High alert medications (HAM)
Lecture presented in the unit of clinical pharmacy, Al-Mahmoudiya General Hospital
As part of the training course for clinical pharmacy 22/5/2023
Pharmacist: Thorya Al-zahrany
Member In National Drug Information Center
supervisor of medication patient education at pharmacy care administration at Medina Region
Pharmacist: Thorya Al-zahrany
Member In National Drug Information Center
supervisor of medication patient education at pharmacy care administration at Medina Region
The existence of look alike and sound alike drug names is a one of the most common causes of medication error and is of concern worldwide. As more medicines and new brands are being marketed in addition to the thousands already available. Many of these medication names may look or sound alike. Thus, the potential for error due to confusing drug names is very high. According to the survey from United States Pharmacopoeia, around commonly used medications were involved in such errors. Error prone medication pairs that can easily cause confusion while prescribing, dispensing and administration/consumption were sorted out. Also real life experiences of medication errors and near misses due to error prone drug pairs were collected from the doctors and the dispensers. It is very important that we circulate the list of confusing brand names among the practicing doctors, pharmacists and also to the drug manufacturers. Preventing confusion between already marketed products typically involves collecting voluntary reports of names involved in confusion errors, posting warnings and alerts both electronically and in areas where drugs are used. The fear of malpractice lawsuits and public embarrassment has made the physicians and nurses reluctant to report medication errors. It is more important to create the open environment that encourages the reporting of errors than to develop less meaningful comparative error rates. One possible approach to improving medical error reporting systems. This type of system should also enable internal tracking, trending and comparative analyses. We need to have such system in India.
High risk medications are medicines that are most likely to cause significant harm to the patient, even when used as intended. The Institute for Safe Medication Practices (ISMP) reports that the incident rates of this group of medicines may not necessarily be higher than the other medicines but when incidents occur the impact on the patients would be serious (significant).
In seeking to improve patient safety, the primary focus should be on preventing errors with the greatest potential for harm. Many of the highest risk medications - e.g., heparin, insulin, morphine, and propofol e are delivered by IV infusion. 61% of the most serious and life threatening potential adverse drug events (ADEs) are IV drug related.
IV administration often results in the most serious outcomes of medication errors.
Medications are a critical component of the care provided to patients and are used for diagnostic, symptomatic,
preventive, curative, and palliative treatment and management of diseases and conditions. A medication
system that supports optimal medication management must include processes that support safe and effective
medication use. Safe, effective medication use involves a multidisciplinary, coordinated effort of health care
practitioners applying the principles of process design, implementation, and improvement to all aspects of
the medication management process, which includes the selecting, procuring, storing, ordering/prescribing,
transcribing, distributing, preparing, dispensing, administering, documenting, and monitoring of medication
therapies
This is a knowledgeable and conceptual presentation which covers medication administration rights and potential risks/ errors that are very common in healthcare. We need to understand their root cause and make a medication error free environment in the healthcare.
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
lecture presented at 5th. March 2024 as part of the newly pharmacist training course about patient safety program
high alert medications
look alike sound alike medication
The existence of look alike and sound alike drug names is a one of the most common causes of medication error and is of concern worldwide. As more medicines and new brands are being marketed in addition to the thousands already available. Many of these medication names may look or sound alike. Thus, the potential for error due to confusing drug names is very high. According to the survey from United States Pharmacopoeia, around commonly used medications were involved in such errors. Error prone medication pairs that can easily cause confusion while prescribing, dispensing and administration/consumption were sorted out. Also real life experiences of medication errors and near misses due to error prone drug pairs were collected from the doctors and the dispensers. It is very important that we circulate the list of confusing brand names among the practicing doctors, pharmacists and also to the drug manufacturers. Preventing confusion between already marketed products typically involves collecting voluntary reports of names involved in confusion errors, posting warnings and alerts both electronically and in areas where drugs are used. The fear of malpractice lawsuits and public embarrassment has made the physicians and nurses reluctant to report medication errors. It is more important to create the open environment that encourages the reporting of errors than to develop less meaningful comparative error rates. One possible approach to improving medical error reporting systems. This type of system should also enable internal tracking, trending and comparative analyses. We need to have such system in India.
High risk medications are medicines that are most likely to cause significant harm to the patient, even when used as intended. The Institute for Safe Medication Practices (ISMP) reports that the incident rates of this group of medicines may not necessarily be higher than the other medicines but when incidents occur the impact on the patients would be serious (significant).
In seeking to improve patient safety, the primary focus should be on preventing errors with the greatest potential for harm. Many of the highest risk medications - e.g., heparin, insulin, morphine, and propofol e are delivered by IV infusion. 61% of the most serious and life threatening potential adverse drug events (ADEs) are IV drug related.
IV administration often results in the most serious outcomes of medication errors.
