When a person is admitted to the hospital due to a disease, illness, or injury there is a reasonable expectation that if medication is needed it will be appropriate for the individual’s specific condition and prescribed at a safe dosage. However, mistakes involving medications are among one of the most common healthcare errors resulting in longer hospital stays, increased healthcare costs, and even death in the most severe cases.1The Institute of Medicine Committee on Identifying and Preventing Medication Errors has estimated that at least 1.5 million preventableadverse drug events occur each year in the United States. This post will identify and explain high-alert medications, as well as outline the general prevention methods hospitals should be following in order to reduce medication errors.
Identifying High-Alert Medications
The degree of potential harm caused to an individual as a result of a medication error can vary depending on the class of medication prescribed. The Institute for Safe Medicine Practices has identified a select group of drugs referred to as high-alert medications (HAMs) that are frequently associated with a higher incidence of devastating patient effects, even when used as intended.2The Joint Commission describes these high-alert medications as “Medications that bear a heightened risk of significant harm to individuals when they are used in error.”3
Four drug classes contained in the high-alert medications list include anticoagulants, sedatives, insulin, and opioids. It is important to note that not only are these medications considered high-risk, but they are also some of the more commonly prescribed medications in inpatient hospital settings.4The most prevalent forms of harm associated with these medications involve bleeding, delirium, low blood pressure, low blood sugar, and slowed heart rate.2
Errors in Medication Administration
Incorrect administration of these drugs can occur in various ways. For instance, the wrong medication or wrong dosage of the medication could be given. If a healthcare professional does not conduct a thorough review of the patient’s medical charts the patient could also be administered a drug that he/she is allergic to. Additionally, failure to adjust for drug-drug interactions may also result in placing a patient at risk for a preventable adverse drug event.1,2,5
Prevention Strategies to Reduce Harm
General prevention practices that hospitals and other healthcare settings should adhere to in order to prevent the incidence of medication errors include: designing medication management practices to prevent errors and harm from occurring, developing methods to quickly identify errors when they occur, and establishing procedures to mitigate harm.2Additionally, healthcare providers ought to discuss potential side effects and other information regarding the medications being prescribed with the patient or their power of attorney.
Knowledge of the high-alert medications can assist you in identifying if a preventable medication error has occurred for a client, or if a client has been wrongly accused of committing a medication error for which they followed the standard prevention methods set forth by the hospital. As mentioned previously in this post not all adverse drug events that occur are due to preventable medication errors. However, patient harm and healthcare spending could both be reduced through implementation and increased hospital adherence to medication management practices.
In the next blog post, specific medication management practices to reduce the occurrence of high-alert medication errors will be discussed in further detail.
- Anderson P, Townsend T. Preventing high-alert medication errors in hospital patients. Am Nurse Today. 2015;10(5). https://www.americannursetoday.com/wp-content/uploads/2015/05/ant5-CE-421.pdf. Published May, 2015. Accessed October 4, 2018.
- How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: Institute for Healthcare Improvement; 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx. Accessed October 7, 2018.
- The joint commission e-dition. https://e-dition.jcrinc.com/Frame.aspx. Accessed October 7, 2018.
- ISMP list of high-alert medications in acute care settings. ismp.org. https://www.ismp.org/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf. Updated August 23, 2018. Accessed October 7, 2018.
- Medication errors and adverse drug events. Psnet.ahrq.gov. https://psnet.ahrq.gov/primers/primer/23/Medication-Errors-and-Adverse-Drug-Events. Updated August 2018. Accessed October 7, 2018.