HIGH ALERT

DEFINITION OF MEDICATION
Medication Error ERROR
A medication error is any preventable
event that may cause or lead to
inappropriate medication use or patient
harm.
It can involve any one of the following processes:
Prescribing, Ordering, Dispensing, Distribution, Preparation,
Administration, Labelling, Packaging, Nomenclature,
Communication, Education, Use And Monitoring Of Treatment

HIGH ALERT MEDICATION

 WHAT IS HIGH ALERT MEDICATION

High-alert medications are medications that are

most likely to cause SIGNIFICANT HARM to the
patient, even when used as intended.
Although any medication used improperly can cause
harm, high-alert medications cause harm more
commonly and the harm they produce is likely to be
more serious and leads to patient suffering
and additional costs associated with care of these
patients.
 LIST OF HIGH ALERT MEDICATION
THAT ARE AVAILBLE @ HBUK
1. Adrenaline 1mg/ml Inj 10. Midazolam 5mg/ml Inj

2. Cobra Antivenom Inj 11. Morphine 10mg/ml Inj

3. Dextrose 30% Inj 12. Noradrenaline 4mg/4ml Inj

4. Dextrose 50% Inj 13. Pit Viper Antivenom Inj

5. Digoxin 0.5mg/2ml Inj 14. Potassium Chloride 1Gm/10ml Inj

6. Dobutamine 250mg/20ml Inj

7. Dopamine 200mg/5ml Inj

8. Heparin 5000 unit/ml Inj

9. Actrapid 1000unit/10ml Inj

 COMMON RISK
COMMON RISK FACTORS
FACTORS
Poorly written medication orders
Incorrect dilution procedures
Confusion between IM, IV, intrathecal, epidural
preparations
Confusion between strengths of the same medications
Ambiguous labeling on concentration and total volume
of medications
Wrong infusion rate
Look alike or sound alike product and similar
packaging
 STRATEGIES TO AVOID
STRATEGIES ERRORS
TO AVOID INVOLVING
ERRORS
HIGHHIGH
INVOLVING ALERT MEDICATION
ALERT MEDICATION

All High Alert Medication containers, product packages and loose vials or
ampoules stored must be labeled as HIGH ALERT MEDICATION

All personnel should read the High Alert Medication labels carefully
before storing to ensure medications are kept at the correct place

All High Alert Medications should be kept in individual labeled containers.

Whenever possible, avoid sound-alike and look-alike drug or different
strengths of the same drug being stored side by side.

Use TALL-man lettering to emphasize differences in medication name

(eg: DOPamine and DOBUTamine)
EXAMPLES
EXAMPLE:
 THIS EXAMPLE ALSO CAN BE
CATEGORISED AS HIGH ALERT
MEDICATION!!!
STRATEGIES TO AVOID ERRORS INVOLVING
CONT:
HIGH ALERT MEDICATION

Do not use abbreviations when prescribing High Alert

Medications
Specify the dose, route, and rate of infusion for High
Alert Medications prescribed (eg: IV Dopamine
5mcg/kg/min over 1 minutes)
Prescribe oral liquid medications with the dose
specified in miligrams
Do not use trailing zero when prescribing (eg: 5.0mg
can be mistaken as 50mg)
 STRATEGIES TO AVOID ERRORS INVOLVING
CONT:
HIGH ALERT MEDICATION

The following particulars shall be independently counter checked

against the prescription or medication chart at the bedside by two
appropriate persons before administration:
Patients name and RN
Name and strength of medication
Dose
Route and rate
Expiry date

Return all unused medication to pharmacy when no longer

required
Avoid ordering High Alert Medications verbally. In cases of
emergency, phone orders have to be repeated and verified
STRATEGIES TO AVOID ERRORS INVOLVING
CONT:
HIGH ALERT MEDICATION

Closely monitor vital signs, laboratory data,

patients response before and after
administration of medication
Keep antidotes and resuscitation equipment
in wards
STRATEGIES TO AVOID ERRORS INVOLVING
CONT:
HIGH ALERT MEDICATION

All personal shall be trained prior to handling

of High Alert Medication and documentation
kept.
Staff must be trained to prevent potential
errors and enable them to response promptly
when mistakes do occur
STRATEGIES TO AVOID ERRORS INVOLVING
CONT:
HIGH ALERT MEDICATION

References or dilution guide should be made

available in the wards

Monitor adverse drug reaction and

medication errors related to High Alert
Medications
Strength/unit 100 units/ml (1000 units/vial)
Diluents for NS
infusion

Method of 1) Slow IV bolus: administer undiluted solution over 3-5 minutes

administration 2) Continuous IV infusion: dilute 50 units insulin in 50 ml NS (1
units/ml)

Remarks Monitor sign and symptoms of hypoglycemia

If hypoglycemia occurs, stop infusion. For conscious patient, give
sweetened drink. For unconscious patient, administer D50% or glucagon.
Check blood glucose after 15 minutes
MAY CAUSE NEUROHYPOGLYCEMIA AND CAN BE FATAL
Overlap with IV infusion for 1 hour with SC insulin (when converting IV
infusion to SC insulin)
Strength/unit 10% W/V, 10mL
Diluents for NS
infusion Max recommended concentration (peripheral line): 80mmol/L or 6g/L
Max recommended concentration (central line): 150mmol/L or 11g/L

Method of 1) Normal, slow and safe correction of hypokalemia in open wards

correcting 1g KCl should be diluted in 500ml NS and transfused over 2-3 hours in a
hypokalemia peripheral line. (infusion rate not exceeeding 20mmol/hr)
2) Rapid correction of hypokalemia
1g KCl should be diluted in the desired concentration of NS in an infusion
pump through central line at rate of 1 hour or less under continuous
ECG monitoring (in an ICU setting)
Remarks Caution in pt with cardiac disease
Do not administer undiluted or iv push
1g KCL = 13.4mEq KCl
Strength/unit 0.5mg/2ml
Diluents for NS
infusion D5%

Method of 1) Dilution: dilute 0.5mg (1 ampoule) in 50ml for IV infusion

administration 2) Slow infusion is preferred over bolus administration (at least 5
minutes or longer)
3) IV infusion should be given over 10-20 minutes

Remarks Arrhytmias may be precipitated by digoxin toxicity. So, monitoring of

HR is necessary before, during, and after digoxin administration
IM route is not recommended due to painful and a/w muscle
necrosis
Rapid injection is not recommended as it may cause systemic and
coronary arteriolar constriction
Digitalized patient with hypoalcemia should be given IV calcium slowly
and in a small amount to avoid serious arrythmias
Strength/unit 25,000iu/5ml
Diluents for NS
infusion

Method of 1) Dilution: 1 vial diluted with 50ml

administration 2) CONVERSION FROM IU/HOUR TO ML/HOUR
BY DIVIDING WITH 500IU
Eg: from 700IU/hour 1.4ml/hour

MODERATELY HIGH DOSE CAN CAUSE EXCESSIVE INTERNAL BLEEDING

THAT MAY LEAD TO PARALYZING OR LETHAL STROKES
 REFERENCES
Dilution Guide for High Alert Medications,
Pharmaceutical Services Division
Guideline On Safe Use of High Alert
Medication
Injectable Drugs Dilution 2010
Thank You
MEDICATION SAFETY IS EVERYONES
RESPONSIBILITY!

yatiazmir@pharmacy2013
yatiazmir@pharmacy2013