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HOSPITAL NAME Department: TITLE/DESCRIPTION INSTITUTIONAL POLICY AND PROCEDURE (IPP) Manual: Section: POLICY NUMBER REPLACES NUMBER NO. OF PAGES 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) JCI Standards CBAHI Page 1 of 3 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: JCI Standards CBAHI Page 2 of 3 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 Page 3 of 3