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Introduction
all hospitals pharmacy still complainhng of medications errors problems which lead to increasing number of patients die until now. The research for the methods or ways to reduce these medications errors is a great challenge Sowe must know more information about medications that consider as High Alert Medications and how to deal with them?
Key points
Definition. High alert medications. The top five high-alert medications. Reduce the risks of high-alert drugs. Safeguards for the use of high alert medications.
I. Definition
High Alert Medications :
Drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients.
Oral hypogylcemics.
Inotropic medications I.V ( e.g, digoxin , milrinone ). Moderate sedation agents I.V (e.g, midazolam), Oral (e.g, chloral hydrate) Narcotics/Opiates I.V, transdermal and oral. Neuromuscular blocking agents ( e.g, succinylcholine).
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Specific medications
Colchicine injection . Insulin : S.C and I.V. Magnesium sulfate injection. Methotrexate : oral ( non oncologic use ) . Oxyticin I.V. Nitroprusside sodium for injection. Potassium chloride for injection . Promethazine I.V.
1- Insulin
Hypoglycemia is the most common complication of any insulin therapy.
Factors contributing to harm :
- Complexity of dosing. - Frequent monitoring. - Pharmacokinetics differ based on insulin type.
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- Many insulin products available : ( look alike sound alike names ) - Lack of dose check systems - Insulin and heparin vials kept in close proximity to each other on a nursing unit, leading to mix-ups. - Use of "U" as an abbreviation for "units" in orders (which can be confused with "O," resulting in a 10-fold overdose) - Incorrect rates being programmed into an infusion pump.
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- Parenteral narcotics stored in nursing areas as floor stock.
- Confusion between hydromorphone and morphine. - Patient-controlled analgesia (PCA) errors regarding concentration and rate.
Adverse effet :
- Respiratory depression - Confusion - Lethargy
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3- Injectable Potassium Chloride or Phosphate
Adverse effect :
1- Muscular or respiratory paralysis.
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2- Mental confusion.
3- Hypotension. 4- Cardiac arrhythmia. 5- Heart block.
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Common Risk Factors
- Unclear labeling regarding concentration and total
volume.
- Multi-dose containers.
- Confusion between heparin and insulin due to similar measurement units.
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1.
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Technological aids:
1- Computerized prescriber order entry (CPOE)
2- Bar coding
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Have another person verify the medication order and infusion pump setting :
just before you start an infusion. every time you change an infusion rate. every time you replace an empty infusion bag or cassette.
Use this method exclusively for high-alert drugs to avoid double-check fatigue and complacency.
b. Rely on redundancies
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Match high-alert drug orders to the patients diagnosis, the drugs indication, and vital patient information. If possible, avoid verbal orders. If theyre necessary, write down the order in the chart and then read back: patient name drug order as written spelling of the drug name
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- Use of tall man letters for sound-alike and look-alike names (e.g. DOBUTamine and DOPamine).
- Careful review of how products are arranged on shelves to avoid similar packaged or sound-alike medications being side by side.
Conclusion
- Use of visible coloured auxiliary warning
labels.
References
5 Million Lives Campaign Getting Started Kit: Prevent Harm from High-Alert Medications How-to Guide. Institute for Healthcare Improvement, 2007. http://www.ismp.org/newsletters/acutecare/articles/ 20070517.asp