High Alert/ High Risk Medications

What are High alert or high risk meds?

Drugs that have increased risk of causing significant patient harm or injury when misused.

Abbreviation for High alert medications?

HAM’s

What is an NTI drug?

Narrow Therapeutic Index drugs are medications where a small difference in dose can lead to significantly dangerous health outcomes.

What is ISMP?

Institute for Safe Medication Practices

devoted to preventing medication errors and providing safety information.

Misuse outcomes for Insulin and Sulfonylureas

Potent blood sugar lowering→ coma→death

Misuse outcomes for Opiods

Respiratory depression→death

Misuse outcomes for Anticoagulants

Risk of bleeding→serious adverse effects→ death

Misuse outcomes for Chemotherapy drugs

toxicity→serious adverse effects→ death

Misuse outcomes for Neuromuscular blockers

paralysis→ permanent injury→ death

Medications that have a potent effect on BP and HR

• epinephrine

• epoprostenol IV (Flovan)

• vasopressin injection (Pitressin)

• sodium nitroprusside injection (Nitropress)

High risk hormone that induces labor

• oxytocin IV (Pitocin)

High Risk Electrolytes

• injectable potassium

• injectable NaCl > 0.9%

• magnesium Sulfate injections

High risk seizure medications

• Carbamazepine (Tegretol)

• Lamotrigine (Lamictal)

• Phenytoin (Dilantin)

• Valproic Acid (Depakene)

Others

• Insulin U-500 (greater than U-100)

• methotrexate(chemotherapy/immunosuppressant)

• Promethazine Injection (Phenergan)

• Opium tincture

What does TJC do regarding HAMs?

The joint commission on accreditation of healthcare (JCAHO)

• informs and evaluates health care facilities regarding safe and effective patient care

The 5 high alert medications identified by JC are…

1. Insulin

2. Opiates and Narcotics

3. Injectable potassium concentrates (electrolytes)

4. Intravenous anticoagulants-heparin

5. Sodium Chloride solutions above 0.9%