Medications are a critical component of the care provided to patients and are used for diagnostic, symptomatic,
preventive, curative, and palliative treatment and management of diseases and conditions. A medication
system that supports optimal medication management must include processes that support safe and effective
medication use. Safe, effective medication use involves a multidisciplinary, coordinated effort of health care
practitioners applying the principles of process design, implementation, and improvement to all aspects of
the medication management process, which includes the selecting, procuring, storing, ordering/prescribing,
transcribing, distributing, preparing, dispensing, administering, documenting, and monitoring of medication
therapies
This is a knowledgeable and conceptual presentation which covers medication administration rights and potential risks/ errors that are very common in healthcare. We need to understand their root cause and make a medication error free environment in the healthcare.
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
lecture presented at 5th. March 2024 as part of the newly pharmacist training course about patient safety program
high alert medications
look alike sound alike medication
Pharmacovigilance is science of detection,
assessment, reporting and prevention of adverse
reactions to drug(s).
Major aims of pharmacovigilance are:
1. Early detection of hitherto unknown adverse
reactions and interactions
2. Detection of increases in frequency of (known)
adverse reactions
3. Identification of risk factors and possible
mechanisms underlying adverse reactions
4. Estimation of quantitative aspects of benefit/risk
analysis and dissemination of information needed to
improve drug prescribing and regulation.
lecture presented at 3rd. March 2024 about the Iraqi pharmacovigilance system as part of the newly appointed pharmacist training course (2024),
Update was performed depending on the latest version of the (Iraqi Pharmacovigilance Guidelines for Healthcare Professionals) 2024
IPhVC recommendations & monitoring requirement of biosimilars, Worldwide & Iraq control of Bioproducts & biosimiliars, as well as references enlisted adverse reactions to common products used in our hospital
Lecture presented at the 31st Jan 2024 in our hospital
Systemic & inhaled Quinolone antibiotic EMA/MAHRA update considering when not to administr this groups of antibiotics
According to the Iraqi Pharmacovigilance Centre instructions
Benzyl alcohol as parenteral drugs additives
Their effects on specialist populations like pediatrics, pregnant and lactating females
With possible prepartaions were they are added
According to the Iraqi Pharmacovigilance Centre instructions
Antibiotic stewardship, Clinical pharmacyDrug information Centre, Medication...Alaa Fadhel Hassan Alwazni
Training workshop held at Al-Mahmoudiya General Hospital in 18/10/2023
about work & duties of different comittes & units realted to the clinical pharmacy & pharmacovigilance
lecture presented at Al-Mahmoudiya General hospital in the 30th Aug 2023
based upon recent governmental protocols of antibiotic selection, dosage forms conversion by MOH 2023
IV drug additives
Updated on 1st Aug 2023
Refrences:
British National Formulary, (Sep. 2022) v3.1.6 android application
* Medscape, (July, 2023) v1131.0 & v181.0 android application
**Others: Elsevier’s Intravenous Medications: A Handbook for Nurses and Health Professionals,
Mosby’s Drug Reference for Health Professions,
Drugs.com website, Professionals, AFHS Monographs,
Electronic Medicines Compendium (emc) website,
& MMS home website, Drugs, Info.
The medical ethics lecture was presented online as part of the newly - employed pharmacists training course on 23/5/2023
Al-Mahmoudiya General Hospital
brief review on clinical pharmacy, drug information centre & patient safety program
The lecture was presented at Al-Mahmoudiya General Hospital as part of the training course for fresh appointed pharmacist at 16/5/2023 at 11 & 15/5/2023
Intravenous dextrose (glucose water) available conc., doses, side effects, precautions & direction for adm.
presented at Al-Mahmoudiya General Hospital on 20/12/2022
Resistant culture for the bacterial isolate of Al-Mahmoudiya G.Hospital as part of antibiotic stewardship mission
presented on 23/11/2022 at our hospital
differences & indications of ringers (solution/buffered with lactate & acetate) Vs Normal saline in different medical conditions
Presented as lecture at 25th.July 2022
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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2. z
High alert medications (HAM)
Defined as the medications which can cause significant
medical harm when used in error, i.e. errors whether
common or few with such medications, they are expected to
have more devastating consequences to the patients
They must be double checked before administration by two
licensed healthcare professions (authorized to administer/or
dispense medications).
