High-alert medications, which pose a significant risk of patient harm when used in error, include categories like anticoagulants and narcotics. Common risk factors leading to errors involve confusion between similar medications, incorrect administration methods, and unclear labeling. To minimize these risks, strategies such as proper labeling, independent verification of medication details, and comprehensive training for personnel handling these drugs are essential.

1. HIGH ALERT

2. High-alert medications are drugs that bear a
heightened risk of causing significant
patient harm when they are used in error.
DEFINITIONOF High-Alert Medications
HIGH ALERT MEDICATION
Purpose
This term "High-Alert Medications" has
been assigned to these medications to
draw attention to their potential danger.

3. • high-alert medications cause harm more commonly
and the harm is likely to be more serious and leads
to patient suffering and additional cost
Why HIGHALERT MEDICATION

4. COMMON RISK FACTORS
• Poorly written medication orders.
• Incorrect dilution procedures.
• Confusion between IM, IV, intrathecal, preparations.
• Confusion between strengths of the same medications.
• Wrong infusion rate.
• Look alike or sound alike product and similar packaging.
COMMON RISK FACTORS

5. EXAMPLE:EXAMPLES

7. • Based on:
– Previous medication errors
– ISMP, USP and other national data list.
• High alert medications are usually listed in one of
two ways:
1-class/category medications
2-Specific medications
Selection of High Alert Medications
https://www.ismp.org/tools/highalertmedications.pdf

9. • Classes/Categories of High Alert Medications Examples:
• Antithrombotic agents (anticoagulants), including warfarin,
low molecular weight heparin, IV unfractionated heparin
• Chemotherapeutic agents, parenteral and oral
• Epidural or intrathecal medications
• Hypoglycemics, oral
• Narcotics/opiates, IV, transdermal, and oral (including
liquid concentrates, immediate and sustained-release
formulations)
• Radiocontrast agents, IV
Classes/Categories of Medications

10. • Special Medication Examples
• Insulin, subcutaneous and IV
• Magnesium sulfate injection
• Potassium chloride for injection concentrate
• Sodium chloride for injection, hypertonic (greater
than 0.9% concentration)
Specific medications

11. COMMON RISK FACTORSTOP FIVE HIGHALERT MEDICATIONS
Ref. ISMP Survey on High-Alert Medications

12. • Factors contributing to harm :
• Insulin & heparin vials kept in close proximity
to each other on a nursing units, leading to mix-
ups
• Pharmacokinetics differ based on insulin type.
• Complex of dosing
• Use of “U” or “IU”
• Frequent monitoring
• Many insulin products available : ( look alike –
sound alike names )
INSULIN

13. Factors contributing to harm :
• Calculation errors.
• IV to PO conversion errors.
• Errors converting potency when changing from
one narcotic to another.
• Many dosage forms.
• Parenteral narcotics stored in nursing areas as
floor stock.
Opiates and Narcotics

14. Factors contributing to harm :
 Mixing pot. chloride/ phosphate
 Request for unusual concentrations
 Unclear labels
Injectable Potassium Chloride or Phosphate

15. Common Risk Factors
• Narrow therapeutic range.
• Complex dosing.
• Frequent monitoring.
• Many interaction
• Unclear labeling regarding concentration and
total volume.
• Multi-dose containers.
• Confusion between heparin and insulin due
to similar measurement units.
Injectable anticoagulant ( Heparin )

16. • Storing sodium chloride solutions above 0.9
percent on nursing units.
• Large number of concentrations/formulations
available.
• No double check system in place.
Sodium chloride solution above 0.9%

17. 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’
Use TALL-man lettering to emphasize differences in
medication name
(eg: DOPamine and DOBUTamine)
STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT
MEDICATION

18. 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)
Do not use trailing zero when prescribing (eg:
5.0mg can be mistaken as 50mg)
STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT
MEDICATION

19. 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 MR
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.
STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT
MEDICATION

20. CON’T:
All personal shall be trained prior to handling
of High Alert Medication .
STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT
MEDICATION

21. CON’T:
Closely monitor vital signs, laboratory data,
patient’s response before and after
administration of medication
STRATEGIES TO AVOID ERRORS INVOLVING HIGH ALERT
MEDICATION

22. 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

23. • Remove or minimize high alert medications from
clinical areas, where possible.
• Using "U" instead of "Units" in physician orders
for heparin and insulin is not accepted.
• Verbal and Telephone orders should be kept to
minimum when prescribing high alert
medications.
Take Home Message

24. • The organization should establish a checklist
that is used for the independent verification.
• Checklist items should include concentration
calculations, infusion pump , rates, and
correct line attachments.
• The prepared solution is labeled with a HIGH
RISK WARNING label prior to administration.
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25. • Ideally, removal of concentrated electrolyte
solutions from all nursing units is
accomplished, and these solutions are only
stored in specialized pharmacy preparation
areas or in a locked area.
• Potassium vials, if stored in a specialized
patient care area, must be labeled individually
with a visible florescent warning label that
states MUST BE DILUTED.
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26. • 1. Reduce or eliminate the possibility of errors
• 2.Make errors visible
• 3. Minimize the consequences of errors
Three principles may be used to safeguard the
use of high-alert medications:
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