Anesthesia Medication Safety in Relation to Pharmacopeia Medication Use Best Practice Initiatives.

Improvement to anesthesia medication safety is a useful and worthwhile area of research. Anesthesia is one of the few healthcare professions to have immediate access to compounding and label high-hazard medications at the bedside. There is a need to assess the perceptions of anesthesia medication safety and this relationship with pharmacopeia's updated recommendations for anesthesia to improve medication safety and prevent adverse drug events. Certified registered nurse anesthetist (CRNA) perceptions of medication safety climate in Florida were measured utilizing a validated Likert-scale that merged the Attitudes Questionnaire themes of teamwork, climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture themes utilized were organizational learning, error communication, and support for patient safety. The overall email invitations delivered 5,890, 524 participants voluntarily started, and 401 completed the questionnaire resulting in a 77% completion rate. The overall response rate was 8.896% and 6.8% overall completion rate. The findings demonstrate a correlation between themes related to supportive organizational learning, stress reduction, positive changes, and creating anesthesia medication quality improvements. CRNAs' openness in adopting new pharmacopeia best practice recommendations can improve anesthesia medication safety delivery. The survey indicated clinical noteworthiness that supports the importance of additional examination of frontline providers' perceptions regarding anesthesia medication safety, buy-in, and adoption of updated pharmacopeia recommendations.

Assessment of Medication Safety Incidents Associated with High-alert Medication Use in Intensive Care Setting: A Clinical Pharmacist Approach.

Background: High-alert medications (HAMs) potentiate heightened risk of causing patient harm ranging from 0.24 to 89.6 errors per 100 prescriptions. High-alert medications are crucially utilized in the intensive care settings (ICUs) due to their excellent potential in delivering therapeutic efficacy, yet these medications could cause severe harm if used inappropriately. Despite the cautious use of these medications, medication safety issues persist, which compromises patient safety. Methods: A prospective interventional study was conducted in ICUs for a period of 6 months. The HAMs were adopted from the Institute for Safe Medication Practices (ISMP) list of HAMs that were used. A suitably designed medication error assessment form was used to capture the necessary data, including demographics, medications, medication error, and the contributing factors. The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) index was used to categorize the medication errors (MEs). The error rate was calculated using error rate formula. Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were presented in frequencies and percentages. Results: A total of 165 patients were enrolled during the study period, with 98 (59.4%) being male and 67 (40.6%) female. The majority [54 (32.73%)] of the study participants belonged to the 61-70 age range. A total of 204 MEs were reported, of which [92 (41.5%)] errors were prescribing errors, followed by documentation errors [69 (33.82%)] and administration errors [43 (21.08%)]. The baseline medication error rate was noted to be 160.12/1,000 patient days. Potassium chloride, tramadol, propranolol, aspirin, insulin, and metoprolol were identified as the most common HAMs to cause errors. According to NCC MERP classification, 41.18% were categorized as category B, followed by category C (35.78%). An overall of 666 contributing factors (CFs) were identified for 204 errors. Stress (24.32%) was the most common factor that contributed to the MEs, followed by workload (21.47%). Conclusion: While great strides have been adopted in error prevention, yet the goal of making HAM errors "never" event has not been achieved. Thus, an active surveillance by a clinical pharmacist could support the healthcare team in promoting patient care. How to cite this article: Aradhya PJ, Ravi R, Subhash Chandra BJ, Ramesh M, Chalasani SH. Assessment of Medication Safety Incidents Associated with High-alert Medications Use in Intensive Care Setting: A Clinical Pharmacist Approach. Indian J Crit Care Med 2023;27(12):917-922.

Are "High-alert Medication" Used Safely in Intensive Care Units?

How to cite this article: Clerk AM. Are "High-alert Medication" Used Safely in Intensive Care Units? Indian J Crit Care Med 2023;27(12):871-872.

