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High alert medication
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- 2. Contents 1. Discuss theconcept of high-alert medications 2. Identify the many drug classes considered to be high-alert status 3. Describe various strategies for safeguarding the use of high-alert medications
- 3. Definition: High-Alert Medications High-alertmedications are drugs that bear a heightened risk of causing significant patient harm when 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
- 4. Classes/Categories of Medication 1Adrenergic agonists I.V Adrenaline, noradrenaline, norepinephrine 2 Adrenergic antagonists I.V e.g, propranolol, metoprolol, labetalol 3 Anasthetic agents: inhaled and IV e.g, propofol, ketamine 4 Antiarrhythmics, I.V e.g, lidocaine, amiodarone 5 Anticoagulant e.g, heparin, warfarin 6 Dextroe, hypertonic greater than 20% 7 Insulin / SC and IV 8 Magnesium Sulphate injection 9 Moderate sedation agents I.V e.g, midazolam, Oral e.g, chloral hydrate 10 Narcotics/Opiates I.V 11 Neuromuscular blocking agents e.g, succinylcholine 12 Sodium chloride solution Greater than 0.9%
- 5. Common risk factor 1)Poorly written medication orders 2) Incorrect dilution procedures 3) Confusion between IM, IV etc 4) Confusion between different strength of the same medication 5) Ambiguous labelling on concentration and total volume of medication 6) Wrong infusion rate 7) Look alike Sound Alike product
- 6. Strategies to avoiderrors involving HAM 1) Procurement 2) Storage 3) Prescribing 4) Preparation 5) Dispensing/ supply 6) Administration 7) Monitoring 8) Training 9) Information 10) Evaluation of action
- 7. PROCUREMENT Limit thedrug strengths avalable in the formulary of each facilities AVOID FREQUENT CHANGE of brand or color. Notify to end users whenever there are changes. Inform all relevent personnel of new HAM Encourage the purchase of equipment and consumables with safety features fot safe drug administration
- 8. STORAGE Carefully storeto ensure medication are kept at the correct place Kept in individual labeled containers Avoid look alike sound alike drugs or different strength of the same drug being stored side by side Use TALL-MAN lettering to emphasize the differences Limit unit’s floor stock MUST labeled HIGH ALERT MEDICATION
- 9. PRESCRIBING Do notuse abbreviations when prescribing HAM Specify the dose, route and rate on treatment Use read-back procedure for verbal orders Prescribed in milligrams Write clearly and Eliminate illegible handwriting
- 10. PREPARATION Establish acounterchecking system All dilutied medication MUST BE LABELLED with the name and strength IMMEDIATELY upon dilution. Drug: ______________ Concentration:_____mg in ____NS/D5/___ Date: Time: Patient’s name: RN: Prepared by: Checked by:
- 11. ADMINISTRATION Ensure nodistraction during administration of medication Return all unused or remaining specially formulated preparation to the pharmacy when no longer required. Processed done by trained personnel Avoid ordering HAM verbally, in case of emergency, phone order have to be repeated and verified
- 12. MONITORING Closely monitorvital sign, labolatory data and patient’s respone before and after administration and adverse drug reactions Keep antidotes and resuscitation equipments in units
- 13. Information References ordilution guide should be available in units
- 14. LABELLING HIGH ALERT MEDICATIONon storage shelves, container, product package and loose vials
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- 16. On Shelves, rackor drawer
- 17. Sila rujuk ‘Guideline OnSafe Use Of High Alert Medications ‘ untuk maklumat lanjut.