1. Achieving safe and effective use of
medications requires coordinated
efforts by all stakeholders (physicians,
nurses, pharmacists patients and their
families
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Medication-use Process
الدواء استخدام عملية
4. High-alert medications
الخطورة عالية األدوية
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This term "High-Alert Medications" has been assigned to these
medications to draw attention to their potential danger.
5. High-alert medications (cont.)
الخطورة عالية األدوية(تابع)
Classes/Categories of High Alert Medications :
1. Adrenergic agonists, IV (e.g., epinephrine, phenylephrine, norepinephrine)
2. Adrenergic antagonists, IV (e.g., propranolol, metoprolol)
3. Anesthestic agents, general, inhaled and IV (e.g., propofol)
4. Antiarrhythmics, IV (e.g., lidocaine, amiodarone)
5. Antithrombotic agents (anticoagulants), including warfarin, low molecular weight
heparin, Factor Xa inhibitors (fondaparinux), direct thrombin inhibitors (e.g.,
argatroban, lepirudin, bivalirudin), thrombolytics (e.g., alteplase, reteplase,
tenecteplase), and glycoprotein llb/llla inhibitors (e.g., eptifibatide)
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6. High-alert medications (cont.)
الخطورة عالية األدوية(تابع)
Classes/Categories of High Alert Medications (cont.):
6. Inotropic medications, IV (e.g., digoxin, milrinone)
7. Moderate sedation agents, IV (e.g., midazolam)
8. Narcotics/opiates, IV, transdermal, and oral (including liquid concentrates,
immediate and sustained-release formulations)
9. Neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium)
10. Radiocontrast agents and Metformin
11. Total parenteral nutrition solutions
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7. Center Of Disease Control And
Prevention (CDC) USA
15000 Americans died because an over dose of
OPIODS by doctors orders
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8. Use Forcing Functions (oral
syringe for oral liquid dose)
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Reduce Options
High-alert medications (cont.)
الخطورة عالية األدوية(تابع)
Recommendation to prevent/minimize errors associated
with High-alert medication:
9. • Limit Access
High-alert medications should only be stored in
the pharmacy where only a pharmacist can
access them.
• Store Medications Appropriately (Separate)
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High-alert medications (cont.)
الخطورة عالية األدوية(تابع)
11. Look-alike and Sound-alike Medication LASA
النطق و الشكل في المتشابهة األدوية
• Presence of thousands of drugs name.
• LASA is one of the most common causes of medication error
Methylprednisolon # Methylergonovine
Dopamine # Dobutamine
Hydralazine # Hydrochlorothiazide
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13. Implementing clinical protocols which;
• Minimize the use of verbal/telephone orders.
• carefully read (…and again …)
• check the purpose.
• Use separate locations
(store in non-alphabetical order)
• Include both the nonproprietary name and the brand name
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Look-alike & Sound-alike Medication LASA(cont.)
النطق و الشكل في المتشابهة األدوية(تابع)
14. The use of some abbreviations, symbols, and
dose designations has been identified as an
underlying cause of serious, even fatal
medication errors.
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Error-Prone Abbreviations, Symbols, and Dose
Designations (cont.)
اإلختصاراتوالرموزاألكثرالخطأ عرضة(تابع)
15. Error-Prone Abbreviations, Symbols, and Dose
Designations (cont.)
اإلختصاراتوالرموزاألكثرالخطأ عرضة(تابع)
Abbreviations Intended
Meaning Misinterpretation Correction
IU** International
unit
Mistaken as IV
(intravenous) or 10
)ten( Use “units”
Use “units”
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** Do-not-use list
16. The Synthroid order looks more like 1 mg than 0.1 mg. After
receiving an overdose for several weeks, the patient was
admitted to the hospital for hyperthyroidism and weight loss.
The medication error was recognized during a medical
history when the patient showed a physician the prescription
container label. At the time, tablets of 0.5 mg were marketed
so the error was made using only two tablets per dose.
Dose Designations
and Other Information
Intended Meaning Misinterpretation Correction
No leading zero
before
a decimal point
(e.g., .5 mg)**
0.5 mg Mistaken as 5 mg if the
decimal point is not
seen
Use zero before a
decimal point when the
dose is less than a
whole unit
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Error-Prone Abbreviations, Symbols, and Dose
Designations (cont.)
اإلختصاراتوالرموزاألكثرالخطأ عرضة(تابع)
** Do-not-use list
17. Dose Designations
and Other
Information
Intended Meaning Misinterpretation Correction
Trailing zero after
decimal point
(e.g., 1.0 mg)**
1 mg Mistaken as 10 mg if
the decimal point is
not seen
Do not use trailing
zeros for doses
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Error-Prone Abbreviations, Symbols, and Dose
Designations (cont.)
اإلختصاراتوالرموزاألكثرالخطأ عرضة(تابع)
** Do-not-use list
A line on a prescription form on the colchicine order above obliterated
the decimal point, making the dose look more like 10 mg than 1.0 mg.
18. 18
Error-Prone Abbreviations, Symbols, and Dose
Designations (cont.)
اإلختصاراتوالرموزاألكثرالخطأ عرضة(تابع)
in this example, although the order was also communicated
verbally, as “morphine”, the widespread practice of
abbreviating drug names (e.g., “morph” for “morphine”)
was found to be one of the contributing factors in a fatal
event where hydromorphone was given instead of
morphine. This example also emphasizes the need for
legible handwriting.
Note: 8mg of Hydromorphone is equivalent to 32mg of Morphine.
19. At-risk behaviors used to drive review
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Not questioning unusually large doses
of medications
Drug Information
21. Summary
• Transcription IS 50 %
• Patient Identification
• Check The Purpose
• Involve The Patient
• Do Not Abbreviate
• Medication Error documented in Patient file
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22. Writing the error and “Adverse drug reaction” in
patients file.
It will prevent the error from reoccurring
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