Developing separate lists for medications identified as high-alert and/or hazardous Organizations determine how staff and practitioners will be educated regarding processes for managing these medications. redundancies such as automated or independent https://www.ismp.org/recommendations/high-alert-medications-community-ambulatory-list, Long-Term Care Setting: 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. 440,000 . To update the list, practitioners were once again surveyed. The Best Practices address safety issues that ISMP continues to receive numerous reports about, says Christina Michalek, BS, RPh, FASHP, Medication Safety Specialist and Administrative Coordinator for the Medication Safety Officers Society (MSOS). 2 0 obj from the University of British Columbia. 1. This fact sheet provides a list of potential high-alert medications prevalent in long-term care settings that should be administered with particular care due to the heightened potential for harm. https://ismpcanada.ca/resource/definitions-of-terms/. The current list includes new Best Practices on preventing errors with oxytocin and high-alert medications as well as maximizing the use of barcode verification by expanding beyond inpatient areas. Drug name pairs or larger groupings that look similar utilize bolded uppercase letters to help draw attention to the dissimilarities in look-alike drug names. hb``b``c [NY8!O8`SxKlIlhGe!0nZ !|, P High-Alert Medications in Acute Care Settings. Policies, HHS Digital This fact sheet lists medications with a high risk of causing significant harm to patients when incorrectly administered. % Sites, Contact Work-arounds observed by fourth-year nursing students. ), High-Alert Medications in Community/Ambulatory Care Settings, High-Alert Medications in Long-Term Care (LTC) Settings, Look-Alike Drug Names with Recommended Tall Man (Mixed Case) Letters, Medication Safety Officers Society (MSOS), adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol), anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine), antiarrhythmics, IV (e.g., lidocaine, amiodarone), chemotherapeutic agents, parenteral and oral, dialysis solutions, peritoneal and hemodialysis, inotropic medications, IV (e.g., digoxin, milrinone), liposomal forms of drugs (e.g., liposomal amphotericin B) and conventional counterparts (e.g., amphotericin B desoxycholate). Manual: Ambulatory Chapter: Medication Management MM Last reviewed by Standards Interpretation: October 19, 2021 Represents the most recent date that the FAQ was reviewed (e.g. Start the year off right by addressing these top 10 medication safety concerns from 2021. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. Medication administration and interruptions in nursing homes: a qualitative observational study. Strategies may include: Standardizing the prescribing, storage, preparation, dispensing, and administration of these medications, Improving access to information about these drugs, Using auxiliary labels and automated alerts. ISMP List of High-Alert Medications in Acute Care Settings. Which of the following drug classifications is not listed on the ISMP List of High-Alert drug Classes or Categories of mediciatons? For example, after fatal wrong route errors were identified as a potential threat with the new drug EXPAREL (bupivacaine [liposomal] used for local anesthesia into surgical sites) due to its similar appearance to propofol,6 hospitals that added this drug to their formulary should have considered it for addition to their high-alert medication list. American Geriatrics Society (AGS) Policy Brief: COVID-19 and nursing homes. which medications require special safeguards to oxytocin, IV. Writing Act, Privacy Sources to identify high -risk medications for the purposes of responding to this item can include the ISMP High Alert Medication List, Beer's Cr iteria, Joint Commission's High Alert Medication lists, or other authoritative resources. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. Should I report? During June and July 2018, practitioners responded to an ISMP survey designed to identify which drugs were most frequently considered high-alert medications by individuals and organizations. Communicate orders for oxytocin infusions in terms of the dose rate (e.g., milliunits/minute) and align with the smart infusion pump dose error-reduction system (DERS). To learn more about Liked by Avo Arikian, Pharm.D. Your use of this website constitutes acceptance of Haymarket MediasPrivacy PolicyandTerms & Conditions. epoprostenol (Flolan), IV. Among medication error reports submitted to PA-PSRS, approximately one out of four reports involve high-alert medications. Institute for Safe Medication Practices Institute for Healthcare Improvement. High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. /Type/ExtGState (e.g., chemotherapy, opioid infusions, intravenous [IV] insulin, heparin infusions). study, administration of the high-alert medications described by ISMP has been shown to be a risk factor for harm in neonatal patients (Stavroudis et al., 2010). So, what does it mean if a drug is on your hospitals high-alert medication list? ISMP List of High-Alert Medications in Long-Term Care (LTC) Settings. Institute for Safe MedicationPractices HIGH-ALERT MEDICATION SAFETY BEST PRACTICE: The purpose of identifying high-alert medications is to establish safeguards to reduce the risk of errors with these drugs in all phases of the medication use process. >> Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. /Type/XObject /ColorSpace/DeviceCMYK The list will be informed by an environmental scan, consultation with Canadian health care practitioners, consumers, and their caregivers, and medication incidents reported to the Canadian Medication Incident Reporting and Prevention System (CMIRPS). In addition to insulin, anticoagulants, and opioids, high-alert. Policy, U.S. Department of Health & Human Services. This fact sheet lists medications with a high risk of causing significant harm to patients when incorrectly administered. Clinical Uncertainty in Primary Care: The Challenge of Collaborative Engagement. moderate sedation agents, IV (e.g., dexmedetomidine, midazolam, moderate and minimal sedation agents, oral, for children (e.g., chloral hydrate, midazolam, ketamine [using the parenteral form]), neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium), sodium chloride for injection, hypertonic, greater than 0.9% concentration, sterile water for injection, inhalation and irrigation (excluding pour bottles) in containers of 100 mL or more, sulfonylurea hypoglycemics, oral (e.g., chlorpro, potassium chloride for injection concentrate, Standardizing the ordering, storage, preparation, and administration of these medications, Improving access to information about these drugs, Limiting access to high-alert medications, Using auxiliary labels and automated alerts. Copyright 2023 Haymarket Media, Inc. All Rights Reserved Patient safety perceptions of primary care providers after implementation of an electronic medical record system. The list of high-alert medications includes as many as 19 categories and 14 specific medications. Use ISMP's List ofHigh-Alert Medications in Acute Care Settingsto determine which medications in your organization require special safeguards to reduce the risk of errors and minimize harm. /Length 64894 for all of the medications on the list). A clinical reminder about the safe use of insulin vials. A failure mode and effects analysis or self-assessment tool also might help identify underlying risks associated with each high-alert medication/class of medications. Signal and noise: applying a laboratory trigger tool to identify adverse drug events among primary care patients. JFIF Adobe e C Please select your preferred way to submit a case. Note that even if you have an account, you can still choose to submit a case as a guest. Enhance patient safety by identifying and minimizing risk exposures affecting nurse practitioner practice. For each medication on the facilitys high-alert medication list, outline a robust set of processes for managing risk, impacting as many steps of the medication-use process as feasible. Numerous risk-reduction strategies must be layered together to address the targeted risk. Alice is involved in medication safety, medication reconciliation, incident analysis and has a passion for engaging patients and . Nursing Interventions Classification (NIC) - Gloria M. Bulechek . Ambulatory care sites such as long-term care facilities, long-term acute care facilities, dialysis facilities, ambulatory surgery centers, and the pharmacies that provide services to them should also reference the ISMP List of High-Alert Medications in Long-Term Care (LTC) Settingsand/or the ISMP List of High-Alert Medications in Acute Care Settings. 2023 Institute for Safe Medication Practices. Long-Term Trends of Psychotropic Drug Use in Nursing Homes. . /Height 237 You must have JavaScript enabled to use this form. Instead, they have a hastily devised list of high-alert medications, which often are not well known to all clinicians, and they may rely on low-leverage risk-reduction strategies to prevent errors, such as staff education and high-alert medication labels on pharmacy bins, to keep patients safe. This Ethical Issues . - direct oral anticoagulants and factor Xa inhibitors (e.g., dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban, fondaparinux) - direct thrombin inhibitors (e.g., argatroban, bivalirudin, dabigatran) - glycoprotein IIb/IIIa inhibitors (e.g.,eptifibatide) - thrombolytics (e.g.,alteplase, reteplase, tenecteplase) cardioplegic solutions May 17, 2021 Horsham, PA: Institute of Safe Medication Practices; 2021 Long-term care patients often have concurrent conditions that increase their risk of medication error. M(#iueno9Q!6G5^1Ai~Qk1+jh ]T*RA#ZnAE:q"h V.d9#uG[roh+^GV[sab4C19}K7^+@{ym8U~nM+S#B_h~OI)UOx &%Eg*5wk:SJ^IU f#*`>I:koQ%R8jk9I~/$O|AOJ_=5x,/ Accessed August 24, 2022. Job functions include patient and medication safety, staff development/training and medication use improvement. To sign up for updates or to access your subscriber preferences, please enter your email address . This may include strategies Prescribers' interactions with medication alerts at the point of prescribing: a multi-method, in situ investigation of the humancomputer interaction. Specifically target clinical areas with an increased likelihood of a short or limited patient stay (e.g., emergency department, perioperative areas, infusion clinics, dialysis centers, radiology, labor and delivery areas, catheterization laboratory, outpatient areas). Insulin pen safety - one insulin pen, one person. The list will be informed by an environmental scan, consultation with Canadian health care practitioners, consumers, and their caregivers, and medication incidents reported to the Canadian Medication Incident Reporting and Prevention System (CMIRPS). the August 23, 2018 Horsham, PA; Institute for Safe Medication Practices: 2018. below. Nursing home patient safety culture perceptions among US and immigrant nurses. The ISMP is relying on ambulatory-care and community settings to use this updated list as a resource to identify the high-alert medications prescribed, stored, dispensed, and/or administered in their organizations or the facilities they serve. The list is lengthy and includes categories of medications that are used only in specialized settings, such as anesthetics, chemotherapeutic agents, dialysis solutions, neuromuscular blocking agents, and radiocontrast agents. Medications requiring special safeguards to reduce the risk of errors and minimize harm. Does the list serve only to increase awareness of the risk of harm with these medications, or has a robust plan been implemented for each drug or drug class to reduce the risk of errors? ISMP; 2021. or may not be more common with these drugs, the Ensure that the strategies address system vulnerabilities in each stage of the medication-use process (i.e., prescribing, dispensing, administering, and monitoring) and apply to prescribers, pharmacists, nurses, and other practitioners involved in the medication-use process. ISMP's List of High-Alert Medications in Acute Care Settings. 