Main principles that affect HAM’s safe use:
Patients and the public
Healthcare professionals
Medicines
System and practices of medications
4. z
Institute for Safe Medication
Practices (ISMP) High Alert
Medications - Classes/ Categories
of Medications
5. z
ISMP Classes /Categories of Medications
adrenergic agonists, IV (e.g., epinephrine, phenylephrine,
norepinephrine)
adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol)
anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine)
antiarrhythmics, IV (e.g., lidocaine, amiodarone)
antithrombotic agents, including:
anticoagulants (e.g., warfarin, low molecular weight heparin,
unfractionated
heparin)
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
6. z
ISMP Classes /Categories of Medications
chemotherapeutic agents, parenteral and oral
dextrose, hypertonic, 20% or greater
dialysis solutions, peritoneal and hemodialysis
epidural and intrathecal medications
inotropic medications, IV (e.g., digoxin, milrinone)
insulin, subcutaneous and IV
liposomal forms of drugs (e.g., liposomal amphotericin B) and
conventional counterparts (e.g., amphotericin B desoxycholate)
moderate sedation agents, IV (e.g., dexmedetomidine, midazolam,
lorazepam)
moderate and minimal sedation agents, oral, for children (e.g., chloral
hydrate, midazolam, ketamine –the parenteral form)
7. z
ISMP Classes /Categories of Medications
opioids, including:
IV, transdermal
oral (including liquid concentrates, immediate- and sustained-release
formulations)
neuromuscular blocking agents (e.g., succinylcholine, rocuronium,
vecuronium)
parenteral nutrition preparations
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., chlorpropamide, glimepiride,
glyburide, glipizide, tolbutamide)
8. z
ISMP Specific Medications
epinephrine,
subcutaneous
Epoprostenol, IV
insulin U-500
magnesium sulfate
injection
methotrexate, oral,
nononcologic use
nitroprusside sodium for
injection
opium tincture
oxytocin, IV
potassium chloride for
injection concentrate
potassium phosphates
injection
promethazine injection
vasopressin, IV and
intraosseous
10. z
What to do for safe handling of HAM
Procurement (limit available medication strength, avoid frequent
changes of brands & colours)
Storage (use cautionary labels “High alert medication” on both
medication package; that don’t cover medications details, and
storage shelves‘, avoid storing with Look-alike & Sound alike
medications “LASA”, label different strength of the stocked
medication, & finally use TALL-man lettering to emphasize
differences of medication names (eg. DOPamine and
DOBUTamine).
Prescribing (use standard forms for written orders of cytotoxic
medications and parenteral nutrition, avoid abbreviation, specify
clear dose, route and rate of infusions, prescribe oral liquid
medications with the specific dose in mg, write leading zero with
decimal doses, use generic names, state the body weight and
surface area for chemotherapy &/ special pt. like paediatric, avoid
HAM verbal medication order unless emergencies exist &
document them as soon as possible)
11. z
What to do for safe handling of HAM
Preparations (establish checking order for all HAM
preparations, HAM calculations to be checked includes
cytotoxic medications, parenteral nutrition &
extemporaneous preparations, label All diluted medications
with the name and strength immediately upon dilution)
Ex. Our hospital recommended labels for parenteral
preparations
12. z
What to do for safe handling of HAM
Administration (estimate double checking order by 2
qualified healthcare professions of prescribed medication
chart at the bedside for all details of management including
pt. identifiers, medication & administrations full details,
expiry date, parenteral lines attachments, return all unused
or remaining preparations to the pharmacy, ensure
administration of intrathecal, cytotoxic medications, epidural
analgesics and parenteral nutrition is carried out by trained
healthcare professions)
Monitoring (monitor and document pt. vital signs,
laboratory data, response before and after administration of
HAM, prepare antidotes and resuscitation equipment in
wards/emergency room/units, intensive care units).
13. z
What to do for safe handling of HAM
Documentation (check any unclear or inaccurate
documentation prior to dispensing or administering &
complete all medication record documentation)
Medication Information (prepare an easily accessed &
accurate List of high alert medications to all healthcare
professions, prepare updated medication references or
dilution guide, monitor and report all adverse drug reactions
and medication errors related to HAM)
Healthcare Professions Training (All healthcare
professions should be trained for safe handling of HAM &
emphasize the importance of accurate checking to
prevent/& and respond promptly to potential medical errors)
14. z
What to do for safe handling of HAM
Patient education
always educate pt. and family members/caregivers on:
(the 5 Rights(5R) - Know Your Right patient to be given the
Right medication in the Right dose, the Right route & for the
Right time, inform them about common side effects/potential
adverse reactions & finally inform them to adhere to specified
medication regimen)
15. z
References
The Institute for Safe Medication Practices (ISMP) Recommendations.
https://www.ismp.org/resources?field_resource_type_target_id[13]=13#
resources--resources_list
Institute for Safe Medication Practices. ISMP List of High-Alert
Medications in Acute Care Setting, 2018
https://www.ismp.org/sites/default/files/attachments/2018-
08/highAlert2018-Acute-Final.pdf
Pharmacy Service, UNM Hospitals. High Alert, and Look-Alike Sound-
Alike Medications. Aug. 2018
Medication Safety Section, Pharmacy Practice and Development
Division, Pharmaceutical Services Programme, Ministry of Health
Malaysia. GUIDELINE ON SAFE USE OF HIGH ALERT
MEDICATIONS (HAMs). 2nd Edition Nov. 2020
https://www.pharmacy.gov.my/v2/sites/default/files/document-
upload/guideline-safe-use-high-alert-medications-hams-2nd-
edition_1.pdf