Medicamentos potencialmente perigosos: a expertise dos enfermeiros que atuam em unidade de urgência e emergência / High-alert medications: the expertise of nurses who work in an emergency and emergency unit / Medicamentos potencialmente peligrosos: la experiencia de las enfermeras que trabajan en una unidad de emergencia y emergencia

Objetivo: Identificar o conhecimento dos enfermeiros de um setor de urgência e emergência sobre os medicamentos potencialmente perigosos. Métodos: Estudo descritivo quantitativo desenvolvido com 23 enfermeiros em hospital de nível terciário municipal. Foi aplicado o Questionário de Medicamentos Potencialmente Perigosos. Para a análise dos dados, foi utilizado o software SPSS e foram utilizadas as medidas de tendência central e as medidas de dispersão. Resultados: A média±(DP) do tempo de formação foi 9,7 ± 3,0 anos e o tempo de serviço na instituição obteve média±(DP) 3,9 ± 3,8 anos. A média±(DP) de acertos no domínio 1 foi de 7 ± 1,74 e no domínio 2 foi 6,9 ± 1,55. Muitos profissionais referiram ter alguma dúvida relacionada ao uso de Medicamentos Potencialmente Perigosos. O domínio 2 obteve menor número de acertos quando comparado ao domínio 1. Conclusão: Os enfermeiros possuem conhecimento sobre a temática, pois a média de acertos nos dois domínios foram satisfatórias, mas apresentaram o menor número de acertos quanto ao uso de alguns fármacos, como prometazina e amiodarona. Com isso, reforça-se a importância de capacitar esses profissionais visando a segurança do paciente. (AU)

Objective: To identify the knowledge of nurses in an urgency and emergency sector about potentially dangerous drugs. Methods: Quantitative descriptive study developed with 23 nurses in a municipal tertiary level hospital. The Questionnaire of High-Alert Medicationswas applied. For data analysis, the SPSS software was used and measures of central tendency and dispersion measures were used. Results: The mean ± (SD) time since graduation was 9.7 ± 3.0 years and the length of service at the institution had a mean ± (SD) 3.9 ± 3.8 years. The mean ± (SD) of correct answers in domain 1 was 7 ± 1.74 and in domain 2 its was 6.9 ± 1.55. Many professionals reported having some doubt related to the use of Potentially Dangerous Medicines. Domain 2 had a lower number of correct answers when compared to domain 1. Conclusion: Nurses have knowledge on the subject, as the average of correct answers in the two domains were satisfactory, but they had the lowest number of correct answers regarding the use of some drugs, such as promethazine and amiodarone. With this, the importance of training these professionals is reinforced with a view to patient safety. (AU)

Objetivo: Identificar el conocimiento de los enfermeros en un sector de urgencia y emergencia sobre medicamentos potencialmente peligrosos. Métodos: Estudio descriptivo cuantitativo desarrollado con 23 enfermeras de un hospital municipal de nivel terciario. Se aplicó el Cuestionario de medicamentos potencialmente peligrosos. Para el análisis de los datos se utilizó el software SPSS y se utilizaron medidas de tendencia central y medidas de dispersión. Resultados: El tiempo medio ± (DE) desde la graduación fue de 9,7 ± 3,0 años y el tiempo de servicio en la institución tuvo una media ± (DE) 3,9 ± 3,8 años. La media ± (DE) de respuestas correctas en el dominio 1 fue de 7 ± 1,74 y en el dominio 2 fue de 6,9 ± 1,55. Muchos profesionales informaron tener alguna duda relacionada con el uso de medicamentos potencialmente peligrosos. El dominio 2 tuvo un número menor de respuestas correctas en comparación con el dominio 1. Conclusión: Los enfermeros tienen conocimiento sobre el tema, ya que el promedio de aciertos en los dos dominios fue satisfactorio, pero tuvieron el menor número de aciertos en cuanto al uso de algunos fármacos, como prometazina y amiodarona. Con ello, se refuerza la importancia de formar a estos profesionales con miras a la seguridad del paciente. (AU)

A Fatal Fate: A Medical Error Leading to Acute Methotrexate Toxicity.

Methotrexate is an anti-metabolite, which is commonly utilized as an anti-cancer, anti-rheumatic, and anti-inflammatory drug used to treat a large variety of connective tissue disorders. Methotrexate when consumed at low doses for longer periods usually has a very limited side effect profile, however, accidental ingestion of large methotrexate doses is common which can result in a wide variety of adverse effects and can even result in fatal demise. We, unfortunately, relate the incidence of a 75-year-old female, who unintentionally consumed 200mg of methotrexate instead of methylcobalamin because the pharmacist misunderstood the prescription. The patient presented to the Accident and Emergency (A&E) department of Jinnah Hospital, Karachi, with extensive hemorrhagic oral ulcers, maculopapular dermatitis, and inability to swallow, which further progressed to acute renal insufficiency, neutropenic sepsis, and respiratory distress. The patient was managed with leucovorin rescue therapy, intravenous rehydration, urinary alkalinization, neutropenic protocol, and oxygen support given her respiratory distress, and hemodialysis was arranged for her renal insufficiency. However, despite all these measures the patient met an unfortunate fate and expired. Patients should be given accurate dosage directions, detailed textural information, and audio-visual resources. Additionally, symptoms of toxicity should be explained to all patients. Measures should be taken to minimize such unfortunate events in the future.