5200 Butler Pike Medication safety in primary care practice: results from a PPRNet quality improvement intervention. The update includes changes such as expanded examples of antithrombotic agents listed and removal of IV radiocontrast media due to lack of errors reported with its use. Additional medications to consider for the list may include new drugs added to the formulary, potentially harmful drugs used temporarily during a shortage (which can be removed once the shortage is over), and medications involved in potentially harmful errors based on the hospitals internal reporting process, even if the drug is not on the ISMP list. To learn the causes of errors, review internal medication error-reporting data and the results of any applicable root cause analyses. and high alert medications as such Separate the storage of such items in the carts Verify, re-verify and triple check before giving medications, especially high alert medications - the six rights can help, but may not prevent errorsmore than this is required. In many cases, events like these and others continue to happen in hospitals with medications that are on the hospitals list of high-alert medications. Standardizing the ordering, storage, preparation, and administration of these . Strategies must be sustainable over time. Additional Resources ASHP Center on Medication Safety and Quality Institute for Safe Medication Practices (ISMP) Manual: Ambulatory Institute for Safe Medication Practices. Telephone: (301) 427-1364. Addressing drugs given by a certain route of administration (e.g., intrathecal, epidural) or in special populations (e.g. MM 01.01.03 (2 Elements of Performance) (EP's) . Effective strategies must address the underlying causes of errors with each type of high-alert medication or class of medications. During June and July 2018, practitioners responded to an ISMP survey designed to identify which medications were most frequently considered high-alert medica - ti o ns.F u rh e, al v c d completeness, the clinical staff at ISMP and members of the ISMP advisory board . Another woman receives a rapid infusion of magnesium sulfate postpartum instead of oxytocin, despite staff awareness of prior mix-ups. The original list was developed in 2008, which included input from community pharmacy practitioners who participated in focus groups or responded to an ISMP survey on the topic. Advanced practice nursing students' identification of patient safety issues in ambulatory care. Published 2019. An official website of This fact sheet provides a list of high-alert medications commonly used in ambulatory care and recommends strategies to reduce risk of errors. Problem: Have you ever watched the 1993 movie, Groundhog Day? Policies, HHS Digital In some cases, there are no safety nets in place at all, and hospitals are relying on staff vigilance to keep patients safe when receiving high-alert medications. Electronic medical record availability and primary care depression treatment. $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? Available at: https://www.ismp.org/recommendations/high-alert-medications-acute-list. I knew if I wanted to become a subject matter expert and advance through the ranks of medication safety specialists, I needed to align myself with the organization considered the gold standard for medication safety information. 2012. Boldly label both sides of the infusion bag to differentiate oxytocin bags from plain hydrating solutions and magnesium infusions. Another hospitalized patient experiencing pain receives an overdose of intravenous (IV) HYDROmorphone after a physician prescribes the IV dose in the same amount as the oral dose the patient had been taking at home, and neither the pharmacist nor nurse captures the error. The hospitals high-alert medication list should be updated as needed and reviewed at least every 2 years. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. hypoglycemics. } !1AQa"q2#BR$3br The recommendations are based on error reports received through the ISMP National Medication Errors Reporting Program (ISMP MERP) and are reviewed by an external expert advisory panel and approved by the ISMP Board of Directors. Moderate sedation agents, IV (eg, dexmedetomidine, midazolam, Moderate and minimal sedation agents, oral, for children (eg, chloral hydrate, midazolam, ketamine [using IV form]), Narcotics/opioids, IV, transdermal, oral (including liquid concentrates, immediate and sustained-release forms), Neuromuscular blocking agents (eg, succinylcholine, rocuronium, vecuronium), Sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100mL or more, Sodium chloride for injection, hypertonic, greater than 0.9% concentration, Sulfonylurea hypoglycemics, oral (eg, chlorpro. 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Sheet lists medications with a high risk of errors, review internal medication error-reporting data the! Of mediciatons and immigrant nurses /type/extgstate ( e.g., chemotherapy, opioid,! Movie, Groundhog Day update the list of high-alert medication list special populations (.. Inc. All Rights Reserved patient safety perceptions of primary Care patients learn more about Liked Avo!