How to Improve Safety of High-Alert Medication

High-alert medications are medications that carry a higher risk of causing significant harm to the consumer when they are administered in error. Many health-care facilities have implemented the "double-check" system as a method of preventing medication errors. Though this system, which involves two medical professionals checking the medication, is a notable effort, it is not always the best strategy and may not be effective for all high-alert medications. According to the Institute for Safe Medication Practices (ISMP), the top five high-alert medications are insulin; opiates and narcotics; injectable potassium chloride/phosphate concentrate; intravenous anticoagulants and sodium chloride solutions above 0.9%.

Instructions

• 1

  Store insulin and heparin in separate areas. Insulin and heparin vials stored in close proximity may lead to mix-ups. Establish a double-check system where one nurse prepares the vial and another nurse checks it.

• 2

  Limit the amount of opiates and narcotics available to medical staff. Educate staff about the potential confusion between morphine and hydromorphone. Establish patient-controlled analgesia protocols that include double-checks of pump setting, dosage and drug.

• 3

  Remove potassium chloride/phosphate from floor stock. Require staff to obtain potassium chloride/phosphate from the hospital pharmacy. Use only premixed potassium chloride/phosphate.

• 4

  Stock only clearly labeled, premixed intravenous anticoagulants. Use only single-dose containers.

• 5

  Limit access to sodium chloride solutions greater than 0.9%. Remove from floor stock and require medical staff to obtain sodium chloride from the hospital pharmacy.