Joint Commission IDs five high-alert medsFive high-risk medications frequently result in harm to patients, according to a new bulletin released by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. Both the Joint Commission and the Huntingdon Valley, PA-based Institute for Safe Medication Practices (ISMP) have identified similar problems with medications. 1The Joint Commission began tracking sentinel events in 1995, reviewing 89 cases related to medication errors so far. The findings are presented in a Joint Commission Sentinel Event Alert about medication errors.
High Alert Medications. Per organizational policy MM02 High Alert Medications, the following medications and medication classes have been identified as being high alert at Nebraska Medicine. Antithrombotics and specific anticoagulant agents. Insulin. Adrenergic agonists and inotropic agents. Anesthetic and sedative agents. High Alert Meds as Designated Most Often by Healthcare Facilities. The MOST highly-ranked high-alert medications as designated by the facilities of the respondents to the 2007 ISMP survey were: Medication.% of Respondents’ Facilities Identifying as High-Alert Chemotherapeutic agents, parenteral 90% Insulin, IV 88%.
(See source box at right for information on how to obtain a copy of the bulletin.)Another study backs resultsSimilar findings were found in an ISMP study, the 1996 Benchmarking Project, which culled data on serious medication errors from 161 health care organizations. That report showed that a majority of medication errors resulting in death or serious injury were caused by a specific list of medications. The five 'high-alert medications' are as follows:1.
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Opiates and narcotics;3. Injectable potassium chloride (or phosphate) concentrate;4. Intravenous anticoagulants (heparin);5. Sodium chloride solutions above 0.9%.Both organizations found that those five medications — combined with certain situations — repeatedly resulted in errors, producing poor outcomes for patients. The errors could be avoided by implementing specific practices, according to the bulletin. (See chart, 'High-alert Medications and Patient Safety,' p.