>> A list of high-alert medications is relatively useless unless it is up-to-date, known by clinical staff, and accompanied by robust risk-reduction strategies more effective than awareness, manual double-checks, staff education, and appeals to be careful. Many of these strategies should be translated for use with other medications. %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz Long-term care patients often have concurrent conditions that increase their risk of medication error. In 2003, during its first year of the Medication Safety Support Service (commissioned Standardizing the ordering, storage, preparation, and administration of these . a. Sites, Contact For each medication on the facility's high-alert medication list, outline a robust set of processes for managing risk, impacting as many steps of the medication-use process as . Which of the following drug classifications is not listed on the ISMP List of High-Alert drug Classes or Categories of mediciatons? Moderate sedation agents, IV (eg, dexmedetomidine, midazolam, Moderate and minimal sedation agents, oral, for children (eg, chloral hydrate, midazolam, ketamine [using IV form]), Narcotics/opioids, IV, transdermal, oral (including liquid concentrates, immediate and sustained-release forms), Neuromuscular blocking agents (eg, succinylcholine, rocuronium, vecuronium), Sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100mL or more, Sodium chloride for injection, hypertonic, greater than 0.9% concentration, Sulfonylurea hypoglycemics, oral (eg, chlorpro. Learn more information here. High-Alert Medications in Acute Care Settings. The Joint Commission recommends strategies such as a system that confirms the correct drug, dosage, patient, time, and route. Institute for Safe Medication Practices. Root cause analysis of adverse events involving opioid overdoses in the Veterans Health Administration. 2018. Regularly assess for risk in the systems and practices used to support the safe use of medications by using information from internal and external sources (e.g., Food and Drug Administration (FDA), The Joint Commission, ISMP). 9 0 obj <> endobj 14.2% involved heparin. An official website of The Ministry of Long-Term Care (MLTC) in Ontario is partnering with ISMP Canada for 3 years to support long-term care homes in strengthening medication safety. 37 0 obj <>/Filter/FlateDecode/ID[<511D81E4C823079F14A719C2AEE68921><940396CC49DB344DBB373A7EAC1C47A0>]/Index[9 120]/Info 8 0 R/Length 123/Prev 61533/Root 10 0 R/Size 129/Type/XRef/W[1 2 1]>>stream I knew if I wanted to become a subject matter expert and advance through the ranks of medication safety specialists, I needed to align myself with the organization considered the gold standard for medication safety information. To be effective, all of these interdisciplinary components are needed: Understand the causes of errors. created and periodically updates a list of potential high-alert medications. In addition, five best practices were archived this year or incorporated into other items. ISMP; 2021. 2 0 obj Very few studies have been conducted involving medications commonly used in Anticoagulants (eg, warfarin, low-molecular-weight heparin, unfractionated heparin), Direct oral anticoagulants and Factor Xa inhibitors (eg, dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban, fondaparinux), Direct thrombin inhibitors (eg, argatroban, bivalirudin, dabigatran), Thrombolytics (eg, alteplase, reteplase, tenecteplase), Glycoprotein IIb/IIIa inhibitors (eg, eptifibatide). /Type/XObject C Annual Perspective: Psychological Safety of Healthcare Staff. In total, 14 medications and 4 medication classes were included with the predefined level of consensus of 75%. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Copyright 2000-2023 Institute for Safe Medication Practices Canada (ISMP Canada). Policy, U.S. Department of Health & Human Services. << 440,000 . ISMP's List of High-Alert Medications in Acute Care Settings; . ISMP Canada is developing a Canadian list of high-alert medications. Sites, Contact . ISMP Adds Three New Best Practices to Its 2022-2023 List for Hospitals February 10, 2022 Healthcare organizations that are deciding on the focus for their medication safety efforts during the year can now rely on updated recommendations from the Institute for Safe Medication Practices (ISMP). For example, a May 2017 ISMP safety bulletin featured an unfortunate medication incident which led to the death of a patient from dispensing the incorrect medication. they are used in error. The original list was developed in 2008, which included input from community pharmacy practitioners who participated in focus groups or responded to an ISMP survey on the topic. High-Alert Medications in Long-Term Care (LTC) Settings, High-Alert Medications in Acute Care Settings, Look-Alike Drug Names with Recommended Tall Man (Mixed Case) Letters, Medication Safety Officers Society (MSOS). Note that even if you have an account, you can still choose to submit a case as a guest. Insulin U-500 has been singled out for special emphasis to bring attention to the need for distinct strategies to prevent the types of errors that occur with this concentrated form of insulin. Your use of this website constitutes acceptance of Haymarket MediasPrivacy PolicyandTerms & Conditions. (Note: manual independent double-checks are not always the optimal below. 1 0 obj Nursing home patient safety culture perceptions among US and immigrant nurses. This list of medications and drug categories reflects the collective thinking of all who provided input. Strategies for optimizing OR drug safety. insulins. