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    High-Alert Medications

    The safeguards that you should put in place to reduce risks.


    For example, the high-alert list at Nemours includes antithrombotic agents, chemotherapeutic agents, neuromuscular blocking drugs, parenteral nutrition preparations and lipid emulsions, IV electrolyte replacement or riders excluding maintenance fluids, subcutaneous and IV insulin, and IV opioid infusions.

    Prevention Is Never Ending

    Table 3“There are thousands of items that have been changed and practices that have been changed. There are medications that killed people 20 years ago, but they no longer exist,” said Cohen. These changes have occurred because ISMP contacted the FDA and pharmaceutical manufacturers when mistakes occur. But as new mediations come onto the market and new uses are found for older drugs, vigilance is necessary.

    One way to keep on top of medication errors is to complete ISMP’s Medication Safety Self-Assessment for High-Alert Medications, which provides many recommendations that encourage medication safety leaders to assess if these errors could occur in their institution. There are 60 self-assessments on opioids alone. 

    “It’s a really important practice to reduce harm,” Cohen said. “This is not just pharmacists. We want to pull together people from risk management, the quality department, leadership such as vice president of the hospital, nursing staff, and physicians.”

    Related article: The red pen rules: How to prevent pharmacy error

    Another key method is to always have several pairs of eyes on the process. Even with advanced e-prescribing databases, both hospital and retail pharmacies insist that pharmacists, techs, and other health-care professionals double check each other, according to Fred Pane, PharmD, a former Director of Hospital Pharmacy, and senior consultant at the pharmacy consulting firm Visante Inc. “You try to introduce a couple of people in the process to make sure there are checks and balances with the bedside verification.” 

    At Nemours’ facilities, the “independent double check” is required for all high-alert medications, Dejos said. “Two independent clinical staff members—doctors, nurses, or pharmacists—will check the prescribing, preparation/dispensing, and administering of these medications.” 

    Christine Blank
    Contributing Editor Christine Blank is a freelance writer based in Florida.


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