hi my name's Amanda and I'm a pharmacist today we'll be looking at high alert or high risk medications and if you find this video useful please press the like button subscribe to my channel and share it with others who may find it helpful too and if you would like to have lifetime ad-free access to my Pharmacy learning videos and handouts of all my slides please consider enrolling in my online course today the link to my courses in the comments in the description thanks I really appreciate it so we'll Begin by looking at what are high alert or high risk medications high alert or high risk medications or drugs that have an increased risk of causing significant patient harm or injury when misused or used in error high alert medications or as an acronym hands are not necessarily more prone to medication errors but if a mistake does occur the effects can be life-threatening and permanent high alert medications require extra precautions to reduce the risk of errors so now we'll look at high alert medications versus NTI drugs so NTI drugs that stands for narrow therapeutic index drugs these are medications in which a small difference in dose or blood concentration can lead to Serious therapeutic failures and or adverse drug reactions that are life-threatening or result in significant disability or incapacity so with an NTI drug you have a small change in drug dose or blood concentration and that leads to a very significant undesired effect so many of the high alert medications have a narrow therapeutic index so this is one reason why they can cause significant harm or injury if used in error it only takes a small dose now we'll look at a couple or izations that help with identification and managing high alert medications so the first one is the institute for safe medication practices or ismp The Institute for safe medication practices is an organization devoted to preventing medication errors and providing medication safety information ismp actually provides some high alert medication lists for specific Pharmacy settings they have one for the community and ambulatory care which are like retail pharmacies long-term care which is like nursing homes and acute care which is hospitals so they have individual lists identified for each of these settings that are considered high alert medications and these specific lists can be found at ismp.org now we'll look at some of the high alert medication classes and this collection I have here is composed from the ismp resources so some common high alert medication classes include insulins and sulfonylureas anticoagulants opioid pain medications chemotherapy drugs IV beta blockers such as Propranolol remember these beta blockers end with the suffix o law IV antiarhythmics immunosuppressant agents intrathecal or epidural medications these are medications that go into the spinal cord medications contraindicated during pregnancy neuromuscular blocking agents pediatric liquid medications requiring measurement radio contrast agents moderate sedating agents and this even includes minimally sedating agents when used in children and anesthetic drugs and the ones I have in bold here will look a little more specifically at how or why these are high alert modifications so with the insulins insulin and sulfonylureas insulin is used to lower blood sugar and diabetes and the sulfonylureas they're an oral diabetes medication that also has a dramatic blood sugar lowering effect so the reason these are high alert medications they have a potent blood sugar lowering effect and when given incorrectly an error this can lead to coma and death the opioids these are pain medications when used incorrectly these can cause respiratory depression which it means the person stops breathing and this can lead to death they anticoagulants or blood thinners they pose an increased risk of bleeding and this can have serious adverse effects and even cause death chemotherapy drugs these are drugs used for cancer treatment they carry a high risk of toxicity is because they are like killing cells and they can kill good cells as well so when used incorrectly this can have serious adverse effects and even lead to death and the neuromuscular blockers these are medications that prevent movement like during surgeries when used in error these can cause paralysis or permanent injury and even death so we looked at some of the drug classes now we'll look at some specific high alert medications some individual products and remember high alert medications have an increased risk of causing significant patient harm when used in error so extra caution is needed with these these drugs so first there's epinephrine epoprostenol vasopressin and sodium nitropresside and I've kind of grouped these together these medications can all have a potent effect on the blood pressure and heart rate so that that's something that's definitely extra caution is needed with oxytocin given IV and this is a hormone to induce labor or uterine contractions there's some electrolytes including injectable potassium injectable sodium chloride that's greater than 0.9 percent so this is greater than the normal saline this is a hypertonic solution and magnesium sulfate injection like I said those are all electrolytes insulin u500 this is a more concentrated insulin compared to what's typically seen as the insulin u100 so you can see how that would have an effect with the blood sugar issues Methotrexate this is a medication used I mean cancer treatment and also has other uses so it's just something needs caution promethazine injection Phenergan it can have lots of adverse effects um when administered incorrectly it's used for nausea opiate opium tincture this is related to the pain medications but it's used for patients sometimes like with with diarrhea carbamazepine Lamotrigine phenytoin and valproic acid these are all seizure medications so that those need extra caution as well so we looked at ismp that was one organization that deals with medication safety and has guidelines for the high alert medications and now we'll look at the other organization called The Joint Commission The Joint Commission on a credit accreditation of Health Care organizations it's known as Jayco or abbreviated JC is an organization that informs and evaluates Health Care Facilities such as hospitals regarding safe and effective patient care the standards used by The Joint Commission to accredit and certify Healthcare organizations those standards focus on patient safety and quality of care and The Joint Commission requires organizations to identify and follow a process for managing high alert medications so the Joint Commission has issued a bulletin listing high alert medications that have the highest risk of causing injury when misused so the five high alert medications identified by The Joint Commission are insulin opiates and narcotics these are the pain medications injectable potassium concentrates this is an electrolyte IV anticoagulants namely Heparin this is a blood thinner and sodium chloride Solutions above 0.9 percent this is electrolyte so we've looked at some of these already about why those would be higher medications but we'll just kind of go through that again and look at the extra ones that the Joint Commission pointed out here that we hadn't talked about in detail so with insulin of course that's for diabetes to lower blood sugar you know it has a very potent blood sugar lowering effect this can lead to Coma which can cause death when used inappropriately the opiates and narcotics these are the pain medications we've talked about that also these can cause respiratory depression which causes a person to stop breathing and can lead to death the Avi anticoagulants which are blood thinners you have an increased risk of bleeding and this can lead to Serious adverse effects and death and now we'll look at the electrolytes here why they can cause why they are considered higher medications so in the injectable potassium concentrates they can lead to hyperkalemia which means high potassium levels in the blood this can be problematic because it can increase the heart rate and change the heart rhythm and this can cause death and then the sodium chloride Solutions above 0.9 percent or this is greater than the normal saline this is would be hypertonic solutions they can cause hypernatremia which means high sodium levels in the blood when these levels get too high this can cause brain damage which can lead to death so since we have all these high alert medications what needs to be done are strategies to reduce the errors with the high alert medications so here are some strategies educating staff about specific high alert medications using high alert auxiliary labels such you know just a red label here like I show in the slide just as high alert drug just to identify these products um limiting access to certain high alert medications independent double checks were idc's for certain high alert medications and an independent double check that just means two people are separately checking for the accuracy of various aspects of the higher medications so it could be you know the dose or the amount and then technology for automated double checks such as computer systems to confirm the correct drug correct dosage patient time and route of administration and now we'll just look at a summary and some key points to remember so high alert or high risk medications or hams have an increased risk of causing significant patient harm or injury when misused or used in error ismp and Jayco have resources for helping to identify and manage these high alert medications and some common highlight medications include insulin blood thinners concentrated electrolytes IV medications for seizures IV medications for heart rate and blood pressure and the high alert medications require extra precautions to reduce the risk of Errors such as education and extra checks thanks for watching please 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