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. error-reduction strategy and may not be practical The third new ISMP best practice suggests that providers layer numerous strategies throughout the medication-use process to improve safety with high-alert medications. High-alert medications: the safeguards that you should put in place to reduce risks. The purpose of identifying high-alert medications is to establish safeguards to reduce the risk of errors with these drugs in all phases of the medication use process. Limit the use of independent double checks to select high-alert medications with the greatest risk for error within the organization. All forms of insulin, subcutaneous and IV, are considered a class of high-alert medications. ISMP Publishes 2020-2021 Consensus-Based Medication Safety Best Practices for Hospitals ISMP issued its 2020-2021 Targeted Medication Safety Best Practices for Hospitals to help identify, inspire, and mobilize widespread national action to address recurring problems that continue to cause fatal and harmful errors The following table, adapted from the ISMP US High-Alert List3, is provided as a guide. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. October 1, 2021 Horsham, PA: Institute for Safe Medication Practices; 2021. ^N5#?frqtR ]tE}eb8kbd_>VI. such as standardizing the ordering, storage, Additional Resources ASHP Center on Medication Safety and Quality Institute for Safe Medication Practices (ISMP) Manual: Ambulatory Medications classified as HAMs have a narrow therapeutic. Products with Medication Guides; Narrow Therapeutic Index Drugs; Products with REMS; Package Requires Dilution; Boxed Warning Monographs; Acute High Alert ISMP; Community/Ambulatory High Alert ISMP; Products by Manufacturer Source: Institute for Safe Medication Practices. Products with Medication Guides; Narrow Therapeutic Index Drugs; Products with REMS; Package Requires Dilution; Boxed Warning Monographs; Acute High Alert ISMP; Community/Ambulatory High Alert ISMP; Products by Manufacturer ISMP has issued its 2022-2023 Targeted Medication Safety Best Practices for Hospitals to help identify, inspire, and mobilize widespread national action to address recurring problems that continue to cause fatal and harmful errors despite repeated warnings in ISMP publications. Safety considerations for challenges when using smart infusion pumps. Internal reporting system to improve a pharmacys medication distribution process. Misreading injectable medicationscauses and solutions: an integrative literature review. From physician intent to the pharmacy label: prevalence and description of discrepancies from a cross-sectional evaluation of electronic prescriptions. risk of causing significant patient harm when chemotherapeutic agents. An official website of Writing Act, Privacy 2013 Feb 21;18(4);1-4. Department of Health & Human Services, Horsham, PA: Institute of Safe Medication Practices; 2021. Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: a systematic review and meta-analysis. Copyright 2023 Haymarket Media, Inc. All Rights Reserved Writing Act, Privacy endstream endobj 10 0 obj <> endobj 11 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC]/Properties<>/Shading<>/XObject<>>>/Rotate 0/TrimBox[0 0 612 792]/Type/Page/u2pMat[1 0 0 -1 0 792]/xb1 0/xb2 612/xt1 0/xt2 612/yb1 0/yb2 792/yt1 0/yt2 792>> endobj 12 0 obj <>stream Horsham, PA; Institute for Safe Medication Practices: 2018. . (Pharm.) Monroe PS, Heck WD, Lavsa SM. hbbd``b`I@UH @[ H8$~ 6.a$xfnH0X@ RObA6 bL3@b%3]X` July 29, 2020 View More See More About Hospitals Health Care Providers Medicine Specific to High-Risk Drugs Decreasing surgical site infections by developing a high reliability culture. Extra attention should be given to these drugs, for example, storing paralytics in brightly colored bins. Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients. Published 2019. Office-based physicians are responding to incentives and assistance by adopting and using electronic health records. Rockville, MD 20857 ISMP; 2021. Antibiotics c. Chemotherapeutic agents d. . from the University of British Columbia. This fact sheet lists medications with a high risk of causing significant harm to patients when incorrectly administered. to patients. Magnesium Sulfate Injection. Does the list serve only to increase awareness of the risk of harm with these medications, or has a robust plan been implemented for each drug or drug class to reduce the risk of errors? This important first step should not be skippedif you cant describe the ways that errors have happened or could happen with the drug, your strategies may not lessen the risk of an error at all. Antithrombotic agents, oral and parenteral, including: Anticoagulants (e.g., warfarin, low molecular weight heparin, unfractionated heparin), Direct oral anticoagulants and factor Xa inhibitors (e.g., dabigatran, rivaroxaban, apixaban, edoxaban), Direct thrombin inhibitors (e.g., dabigatran), Oral and parenteral chemotherapy (e.g., capecitabine, cyclophosphamide), Oral targeted therapy and immunotherapy (e.g., palbociclib [IBRANCE], imatinib [GLEEVEC], bosutinib [BOSULIF]), Immunosuppressant agents, oral and parenteral (e.g., azaTHIOprine, cycloSPORINE, tacrolimus), Insulins, all formulations and strengths (e.g., U-100, U-200, U-300, U-500), Medications contraindicated during pregnancy (e.g., bosentan, ISOtretinoin), Moderate and minimal sedation agents, oral, for children (e.g., chloral hydrate, midazolam, ketamine [using the parenteral form]), Opioids, all routes of administration (e.g., oral, sublingual, parenteral, transdermal), including liquid concentrates, immediate- and sustained-release formulations, andcombination products with another drug, Pediatric liquid medications that require measurement, Sulfonylurea hypoglycemics, oral (e.g., chlorproPAMIDE, glimepiride, glyBURIDE, glipiZIDE, TOLBUTamide), Methotrexate, oral and parenteral,nononcologic use (special emphasis)*. Effective strategies must address the underlying causes of errors with each type of high-alert medication or class of medications. To sign up for updates or to access your subscriber preferences, please enter your email address ISMP website. Policies, HHS Digital Develop your own list based on unique utilization patterns and internal data about medication errors and sentinel events High-alert and hazardous medications & look-alike/sound-alike (LASA) medications in the ambulatory setting MM 01.01.03 vs MM 01.02.01 The organization safely manages Provide oxytocin in a ready-to-use form. 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