Evaluation of knowledge and practices about administration and regulations of high alert medications among hospital pharmacists in Pakistan: findings and implications.

BACKGROUND: A death of a nine months old child in Pakistan following the rapid administration of potassium chloride raised serious concerns on the awareness of appropriate use of high alert medications (HAMs) among healthcare professionals (HCPs). This study aimed to ascertain HAMs-related knowledge among hospital pharmacists in Pakistan. METHODOLOGY: A cross-sectional study using exponential non-discriminative snowball sampling was conducted among hospital pharmacists in healthcare settings in Punjab, Pakistan. A validated study tool was used to determine knowledge on administration, regulation, and practices related to the HAMs. Barriers to conducting HAMs training in the hospitals were assessed from an open-ended question. All quantitative data were analyzed using SPSS 22.0 while the content analysis was performed on the qualitative data. RESULTS: A total of 202 hospital pharmacists were included in the study. The mean knowledge score for HAMs administration and regulation were 5.86 ± 1.89 (95% CI 5.60-6.12) and 7.25 ± 1.70 (95% CI 7.02-7.49), respectively. Approximately half of the respondents (49.5%) achieved scores ≥ 70%, demonstrating sufficient knowledge of HAMs. In the multivariable-adjusted model, increasing age and work experience were found to be the positive predictors of good HAMs knowledge. The mean practice score was 36.42 ± 1.97 (95% CI 34.05-38.77), with 62.4% of pharmacists following good HAMs-related practices. We identified several barriers to conducting HAMs training through qualitative analysis. These barriers included lack of knowledge, poor attitude and behavior of medical and paramedical staff, false beliefs, lack of active support by hospital administration, lack of cooperation between HCPs, lack of opportunities, heavy workload, insufficient human resources, financial constraints, and lack of motivation. CONCLUSIONS: A significant proportion of the hospital pharmacists had unsatisfactory knowledge and practices of HAMs. These findings underscore that training on HAMs should be conducted periodically as a part of hospital-based pharmacy education to maximize drug safety.

Call for Decision Support for High-Alert Medication Administration Among Pediatric Nurses: Findings From a Large, Multicenter, Cross-Sectional Survey in China.

Background: Children have a higher risk of medication errors (MEs) than adults. The Institute for Safe Medication Practice (ISMP) defined high-alert medications (HAMs) as a group of medications that could cause significant patient harm or even death when they are used in error. Nurses are actively involved in and responsible for patient care, especially in medication administration. This study aimed to estimate the knowledge, decision-making basis and confidence and decision support needs related to HAMs among pediatric nurses in China. Methods: A web-based, cross-sectional survey was conducted among pediatric nurses who were recruited from 14 member hospitals of the Pediatric Nursing Alliance of National Children's Medical Center in China using a convenient sampling technique. Data were collected using a self-administered instrument composed of four parts: the demographic characteristics of participants, participants' knowledge about HAMs, participants' self-evaluation of the basis of and confidence in decision-making, and decision support needs regarding HAMs. Among the participants, the maximum score for HAM knowledge was 100. All data were entered and analyzed using SPSS 20.0. Results: A total of 966 nurses participated in this study. Nurses were found to have insufficient knowledge about HAMs, with a median (IQR) of 75.0 (70.0, 80.0), out of a maximum score of 100. Knowledge about HAM administration was significantly higher than that about HAM regulation, with a p value < 0.001. The three lowest-scoring items concerned HAM regulation, and the "Treat fentanyl skin patches as a regulated narcotic" item obtained the lowest score, with only 1/5 of respondents answering it correctly. Most participants reported that their basis for decision-making about HAMs was drug instructions (90.0%) or drug handbooks (81.9%) and evaluated their confidence in decision-making about HAMs as high or relatively high (84.6%). The decision-making difficulties when encountering HAMs focused on most stages of HAM administration, especially the appropriateness of prescriptions, checks, preparation and administration. The vast majority of participants assessed decision support as necessary or very necessary (92.0%), and the most popular options for decision support were computerized clinical decision support systems (46.4%) and real-time online communication with pharmacists (23.9%). Conclusion: Our study demonstrated the inadequacies in HAM knowledge, the basis and difficulty of decision-making, and decision support needs regarding HAMs in Chinese pediatric nurses. Nurses need greater support in HAM administration, including not only training but also adequate technology, mutually beneficial interprofessional collaboration, and a positive institutional culture.

