safety of high alert medication (1)
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Improve the Safety of High
AlertDrugs
JCI Definition
High Alert Medications:
Involve a higher percentage of errors
Cause Sentinel Events if given inadvertantly
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Medications that carry higher risk for adverseoutcomes
Soundalike! lookalike drugs
High Alert Drugs
Adrenergic Agonists
Adrenergic Antagonists
Anaesthetic Agents
Chemotherapeutic Agents "oral and parenteral#
Epidural or intrathecalMedications
$ Inotropic Medications
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$ Sedation Agents
$ %arcotics& 'piates
$ (adiocontrast Agents
$ Concentrated Electrolytes
$ Insulin
$ Anticoagulants
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Dangerous Drugs
')ycodone
Hyrdocodone
Dia*epam +ema*epam
Alpra*olam
Do)ylamine
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JCI (e,uirements
-olicies or procedures address theidentification! location! storage and la.elling/
Concentrated electrolytes not present in patientcare units unless clinically necessary/
Actions taken to prevent inadvertantadministration of concentrated electrolytes/
Concentrated electrolytes in patient care unitsare clearly la.elled and stored in a manner thatrestricts access/
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Concentrated Electrolytes
-otassium Chloride01mE,&ml
-otassium -hosphate
02mmol&ml
Sodium Chloride 03/45
Magnesium Sulphate
0635
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-otassium Chloride 7g&73ml
Dilute in large volumeinfusion/
Concentration of finalsolution should not
.e more than83mmol&9/
(ate of administration shouldnot e)ceed 13mmol&
hour/
Mi) thoroughly toavoid layering;effect/
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Sodium tu.ing must .ecarefully irrigated
?ith 673ml %ormal
Saline after
administration/
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Magnesium Sulphate
1/8@g&6ml -revention and controlof sei*ures in to)emiaof pregnancy! acutenephritis and other conditions/
I> or IM/
I> Solutions dilute to133mg&ml/
Infusion rate should note)ceed 763mg&mine)cept in severeeclampsia/
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Calcium luconate 7g&73ml
Continuous infusion in
large volume De)trose
65 or %ormal Saline/
Administer slo?ly at arate not e)ceeding 3/@
7/=mE,&min/
Avoid mi)ing ?ith
-hosphates!
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-otassium Dihydrogen
-hosphate 7/2B7g&73ml
Compati.le ?ith
De)trose 65 or
%ormal Saline/
Administered .y
slo? infusion to
avoid phosphate
into)ication/
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Atropine 7mg&ml In
A nonselectiveantimuscarinic ?ith
.oth central and
peripheral actions/
SC! IM! slo? I> orin solution as
continuous infusion/
In case of
emergency! I>.olus/
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Adrenaline 7mg&ml In
%onselective
adrenoceptor stimulant/
SC! IM! slo? I> or I>
infusion/
If given IM! avoid.uttocks/ ive I> if .lood
circulation inade,uate/
Intravenous administration
should .e done ?ith
e)treme care! infusionshould .e stopped ?hen a
response is o.tained/
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Heparin Sodium 6333iu&ml
Initiates anticoagulationrapidly/
Symptoms of heparin
induced throm.ocytopenia
include 635 reduction ofplatelet count! throm.osis or
skin allergy/
Inhi.ition of aldosterone may
result in hyperkalemia/
Administration .y motorised
pump advised/
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Streptokinase 7/6Miu
infusion reduces
mortality in MI if infused
?ithin 71 hours after first symptoms/
Dilute ?ith De)trose 65
or %ormal Saline/
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9a.etalol 16mg&6ml
antagonist ?ith
arteriolar vasodilating
action/
9o?er peripheralresistance/
I> over 7 min or I>
infusion/
Dilute to at least 7mg&ml/
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-ropranolol 7mg&ml
%onselective for
adrenoceptors/
iven intravenously
for arrythmia!thyroto)ic crisis/
I> 7mg over 7 minute!
