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High Alert-Long Term Care Setting

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88 views1 page

High Alert-Long Term Care Setting

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RuuNata
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ISMP List of High-Alert Medications in

Long-Term Care (LTC) Settings

H
igh-alert medications are drugs that bear a heightened risk of causing as automated or independent double-checks when necessary. (Note: manual in-
significant patient or resident harm when they are used in error (e.g., dependent double-checks are not always the optimal error-reduction strategy
wrong drug, wrong dose, wrong route). Although mistakes may or may not and may not be practical for all of the medications on the list). Please note that
be more common with these drugs, the consequences of an error with these long-term acute care (LTAC) facilities, and LTC facilities with subacute units or
medications are clearly more devastating to patients or residents. We hope you where a wide variety of intravenous medications are administered, should also
will use this list to determine which medications require special safeguards to use the ISMP List of High-Alert Medications in Acute Care Settings,
reduce the risk of errors. This may include strategies such as standardizing the which can be found at: www.ismp.org/Tools/institutionalhighAlert.asp. Facilities
ordering, storage, preparation, and administration of these products; improving are also encouraged to use other resources, such as the Beers Criteria1 and
access to information about these drugs; limiting access to high-alert medications; STOPP and START Criteria,2 to identify and address medications that should be
using auxiliary labels and automated alerts; and employing redundancies such avoided in the elderly population, which are different from high-alert medications.

Classes/Categories of Medications Specific Medications

anticoagulants, parenteral and oral* digoxin, parenteral and oral

chemotherapeutic agents, parenteral and oral (excluding hormonal agents) EPINEPHrine, parenteral

hypoglycemics, oral (including combination products with another drug) iron dextran, parenteral
insulins, all formulations and strengths (e.g., U-100, U-200, U-300, U-500) methotrexate, oral, non-oncology use **

parenteral nutrition preparations concentrated morphine solution, oral ***


opioids - parenteral, transdermal, and oral (including liquid concentrates, ** All forms of chemotherapy are considered a class of high-alert medications. Oral methotrexate
immediate- and sustained-release formulations, and combination products for non-oncology purposes has been singled out for special emphasis to bring attention to the
with another drug) need for distinct strategies to prevent wrong frequency errors that occur with this drug when
used for non-oncology purposes that can result in death.
* including warfarin and newer agents.
*** All forms of opioids are considered a class of high-alert medications. Concentrated morphine
solution has been singled out for special emphasis to bring attention to the need for distinct
strategies to prevent wrong frequency errors that occur with this drug that can result in death.

Background

Based on error reports submitted to the ISMP National Medication Errors Reporting Program, reports of harmful errors in the literature, and input from practitioners
and safety experts, ISMP created and will periodically update a list of potential high-alert medications in the long-term care setting. During March 2016,
practitioners from LTC facilities responded to an ISMP survey designed to identify which medications were most frequently considered high-alert medications in
this setting. Further, to assure relevance and completeness, the clinical staff at ISMP, members of our LTC Advisory Board, and safety experts throughout the US
were asked to review the potential list. This list of specific medications and medication classes/categories reflects the collective thinking of all who provided input.

REFERENCES
1) American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Copyright 2016 Institute for Safe Medication Practices (ISMP). This document may be freely re-
Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medica- distributed without charge in its entirety provided that this copyright notice is not removed. It
may not be sold or distributed for a charge or for profit or used in commercial documents with-
tion Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227–46. out the written permission of ISMP. Any quotes or references to this document must be properly
www.ismp.org/sc?id=1752 cited. This document is provided “as is” without any express or implied warranty. This document
2) PL Detail - Document, STARTing and STOPPing medications in the elderly. Pharma- is for educational purposes only and does not constitute legal advice. If you require legal advice,
cist’s Letter/Prescriber’s Letter. September 2011. www.ismp.org/sc?id=1753 you should consult with an attorney.

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