Interrater reliability and ease of use of the High-Alert Medication Stratification Tool‒Revised Prospective (HAMST-R PRO): A prospective, multisite study.

OBJECTIVE: The High-Alert Medication Stratification Tool‒Revised (HAMST-R) was originally designed to standardize the identification of high-alert medications (HAMs) according to safety risk. The primary objective of this multisite study was to assess interrater reliability of the HAMST-R PRO, a version of the tool designed to prospectively evaluate safety risk of medications during evaluation for formulary addition. METHODS: HAMST-R was designed as an objective tool to evaluate HAMs at a single site during the HAMST-R phase I study. Phase II of the study demonstrated the validity of the tool in a multisite, national study. In this third study, 11 medication safety experts from 8 health systems across the United States and 1 in Canada facilitated evaluation of medications prospectively with the HAMST-R PRO during the formulary review process for 27 medications. At each site, at least 5 individuals were asked to review each medication. Interrater reliability was evaluated using Kendall's coefficient of concordance. Ease of use was determined by participant interviews. RESULTS: Overall interrater reliability for HAMST-R PRO was found to be 0.76 (P < 0.001) across all sites, indicating substantial agreement between users. Interrater reliability among individual sites ranged from 0.52 to 0.82 (P < 0.05 for all sites). CONCLUSION: Interrater reliability of HAMST-R PRO is substantial, indicating consistency and agreement among pharmacists utilizing this tool to evaluate safety risk of medications before their addition to a health-system formulary. This information can be used to identify potential interventions for each step of the medication-use process that institutions may implement to decrease a medication's potential safety risk.

Utility of a trigger tool (TRIGGER-CHRON) to detect adverse events associated with high-alert medications in patients with multimorbidity.

OBJECTIVE: To determine the utility of a tool (TRIGGER-CHRON) for identifying adverse drug events (ADEs) associated with the administration of high-alert medications in elderly patients with multimorbidity and to determine the medications most frequently implicated. METHODS: A retrospective observational study was conducted at 12 Spanish hospitals. A random sample of five medical records from each hospital was selected weekly for review over a 12-week period. We included patients aged 65 and over with multimorbidities, hospitalised for >48 hours. ADEs detected by the 32 TRIGGER-CHRON signals and caused by high-alert medications included on the Spanish HAMC list for chronic patients were selected for analysis. Triggers identified and ADEs detected were recorded. The severity and preventability of the ADEs were evaluated. The positive predictive value (PPV) of each trigger was calculated. RESULTS: On 720 charts reviewed, 908 positive triggers were identified that led to the detection of 158 ADEs caused by at least one high-alert medication on the HAMC list. These ADEs occurred in 139 patients (prevalence 19.3/100 admissions). The majority of ADEs were mild and 59.5% were deemed preventable. The drugs most frequently associated with ADEs were corticosteroids, loop diuretics, opioid analgesics and oral anticoagulants. Fifteen triggers had PPVs ≥20%. Six triggers (serum glucose >110 mg/dL, abrupt cessation of medication, oversedation/lethargy, hypotension, adverse reaction recorded and constipation) accounted for 69.8% of the ADEs identified. CONCLUSIONS: Applying the TRIGGER-CHRON to hospitalised patients with multimorbidity in 12 Spanish centres allowed detection of one adverse event caused by a high-alert drug for every four patients, which were preventable in a large proportion of patients. This confirms the need to establish interventions that reduce harm with these medications. We believe that TRIGGER-CHRON can be a useful tool to measure this harm and to determine the effects of medication safety improvement programmes as they are implemented.

Incidence of Respiratory Depression in a Postanesthesia Care Unit in Patients Undergoing Anesthesia Using Opioids.

