HIGH-ALERT MEDICATIONS, A STEP FORWARD TO IMPROVE PATIENT SAFETY

European Statement: 

  • Patient Safety and Quality Assurance

Author(s): 

Mercedes Gimeno Gracia
Tránsito Salvador Gómez
Beatriz Abad Bañuelos
Francisco Javier Campos Montellano
María José Cumbraos Sánchez
Oihana Horna Oreja
Laura Sallán Diaz

What was done?: 

A program for identifying and handle high-alert medications in a terciary hospital has been implemented.

Why was it done?: 

The implementation of safe medication practices plays a key role to prevent medication errors (ME) in the hospital setting. High-alert medications (HAMs) are those that bear a heightened risk of causing significant patient harm when they are used in error. Institutions such as the Joint Commission requires that hospitals define institution-specific HAMs and implement good processes. Our objective was to ensure safe medication hospital practices and to eliminate medication errors that may cause harm, which is a priority to achieve patient´s safety goals.

How was it done?: 

The project was carried out in different stages:
-First of all, it was consulted the updated list (published in 2012) by the Institute for Safe Medication Practices. Therefore, a total of 186 drugs were HAMs.
-The second step was identified them using auxiliary red colour labels to warn health professionals of their potential danger.
-Finally, we defined general and specific strategies to take up with HAMs. In general strategies, plant kits were reviewed to remove unnecessary stock and limiting access to HAMs. It was also standardized HAM handling practices. In this way, specific strategies focused on: methotrexate, insulin and heparin. Regarding methotrexate administered orally, it was distributed a fact sheet indicating rules to promote it proper administration. Regarding insulin, a working group was formed to determine the available presentations, reserving the insulin pen for diabetic debuts. For the unfractionated heparin, a procedure for standardized dilution of 5% heparin was performed being the 1% heparin restricted to certain services.

What has been achieved?: 

A total of 186 medications were identifyed as HAMs and different strategies to prevent ME with those was defined. The main objective we have accomplished is becoming aware of their potential danger in case of error.

What next?: 

In the near future, our main objetives are asses the long-term impact of the implemented strategies, monitor ME involving HAMs and reassess the current list of HAMs to promote a needed safety culture in the hospital setting.

Keywords: 

  • Clinical pharmacy›Medication-use system
  • Drug safety›Adverse drug events
  • Patient safety›High risk medication

Conflict of interest: 

I have no potential conflict of interest to disclose

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