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
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.
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.
Remove potassium chloride/phosphate from floor stock. Require staff to obtain potassium chloride/phosphate from the hospital pharmacy. Use only premixed potassium chloride/phosphate.
Stock only clearly labeled, premixed intravenous anticoagulants. Use only single-dose containers.
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.