PURPOSE: To analyze the incidence of respiratory depression (RD) in patients undergoing anesthesia using opioids in a postanesthesia care unit. DESIGN: Retrospective cohort study. METHODS: Quantitative approach, performed by documentary analysis of medical records in the postanesthesia care unit. FINDINGS: A total of 330 patients were included in the study, with a prevalence of female (186; 56.36%) and nonobese patients (295; 89.39%). Five cases of RD in the immediate postoperative period were found, corresponding to an incidence of 1.52%. Each case in this study showed different risk factors related to opioid-induced RD. CONCLUSIONS: Nursing surveillance is essential in the decision-making process regarding the knowledge of physiological, pharmacologic, and risk factors to detect clinical signs of RD.

Serious Inadequacies in High Alert Medication-Related Knowledge Among Pakistani Nurses: Findings of a Large, Multicenter, Cross-sectional Survey.

INTRODUCTION: Deaths-related to medications errors are common in Pakistan but these are not accurately reported. Recently, the death of a 9 months old baby due to abrupt administration of 15% potassium chloride injection sparked the issue of high alert medications (HAMs) related errors in the country. Since drug administration is the prime responsibility of the nurses, it is pivotal that they possess good knowledge of HAMs. Since there is no published data regarding the knowledge of HAMs among Pakistani nurses, we aimed to assess knowledge of HAMs among registered nurses of Pakistan. METHODS: A cross-sectional study was conducted among registered nurses, recruited using a convenient sampling technique, from 29 hospitals all over the Punjab Province. Data were collected using a validated self-administered instrument. All data were entered and analyzed using SPSS version 22. RESULTS: The study sample was comprised of 2,363 registered nurses (staff nurses = 94.8%, head nurses = 5.2%). Around 63% were working in tertiary hospitals whereas almost 25 and 12% were from district headquarter hospitals and tehsil headquarter hospitals, respectively. Around 84% of the study participants achieved scores <70%, indicating majority of Pakistani nurses having poor knowledge of HAMs administration as well as regulation. There was no significant difference of overall knowledge among age, hospitals, departments, training, designations, qualification, and experience categories. Major obstacles encountered during HAMs administration were "getting uncertain answers from colleagues" (72.9%), "unavailability of suitable person to consult" (61.1%) and "receiving verbal orders" (55.6%). CONCLUSION: Our study revealed the serious inadequacies in HAMs knowledge among Pakistani nurses which may lead to adverse patient outcomes. Nurses should receive comprehensive pharmacology knowledge not only during in-school nursing education but also as hospital-based continuing education. Moreover, it is of immense importance to bridge the gaps between physicians, clinical pharmacists, and nurses through effective communication as this will help reduce medication errors and improve patient care.

Nurses' perceptions of high-alert medication administration safety: A qualitative descriptive study.

AIMS: The aim of this study was to determine nurses' perceptions of supports and barriers to high-alert medication (HAM) administration safety. DESIGN: A qualitative descriptive design was used. METHODS: Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one-on-one interviews from July-September, 2017. Content analysis was conducted for data analysis. RESULTS: Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra- and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety. CONCLUSIONS: Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors. IMPACT: Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra- and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.

Knowledge about the administration and regulation of high alert medications among nurses in Palestine: a cross-sectional study.

BACKGROUND: Medication errors (MEs) are unintended failures in the drug treatment process that can occur during prescription, dispensing, storing, preparation or administration of medications. High alert medications (HAMs) are defined as those medications that bear the highest risk of causing significant patient harm when used incorrectly, either due to their serious adverse events or to a narrow therapeutic window. Nurses are responsible for administration of HAMs; incorrect administration can have a significant clinical outcome. This study aimed to assess the level of knowledge of HAMs among nurses in government hospitals in West Bank, Palestine. METHODS: A cross-sectional study was conducted in 2015, in West Bank, Palestine. Data were collected via a face to face interview questionnaire, which was taken from a previous study. Data were collected by convenient sampling. The questionnaire consisted of four parts: demographic characteristics of the nurses, drug administration knowledge (10 true-false questions), drug regulation knowledge (10 true-false questions), and self-evaluation. RESULTS: A total of 280 nurses participated in the study; these nurses were working in the emergency room (ER), intensive care unit (ICU), paediatric or medical ward. The response rate was 93%. Nurses were found to have insufficient knowledge about HAMs; 67.1% of participants had a score of less than 70%, with a mean total score of 59.9 ± 15.1. Factors associated with sufficient knowledge among nurses were HAMs training and ICU training, both with p-values of 0.002. Nurses with a master degree, those working in the ICU ward, head nurses, and male nurses were the most knowledgeable groups, with a p-values < 0.001. 81.8% of respondents hoped to obtain additional training. The leading obstacles reported were inconsistent opinions between doctors and nurses (37.9%), and no established standard operating procedure for HAMs (37.1%). CONCLUSIONS: Lack of knowledge was one of the obstacles that nurses encountered during administration of HAMs which might result in MEs. Nurses reported that they would like to have additional training to update their pharmacology knowledge. Nurses could benefit from additional continuing education and training programs.

