Ensuring Precautions for All High-Alert Meds
Some of the most preventable adverse events are those related to medications, primarily because prescription and nonprescription medications are so widely used. Although any medication can harm a patient if used improperly, the Institute for Safe Medication Practices (ISMP) publishes a list of high-alert medications that are more likely to cause significant, and costly, harm to a patient if used in error.
ISMP has recently updated its list of high alert medications based on a review of reported errors and surveys of practitioners across care settings.¹ Their survey found that 95% of survey respondents reported their facility maintains a list of high-alert medications; however, only 64% said their facility had precautions in place to minimize or prevent harms for all of the listed medications. And for 15% of survey respondents, their facilities had few or no special precautions to prevent harm from high-alert medications on their list.
Since 2012, Oregon’s Patient Safety Reporting Program (PSRP) has received 611 reports of adverse medication events, 259 (42%) of which involved at least one high-alert medication. 106 of the 259 events that involved at least one high-alert medication (41%) resulted in serious patient harm or death. Nearly half of these reports (51/106, 48%) involved either insulin or a narcotic, medication classes that were top concerns for ISMP’s survey respondents.²
What You Can Do
If your facility has not determined which medications used in your organization require special safeguards, begin maintaining a list of the high-alert medications used in your facility. If your facility does maintain a list, it’s time to examine if your facility has precautions in place for each of those medications to minimize or prevent the risk of harm to your patients.
Putting precautions into place for every high-alert medication used in your facility can be daunting.
A variety of tools and resources are available to help. One tool we recommend is the Institute for Healthcare Improvement’s How-to-Guide: Prevent Harm from High-Alert Medications. Although geared toward hospitals and health systems, this guide offers specific interventions that may be applicable to other healthcare settings. The guide specifically focuses on preventing harm from anticoagulants, narcotics and opiates, insulins, and sedatives.
What You’ll Need
Institute for Safe Medication Practices (ISMP)
Ensure you know which drugs being used in your organization have a heightened risk of causing significant patient harm if used in error.
High-Alert Medications in Acute Care Settings
High-Alert Medications in Community/Ambulatory Settings
High-Alert Medications in Long-Term Care (LTC) Settings
Institute for Healthcare Improvement (IHI)
Implement changes in your facility (and measure progress) to prevent harm from high-alert medications (specifically anticoagulants, narcotics and opiates, insulins, and sedatives).
How-to-Guide: Prevent Harm from High-Alert Medications
And One More Thing…
The United States Pharmacopeia’s (USP) New Hazardous Drug Requirements go into effect on December, 1 2019. These requirements provide “standards for safe handling of hazardous drugs to minimize the risk of exposure to healthcare personnel, patients and the environment.” USP’s new standards apply to “all healthcare personnel who receive, prepare, administer, transport or otherwise come in contact with hazardous drugs and all the environments in which they are handled.”
What have you done to address this or similar safety risks? Share what you’ve learned in your organization and contribute to the ongoing learning about adverse events in Oregon through the Patient Safety Reporting Program.
References
¹ Institute for Safe Medication Practices. (2018). High-Alert Medication Survey Results Lead to Several Changes for 2018. August 23, 2018.
² ISMP’s 2018 survey found that “when respondents were asked which 3 medications or classes of medication on their list caused the most concern with regards to medication errors, the top 5 most frequent responses were (in descending order): anticoagulants, insulin, neuromuscular blocking agents, chemotherapy, and opioids.”