Download HIGH-ALERT MEDICATIONS A. To support safe use of medications

HOSPITAL NAME
Department:
TITLE/DESCRIPTION
INSTITUTIONAL POLICY AND PROCEDURE (IPP)
Manual:
Section:
POLICY NUMBER
REPLACES NUMBER
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HIGH-ALERT MEDICATIONS
EFFECTIVE DATE
REVIEW DUE
APPROVED BY
APPLIES TO
PURPOSE
A. To support safe use of medications.
B. To comply with JCAHO guidelines for medication error reduction.
RESPONSIBILITY
CROSS REFERENCES
Area Specific Pharmacy Policies:
Pharmacy Policy, AS201420-40.01, Storage of Medications in the Pharmacy
POLICY
The following medications have been identified as high alert and are treated with extra precaution in order to
avoid the inadvertent use of these medications in their undiluted forms and to avoid inappropriate dosing and
administration:
A. IV hypertonic Saline (concentrations greater than 0.9%)
B. IV Potassium Chloride (2mEq / ml)
C. IV Potassium Phosphate (3mM / ml)
D. Insulin Drips (0.1 unit / ml, 0.5 units / ml, 1 unit / ml)
E. Neuromuscular Blocking Agents (see chart below)
NEUROMUSCULAR BLOCKING AGENTS
Generic Name
Brand Name(s)
Manufacturer
Atracurium beylate
Tracrium )Hospira)
Cisatracurium besylate
Nimbex
(GlaxoSmithKline)
Doxacurium chloride
Nuromax (Hospira)
Mivacurium chloride
Mivacron (Hospira)
Pancuronium bromide
Formerly Pavulon
(Organon)
Rocuronium bromide
Zemuron (Organon)
Succinylcholine chloride
Anectin
(GlaxoSmithKline)
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Quelicin (Hospira)
Norcuron (Organon)
Vecuronium bromide
PROCEDURE
Storage Precautions:
1. High alert medications are identified by specialty labels, which are placed on all storage locations for
high alert medications within the pharmacy.
2. In off-site clinics as approved by the Clinic Pharmacy, special permission has been granted to store
Sodium Chloride 23.4% based on patient need and clinic location. In these locations, these vials are
quarantined from other stock and a sign out procedure is utilized which requires verification and
signature by two licensed staff members.
3. Neuromuscular blockers are stored on patient care units in separate cubies or carousel drawers in Pyxis
or in a separately labeled container in the refrigerator.
Labeling Precautions
1. Patient specific doses are dispensed with the following high alert labels:
a. A small auxiliary high alert label is placed on the vial which is formatted as follows:
HIGH ALERT
MEDICATION
Double Check Drug
and Strength
b. A high alert label is affixed to the large volume bag or ziplock bag which is formatted as follows:
HIGH ALERT
MEDICATION
Double Check Drug
and Strength
Discard Unused
Contents in Sharps
Container
CAUTION
Guidelines for Patient Specific Dispensing:
1. IV Hypertonic Saline (NACL 23.4% / 30ml) is provided for:
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Standards
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a.
b.
c.
d.
Brain edema unresponsive to other therapies
Treatment of cramping in dialysis patients
Electrolyte replacement in a fluid restricted baby in the NICU (diluted via buretrol)
Cosmetic / Plastic Surgery / Dermatology for vein sclerosing
2. IV Potassium Chloride (KCL 40 mEq / 20 ml) is provided for:
a. OB GYN for selective reduction therapy
b. Issued directly to perfusionists for induction of asystole in cardiac surgical procedures
NOTE: KCL for addition to dialysate is added to dialysate by the pharmacy.
3. IV Potassium Phosphate is not dispensed in concentrated form.
4. Insulin drips are dispensed in concentrations of 1 unit / ml to all adult inpatient areas of the hospital as
ordered by the physician. The Hospital prepares as 0.1 unit / ml, 0.5 units / ml, or 1 unit / ml depending
upon the rate and size of the patient in order to make a titratable drip.
FORMS
EQUIPMENT
REFERENCES
Web References:
National Patient Safety Goals
http://www.joint commission.org/Patient Safety/NationalPatientSafetyGoals/06_npsg_cah.htm
Phillips, Marjorie Shaw, Williams, Roger L. “Improving the safety of neuromuscular blocking agents: A
statement from the USP Safe Medication Use Expert Committee.” Am J Health-Syst Pharm 63 (2006): 139-142.
JCI
Standards
CBAHI
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