Differences exist in what pharmacists, nurses consider high-alert medications in acute-care settings
Chemotherapy medications, IV insulin, and antithrombotic agents were considered the top 3 high-alert medications for acute-care settings in a recent survey.
The Institute for Safe Medication Practices (ISMP) surveyed 772 pharmacists, nurses, and risk/quality managers between October, 2011, and February, 2012. Compared to ISMP's 2007 survey on high-alert medications, antithromobotics rose from eighth place to third place, and subcutaneous insulin (including pens and pumps) rose to ninth place on the list.
The biggest change was with IV oxytocin: 58% considered it to be a high-alert drug in 2007 and 71% consider it to be high-alert in 2012.
The top medications considered by practitioners to be most risky, in order, are: chemotherapy drugs, IV insulin, antithrombotic agents, epidural or intrathecal medications, potassium chloride injection, neuromuscular blocking agents, anesthetic agents, potassium phosphate injection, subcutaneous insulin, IV adrenergic agonists, and sodium chloride injection greater than 0.9%.
The survey unveiled interesting differences in pharmacists' and nurses' perceptions on high-alert medications. Thirty-two percent more pharmacists than nurses identified sterile water for injection, inhalation, and irrigation as a high-alert drug and 23% more pharmacists said that sodium chloride injection should be a high-alert medication. Pharmacists also were more concerned about methotrexate and IV promethazine than nurses.
"Findings suggest that perhaps pharmacists have greater awareness of the risk of harm associated with errors involving these medications than nurses," Cohen said. For example, pharmacists are concerned about the adverse effects of giving sterile water by itself, without anything dissolved in it.
At the same time, nurses identified adrenergic antagonists 32% more often than pharmacists, and were also more concerned about IV oxytocin, dialysis solutions, IV radiocontrast agents, IV antiarrhythmics, and IV nitroprusside sodium. "With these drugs, nurses may feel more vulnerable to harmful errors, particularly since the pharmacy may not prepare all doses/infusions of these medications, thus requiring nurse preparation," Cohen said.
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