High-alert medication administration and intravenous smart pumps: A descriptive analysis of clinical practice.

BACKGROUND: The Institute for Safe Medication Practices (ISMP) describes high alert medications (HAM) as medications that represent a heightened risk of patient harm when used in error. IV smart pumps with dose error reduction systems (DERS) were created to help address medication administration errors. Compliance with DERS provides a measure of how accurately a hospital uses smart pump technology to reduce IV medication error. OBJECTIVE: The primary purpose of this research was to use the REMEDI dataset, an aggregate, multi-hospital database inclusive of smart pump analytics, to improve the current understanding of clinical practices for IV HAM administration. METHODS: Descriptive analyses and analysis of variance (ANOVA) were used to test for differences in the mean DERS alert override rate, and mean DERS alert override to reprogram ratio between non-HAM and HAM overall, by hospital system, and by pump type. RESULTS: High mean override rates for non-HAM (73.8%) and HAM (75.8%) and high override to reprogram ratios for both non-HAM (7.30) and HAM (9.92) were seen. No significant differences were found in override rates (p = 0.23) and override to reprogram ratios (p = 0.06) between non-HAM and HAM. By hospital system, significant variability in override rates and override to reprogram ratios were seen. By pump type, there were no significant differences in the mean override rates (Baxter: p = 0.09; BD p = 0.34; ICU Medical p = 0.18) and the mean override to reprogram ratios (Baxter p = 0.84; BD p = 0.03; ICU Medical p = 0.63) between non-HAM and HAM. CONCLUSIONS: These findings indicate that the majority of alerts generated are bypassed by clinicians at the point of care, a symptom of alert fatigue. Given the potential for significant patient harm with HAM and the high DERS alert override rates that routinely occur during IV medication administration, this study provides further support for clinician-driven IV smart pump innovation to improve alert fatigue.

Medication reconciliation and review for older emergency patients requires improvement in Finland.

BACKGROUND: 10-30% of hospital stays by older patients are drug-related. The admission phase is important for identifying drug-related problems, but taking an incorrect medication history often leads to medication errors. OBJECTIVES: To enhance medication history recording and identify drug-related problems (DRPs) of older patients admitted to emergency departments (EDs). METHODS: DRPs were identified by pharmacists-led medication reconciliation and review procedures in two EDs in Finland; Helsinki University Hospital (HUS), and Kuopio University Hospital (KUH). One-hundred-and-fifty patients aged ≥65-years, living at home and using ≥6 medicines were studied. RESULTS: 100% of patients (N = 75) in HUS and 99% in KUH (N = 75), had discrepancies in their admission-medication chart recorded by the nurse or physician. Associations between admission-diagnosis and drug-related problems were found in 12 patients (16%) in HUS and 22 patients (29%) in KUH. Of these, high-alert medications (e.g. antithrombotics, cytostatics, opioids) were linked to eight patients (11%) in HUS and six patients (8%) in KUH. Other acute DRPs were identified in 19 patients (25%) in HUS and 54 patients (72%) in KUH. Furthermore, 67 patients (89%) in HUS and all patients in KUH had non-acute DRPs. CONCLUSIONS: Medication reconciliation and review at admission of older ED patients requires improvement in Finland.

High alert medications administration errors in neonatal intensive care unit: A pediatric tertiary hospital experience.

