By Natalie Benninger and Leigha Laporte
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High-alert medications are medications that bear a heightened risk of causing significant patient harm when they are used in error. Errors are not necessarily more common with these medications, but the consequences of an error can be devastating. High-alert medications include antithrombotic agents, adrenergic agents, chemotherapeutic agents, concentrated electrolytes, insulin, narcotics (opioids), neuromuscular blocking agents, and sedation agents. Ensuring a safe and coordinated use of high-alert medications is also a Required Organizational Practice of Accreditation Canada.
Women’s College Hospital (WCH) promotes safety best practices when dispensing and administering high-alert medications through the implementation of safeguards that reduce the possibility of harm. A number of WCH committees are involved in medication safety, including the Pharmacy & Therapeutics Committee which is responsible for identifying and mitigating risks associated with the medication system. Clinicians share this responsibility which includes reporting incidents through the IRIS system. WCH maintains a list of high-alert medications and associated safeguards as part of the High-Alert Medication Management policy document available on the intranet. Click here to collect the Q-Tip.
Strategies for the safe use of high-alert medications at WCH include:
- Standardizing medication concentrations and volume options
- Using pre-mixed (commercially available) solutions
- Using programmable pumps with dosing limits and automated alerts
- Identifying high-alert products when they are received by Pharmacy Services
- Using visible warning and auxiliary labels
- Using patient-specific labelling for unusual concentrations
- Limiting access to high-alert medications in patient care areas and auditing to assess for items that should be removed
- Standardizing the ordering, storage, preparation, administration, and dispensing of high-alert medications
- Providing training about high-alert medications
- Employing redundancies, such as independent double checks
WCH also has a standardized process for an Independent Double Check of select high-alert medications, where a second practitioner conducts verification without any prior knowledge of the preparatory steps or calculations performed by the first practitioner. This process is then documented in the electronic patient record. You can learn more by reviewing the Independent Double-Check of High-Risk/High-Alert Medications policy document.
To learn more about Accreditation, visit the Accreditation Intranet Hub.