repeated if necessary/
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Ephedrine 23mg&ml
>asoconstrictor
sympathomimetic
Acts on receptors to
increase heart rate/
Slo? I> for reversal of
hypotension from
spinal or epidural
anaesthesia/
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%oradrenaline 8mg&8ml In
>asoconstrictor sympathomimetic/
%onselective agonist/
I> infusion dilute 83mgto 633mls! give throughcentral venous catheter/
(apid I> or intracardiacduring cardiac arrest
F1 3 3mcg&ml/
mailto:@200mcgmailto:@200mcg
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%imodipine 133mcg&ml
Smooth musclerela)ant effectespecially on cere.ralarteries/
Administer viainfusion pumpthrough a Gpiece intoa central catheter donot add to infusion
container/ Incompati.le ?ith
->C giving sets&containers/
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%icardipine 1mg&1ml
(ela)es vascular
smooth muscle and
dilates coronary and
peripheral arteries/
9ess reduction of
myocardial
contractility/
I> .olus or infusionof 7313mg&733ml/
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Digo)in 3/6mg&1ml
Dose tailored to
patient age! lean
.ody ?eight and
renal function/
I> infusion for
emergencies/
Dilute 3/6mg in
633mls given over 1hours/
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Do.utamine 163mg
Must .e given .yintravenousinfusion/
Diluted
concentration 3/67mg&ml!concentrateddilutions of 6mg&mlmust .e given viainfusion pump/
Incompati.le ?ith.icar.onate/
Dopamine 133mg&6ml
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Intravenous
infusion/
Dilute to ma)imum
concentration of
2/1mg&ml/
Incompati.le ?ith
.icar.onate/
-amidronate
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(econstitute ?ith
73ml I and mi)
?ell/
Dilute on 7333ml
3/86 or 3/45 %aCl or
De)trose 65/
Infuse over 118
hours/
ive in a separate I>
line! do not mi) ?ithother drugs/
%euromuscular
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>ecuronium"%orcuron# 8mg&ml
(ocuronium"Esmeron# 63mg&6ml
-ancuronium"-avulon# 8mg&1ml
Atracurium "+racrium#16mg&1/6ml
Su)amethonium733mg&1ml
Anaesthetic Agents
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rusemide 13mg&ml
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9oop diuretic/
IM! slo? I> or
infusion/
+innitus and
deafness ?ith
large I> doses
and rapidadministration/
SoundAlike! 9ookAlike Drugs
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Compounded
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SoundAlike! 9ookAlike
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Ho? +o Improve
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Independent Dou.leCheck
A procedure in ?hich +'
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individuals separately checkeach component of the ?ork
process/e/g/'ne person calculate the
re,uired dose a secondindividual calculates thesame dose independently ofthe first person/ (esults arethen compared and matched
Errorprone A..reviationsMisinterpretation of unfamiliar
a..reviation can cause harmful
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medication error/
+railing *ero after decimal point
9onely; decimal pointIKmistaken as 73 or I>
LD or ,/d/mistaken as,id
K or mistaken as num.er 3 or 8! causing
73fold overdoseErrorprone A..reviations
MgS'8 N mistaken as
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Morphine Sulphate
MS&MS38 N mistaken asmagnesium sulphate
Drug %ame and Dose run together Nespecially drug namesending ?ith l; can .emistaken as 7/
%umerical dose and unit run together N Kmistaken as another
3/Storage
Ensure highalert
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medications arenot easily
accessi.le/ Additional
safeguards tousage andadministration inpolicy/
Storage
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Storage
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Storage
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9a.eling
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Additional ?arning
la.eling:High Alert Drug
Dilute
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Safe Systems
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actor out human error/
-romotion of safepractices/
Standard preparationsand dilutions/
Administration protocols/
Safe Systems
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'rgani*ational safetyinfrastructure supports
training! .est practicesand annualrecertification/
Safe Systems
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Infusion pumps used toadminister
concentratedsolutions/
'ther infusion devicesmust .e monitoredfre,uently/
-hysician orders rate of infusion for these
solutions/
9imit Access
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Concentratedelectrolytes treated as
a controlledsu.stance! includingre,uirements thatrestrict ordering and
esta.lish storage anddocumentationre,uirements/
Is 6 EnoughO
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Documentation
E)piry Date
Allergy
Appropriateness
Contraindications
E)plaination
Dou.le Check
LuestionsO
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