg, 5 mg Induction 10mg daily and adjusted according to prothrombin time response Elderly lower doses Maintenance 2-10mg daily