High alert

medications
By Athirah

Definition compared to other medications

(54.9%) occurred with central
they cause harm more commonly
About 15 years ago, the nervous system, antineoplastic
and the harm they yielded are
Institute for Safe Medication and cardiovascular drug
likely to be more severe. The
Prctices (ISMP) in the United products5. The top five drugs
harm leads not only to patient
States has conducted a research cited for overall incident records,
suffering but also to increment of
to determine the medications and medication errors reaching
costs associated with the care of
conditions which was most patinets without causing harm, or
these patients. The consequences
tendency to harm patients. The errors resulting in patient harm,
associated can be especially
study gathered the results of data were high alert medications such
serious and studies suggest this
submitted by an approximate of as insulin, morphine, heparin,
applies across the board2. In a
161 health care organisation on potassium chloride and
study done by Budnitz D.S., et al.,
serious errors that had taken warfarin6.
insulin, warfarin and digoxin
place during this period. The
were implicated in one of every HAM Categories
outcomes of the study showed
three estimated ADEs treated for
that a majority of the medication
the elderly, in emergency The American
errors resulting in death or
department3. Edgar et al. Pharmaceutical Association has
serious injury involved a small
reviewed medical event reports listed eight HAM categories:
number of specific medications.
in a US national database and cardiovascular drugs,
The ISMP has termed these
reported that heparin, xylocaine, chemotherapeutic drugs,
medications that have the highest
adrenaline and potassium narcotics, opiates, anticoagulants,
risk of causing injury when
chloride were the drugs most benzodiazepines, neuromuscular
misused as High-Alert
commonly involved in critical blocking agents and electrolytes5.
Medications or HAM1.
incidents4. Phillips et al. The ISMP has 19 categories and

High-Alert 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

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Lorem Ipsum
Table 1. List of Classes of Medications categorised under High Alert Medications
Common Risk Factors
The common risk factors for
errors associated with High-Alert
Medications include poorly written
medication orders and incorrect
dilution procedures. Confusion
between IM, IV, Intrathecal, Epidural
preparations and confusion between
different strengths of the same
medications such as sodium chloride
3% and sodium chloride 0.9% may
predispose errors in handing HAM.
Ambiguous labeling on
concentration and total volume of
medications also increases the risk
for errors in prescribing drugs listed
as HAM, apart from look alike or
sound alike product or similar
packaging2.
Aenean sem nulla, blandit
vitae feugiat id, congue eget.
Strategies in Preventing Errors Involving
1. Limit the drugs strengths available In health
Procurement
center formulary.
2. Avoid frequent changes of brand. Notify the end
user whenever there are changes.
1. All HAM should be kept in individual labelled
Storage
containers. Whenever possible avoid look-alike
and sound-alike drugs or different strengths of the
same drug from being stored side by side.
2. Use TALL-man lettering to emphasize
differences In medication names (e.g DOPamine
and DOBUtamine).
3. Label all containers used for storing HAM in red
as "HIGH ALERT".
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 1. Use standardized forms for cytotoxic drugs and
Ordering
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) References:
Preparation 1. Establish a counterchecking system for all
preparations involving HAM. 1. Institue for Safe Medication
Practices (ISMP): Part IIHow to
pre- vent errorsSafety issues
1. All HAM containers issued to wards/units must be with patient-controlled analgesia.
Dispensing/
Supply labeled as "HIGH ALERT". ISMP Medication Safety Alert:
Acute Care, Jul. 24, 2003.
2. All HAM must be counter-checked before dispensing. 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 hospitalized
Conclusion patients. Results of the Harvard
Medical Practice Study II. N Engl J
As the conclusion, High-Alert Medications posses high risk for Med 324:377384, Feb. 7, 1991.
errors and the impact on patients safety is a system problem, which 5. Nolan T.: System changes to
improve patient safety. BMJ
will therefore require a joint effort from all health care participants
320:771773, Mar. 18, 2000.
including doctors, pharmacists and nurses to improve patients safety
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.

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