Labib JR, Youssef MRL, Abd El Fatah SAM. High alert medications administration errors in neonatal intensive care unit: A pediatric tertiary hospital experience. Turk J Pediatr 2018; 60: 277-285. Labib JR, Youssef MRL, Abd El Fatah SAM. High alert medications administration errors in neonatal intensive care unit: A pediatric tertiary hospital experience. Turk J Pediatr 2018; 60: 277-285. This is a hospital-based descriptive cross sectional study, implemented in the NICU, at Cairo University Pediatric hospital. A convenient sample of 33 bedside NICU nurses, who agreed to participate was recruited. A valid, reliable questionnaire was used to measure NICU nurses' general and specific knowledge regarding five therapeutic HAM. An observational checklist was used to assess nurses' administration practices. Both revealed that the mean percentage score of the nurses' knowledge (76.2±11.6) was higher than the mean percentage score of their total practice (69.1±13.3). Analysis of types of nurses' errors, showed that the most common error type was the wrong dose (15%), followed by wrong drug type (13.6%). Nurses' knowledge and training are not mandatorily interpreted into improved implementation practices. Interventions highlighted for preventing HAM errors were developing specific training on HAM for nurses and establishing neonate centered, multidisciplinary teams formed of physicians, nurses, and pharmacists.

Investigation and analysis on recognition of high-alert medications of physician's advice among clinical nurses from grade three and first-class hospital in chongqing / 中国实用护理杂志

Objective To investigate the recognition of physicians′ advice about high-alert medications among clinical nurses from grade three and first-class hospitals in Chongqing and to analyse the relevant training requirements. Methods Using a multistage stratified cluster sampling strategy, the physicians′ advice recognition questionnaire of High- alert medications for clinical nurses was administered to 3029 nurses in eight hospitals, to test the nurses′ advice recognition of high-alert medication and collecte training suggestions. Results More than 82.70％(1946/2353) of nurses responded correctly for 8 out of the 12 questions, the accuracy rate of pethidine hydrochloride injection test was 97.11％(2285/2353) and the dopamine hydrochloride injection test was only 28.56％(672/2353). The nurses′ recognition of physicians′ advice of high-alert medications in gender, department, working time and annual income was statistically significant (P<0.10). 81.34％(1914/2353) of the nurses were able to recognize 11 out of the total 24 wrong advices. Pre-job training、theoretical knowledge related to physicians′advice and case-based learning are the best training time, content and form. Conclusions The recognition level of high-alert medications by clinical nurses from grade three and first-class hospitals in Chongqing was not high and the clinical nurses with different gender, department, working time and annual income had different abilities, the targeted training for clinical nurses should be provided.

Administering and monitoring high-alert medications in acute care.

The nurse's primary role in the medication process is to ensure that drugs are administered safely to patients, thus reducing the risk of unnecessary harm or injury. High-alert medications are a particular concern for healthcare professionals, since they are associated with an increased risk of causing patient harm. This article identifies high-risk medications and outlines measures that can be used to prevent potential harm to patients as a result of these medications, including computerised provider order entry, Tall Man lettering, order sets, independent double-checks and proactive patient monitoring.

Analysis of the Application Effects of High-alert Medications Management Review and Evaluation System Based on Tracer Methodology / 中国药房

OBJECTIVE:To explore the application and feasibility of tracer methodology in the continuous improvement of high-alert medications management in the hospital,and to improve the quality of high-alert medications management and ensure the safety of clinical medication. METHODS:According to the theory and requirements of tracer methodology,a series of interven-tions were applied to the management of high-alert medications in our hospital. The comparisons on the mastery of high-alert medi-cations knowledge,review and evaluation results and the incidence of adverse events were conducted before and after applying trac-er methodology,so as to evaluate the improvement effect of tracer methodology on high-alert medications management. RESULTS:After implementing intervention measures such as the reduction of high-alert medications list and medical staff training about high-alert medications,compared to before management,medical staffs had improved the knowledge level of high-alert medica-tions (the average awareness rate increased from 69.6% to 88.5%);the review and evaluation results had been improved signifi-cantly (the proportion of the terms with qualified level evaluation results or above increased from 66.67% to 88.89%);the inci-dence of adverse events was reduced(from 0.321% to 0.139%). CONCLUSIONS:The tracer methodology has a significant effect on the management of high-alert medications in our hospital. It is feasible and can be widely used in the management of high-alert medications in the hospitals.

Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital.

BACKGROUND: High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. METHOD: Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. RESULTS: The majority of respondents identified the organization's high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. CONCLUSIONS: This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies.