Definition

High-Risk Medications (HRM) can be defined as those which have a heightened risk of causing significant or catastrophic harm when used in error.

Types of high-risk medications

This includes:

1) Medicines with a low therapeutic index
2) Medicines that present a high risk when administered via the wrong route or when other systems errors occur

Medical safety alerts

Medication safety alerts are issued in response to reported incidents or for medicines with known high risks. Medication safety alerts advise action to prevent future adverse medicine events or to lessen the risk of such events.

The aim of alerts is to:

• Warn healthcare professionals about serious known medication risks;
• Outline the action required to minimise risks;
• Provide tools to minimise risk.

How to minimize risk?

To minimize the risk include strategies such as:

• improving access to information about these drugs;
• limiting access to High-Risk medications;
• standardizing the ordering, storage, preparation, administration and monitoring of these products;
• Employing redundancies such as automated or independent double checks when necessary.
• Eventual promotion of using Tallman lettering, using auxiliary labels & automated alerts.

Steps for the inclusion of high-risk medicines in the formulary

• New formulary medications & additional relevant safety information will be reviewed for inclusion on the High-risk Medication list by the Pharmacy and Therapeutics committee.
• Medications that the Pharmacy and Therapeutics Committee (P&T) has deemed to be High Risk or High-Alert include the following category list :

1. Drugs with a narrow therapeutic index
2. Cytotoxic agents
3. Heparin infusions
4. Insulin – both continuous infusions and subcutaneous doses
5. Narcotic drugs.
6. Anticoagulants (anti-thrombotic drugs)
7. Psychotropic substances
8. Look-Alike and Sound-Alike Medication
9. Drugs used in acute conditions eg- Electrolytes, Plasma Expanders, Human Albumin etc.
10. Drugs with greater drug-drug interaction potential

• Subsequently, a list of high-risk medicines is prepared & updated by the Pharmacy & Therapeutics Committee.
• This list is circulated among all the areas where medicines are stored, dispensed and administered, which includes Pharmacy, In-Patient units, Drug mixing rooms Therapeutic units and Operating Rooms.
• These medicines are prescribed by qualified personnel only. E.g. Chemotherapy drugs only by the Oncologists.
• Prior to dispensing, the medicines are crosschecked by the pharmacist. In case of any doubt, the doctor who has written the prescription shall be contacted.
• Report to the PTC if any ADR is suspected.
• Avoid unapproved abbreviations in medication orders.

Note: Preventing harm from high-risk medications is not just dependent on order and dispensing accuracy. Improved medication management & rapid identification of adverse drug events is necessary to minimize serious patient harm.