High Alert Medications Overview

Overview

This lecture covers high alert (high risk) medications, their characteristics, examples, and strategies to minimize medication errors in pharmacy practice.

Definition and Importance of High Alert Medications

• High alert medications have an increased risk of causing significant patient harm if used in error.
• These drugs may not be more likely to cause errors but have severe consequences if a mistake occurs.
• Extra precautions are needed when handling high alert medications.

High Alert vs. Narrow Therapeutic Index (NTI) Drugs

• NTI drugs are those where small dosing differences can cause severe failures or adverse reactions.
• Many high alert medications also have a narrow therapeutic index.

Organizations Guiding High Alert Medication Safety

• The Institute for Safe Medication Practices (ISMP) provides lists of high alert medications for various pharmacy settings.
• The Joint Commission (JCAHO or JC) sets standards and requires facilities to manage high alert medications through defined processes.

Common Classes of High Alert Medications

• Insulins and sulfonylureas: potent blood sugar lowering agents; errors can cause coma or death.
• Anticoagulants (blood thinners): increase bleeding risk; errors can be fatal.
• Opioid pain medications: risk of respiratory depression and death.
• Chemotherapy agents: high toxicity, can damage healthy cells.
• Neuromuscular blockers: can cause paralysis or permanent injury.
• IV beta blockers, antiarrhythmics, immunosuppressants, intrathecal/epidural drugs, pediatric liquids, anesthetics, radiocontrast agents.

Specific High Alert Medications

• Epinephrine, epoprostenol, vasopressin, sodium nitroprusside: greatly affect blood pressure and heart rate.
• IV oxytocin: induces labor; requires precise dosing.
• Injectable electrolytes (potassium, sodium chloride >0.9%, magnesium sulfate): risk of severe side effects if misused.
• Insulin U-500 (very concentrated).
• Methotrexate, promethazine injection, opium tincture: risk of serious adverse effects.
• Seizure medications: carbamazepine, lamotrigine, phenytoin, valproic acid.

Joint Commission’s Five High Alert Medications

• Insulin
• Opiates and narcotics
• Injectable potassium concentrates
• IV anticoagulants (e.g., heparin)
• Sodium chloride solutions above 0.9%

Strategies to Prevent High Alert Medication Errors

• Educate staff about high alert drugs.
• Use auxiliary “high alert” labels.
• Limit access to certain medications.
• Require independent double checks by two people.
• Use technology for automated double checks on drug, dose, patient, time, and route.

Key Terms & Definitions

• High Alert Medication — medication with a higher risk of causing serious harm if used in error.
• Narrow Therapeutic Index (NTI) Drug — drug where small dose changes can cause serious adverse effects.
• ISMP — Institute for Safe Medication Practices, provides safety resources.
• The Joint Commission (JCAHO, JC) — accredits healthcare organizations, sets safety standards.
• Independent Double Check — two individuals independently verify medication accuracy.

Action Items / Next Steps

• Review ISMP’s and The Joint Commission’s high alert medication lists.
• Implement strategies for safe handling of high alert medications in practice.
• Educate yourself and staff on medication safety procedures.