High Alert Medication
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High Alert Medication






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  • Eg that require rapid correction of KCLSevere potassium loss from massive diarrheaHypokalemia in diabetic ketoacidosis during insulin therapy

High Alert Medication High Alert Medication Presentation Transcript

  • Medication Error A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm. DEFINITION OF MEDICATION ERROR HIGH ALERT MEDICATION It can involve any one of the following processes: Prescribing, Ordering, Dispensing, Distribution, Preparation, Administration, Labelling, Packaging, Nomenclature, Communication, Education, Use And Monitoring Of Treatment
  • • High-alert 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 these patients. WHAT IS HIGH ALERT MEDICATION
  • LIST OF HIGH ALERT MEDICATION THAT ARE AVAILBLE @ HBUK 1. Adrenaline 1mg/ml Inj 2. Cobra Antivenom Inj 3. Dextrose 30% Inj 4. Dextrose 50% Inj 5. Digoxin 0.5mg/2ml Inj 6. Dobutamine 250mg/20ml Inj 7. Dopamine 200mg/5ml Inj 8. Heparin 5000 unit/ml Inj 9. Actrapid 1000unit/10ml Inj 10. Midazolam 5mg/ml Inj 11. Morphine 10mg/ml Inj 12. Noradrenaline 4mg/4ml Inj 13. Pit Viper Antivenom Inj 14. Potassium Chloride 1Gm/10ml Inj
  • COMMON RISK FACTORS • Poorly written medication orders • Incorrect dilution procedures • Confusion between IM, IV, intrathecal, epidural preparations • Confusion between strengths of the same medications • Ambiguous labeling on concentration and total volume of medications • Wrong infusion rate • Look alike or sound alike product and similar packaging COMMON RISK FACTORS
  • STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT MEDICATION  All High Alert Medication containers, product packages and loose vials or ampoules stored must be labeled as ‘HIGH ALERT MEDICATION’  All personnel should read the High Alert Medication labels carefully before storing to ensure medications are kept at the correct place  All High Alert Medications should be kept in individual labeled containers. Whenever possible, avoid sound-alike and look-alike drug or different strengths of the same drug being stored side by side.  Use TALL-man lettering to emphasize differences in medication name (eg: DOPamine and DOBUTamine) STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT MEDICATION
  • CON’T: Do not use abbreviations when prescribing High Alert Medications Specify the dose, route, and rate of infusion for High Alert Medications prescribed (eg: IV Dopamine 5mcg/kg/min over 1 minutes) Prescribe oral liquid medications with the dose specified in miligrams Do not use trailing zero when prescribing (eg: 5.0mg can be mistaken as 50mg) STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT MEDICATION
  • CON’T:  The following particulars shall be independently counter checked against the prescription or medication chart at the bedside by two appropriate persons before administration:  Patient’s name and RN  Name and strength of medication  Dose  Route and rate  Expiry date  Return all unused medication to pharmacy when no longer required  Avoid ordering High Alert Medications verbally. In cases of emergency, phone orders have to be repeated and verified STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT MEDICATION
  • CON’T: Closely monitor vital signs, laboratory data, patient’s response before and after administration of medication Keep antidotes and resuscitation equipment in wards STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT MEDICATION
  • CON’T: All personal shall be trained prior to handling of High Alert Medication and documentation kept. Staff must be trained to prevent potential errors and enable them to response promptly when mistakes do occur STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT MEDICATION
  • CON’T: References or dilution guide should be made available in the wards Monitor adverse drug reaction and medication errors related to High Alert Medications STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT MEDICATION
  • Strength/unit 100 units/ml (1000 units/vial) Diluents for infusion NS Method of administration 1) Slow IV bolus: administer undiluted solution over 3-5 minutes 2) Continuous IV infusion: dilute 50 units insulin in 50 ml NS ( 1 units/ml) Remarks Monitor sign and symptoms of hypoglycemia If hypoglycemia occurs, stop infusion. For conscious patient, give sweetened drink. For unconscious patient, administer D50% or glucagon. Check blood glucose after 15 minutes MAY CAUSE NEUROHYPOGLYCEMIA AND CAN BE FATAL Overlap with IV infusion for 1 hour with SC insulin (when converting IV infusion to SC insulin)
  • Strength/unit 10% W/V, 10mL Diluents for infusion NS Max recommended concentration (peripheral line): 80mmol/L or 6g/L Max recommended concentration (central line): 150mmol/L or 11g/L Method of correcting hypokalemia 1) Normal, slow and safe correction of hypokalemia in open wards 1g KCl should be diluted in 500ml NS and transfused over 2-3 hours in a peripheral line. (infusion rate not exceeeding 20mmol/hr) 2) Rapid correction of hypokalemia 1g KCl should be diluted in the desired concentration of NS in an infusion pump through central line at rate of 1 hour or less under continuous ECG monitoring (in an ICU setting) Remarks Caution in pt with cardiac disease Do not administer undiluted or iv push 1g KCL = 13.4mEq KCl
  • Strength/unit 0.5mg/2ml Diluents for infusion NS D5% Method of administration 1) Dilution: dilute 0.5mg (1 ampoule) in 50ml for IV infusion 2) Slow infusion is preferred over bolus administration (at least 5 minutes or longer) 3) IV infusion should be given over 10-20 minutes Remarks Arrhytmias may be precipitated by digoxin toxicity. So, monitoring of HR is necessary before, during, and after digoxin administration IM route is not recommended  due to painful and a/w muscle necrosis Rapid injection is not recommended as it may cause systemic and coronary arteriolar constriction Digitalized patient with hypoalcemia should be given IV calcium slowly and in a small amount to avoid serious arrythmias
  • Strength/unit 25,000iu/5ml Diluents for infusion NS Method of administration 1) Dilution: 1 vial diluted with 50ml 2) CONVERSION FROM IU/HOUR TO ML/HOUR  BY DIVIDING WITH 500IU  Eg: from 700IU/hour  1.4ml/hour MODERATELY HIGH DOSE CAN CAUSE EXCESSIVE INTERNAL BLEEDING THAT MAY LEAD TO PARALYZING OR LETHAL STROKES
  • REFERENCES • Dilution Guide for High Alert Medications, Pharmaceutical Services Division • Guideline On Safe Use of High Alert Medication • Injectable Drugs Dilution 2010
  • Thank You MEDICATION SAFETY IS EVERYONE’S RESPONSIBILITY! yatiazmir@pharmacy2013 yatiazmir@pharmacy2013