Safety of High Alert Medication (1)

8/16/2019 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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Documents

Safety of High Alert Medication (1)