2. Medication Error
A medication error is any preventable
event that may cause or lead to
inappropriate medication use or patient
harm.
DEFINITION OF MEDICATION ERROR
HIGH ALERT MEDICATION
It can involve any one of the following processes:
Prescribing, Ordering, Dispensing, Distribution, Preparation,
Administration, Labelling, Packaging, Nomenclature,
Communication, Education, Use And Monitoring Of Treatment
3. • High-alert medications are medications that are
most likely to cause SIGNIFICANT HARM to the
patient, even when used as intended.
• Although any medication used improperly can cause
harm, high-alert medications cause harm more
commonly and the harm they produce is likely to be
more serious and leads to patient suffering
and additional costs associated with care of these
patients.
WHAT IS HIGH ALERT MEDICATION
5. COMMON RISK FACTORS
• Poorly written medication orders
• Incorrect dilution procedures
• Confusion between IM, IV, intrathecal, epidural
preparations
• Confusion between strengths of the same medications
• Ambiguous labeling on concentration and total volume
of medications
• Wrong infusion rate
• Look alike or sound alike product and similar
packaging
COMMON RISK FACTORS
6. STRATEGIES TO AVOID ERRORS
INVOLVING HIGH ALERT MEDICATION
All High Alert Medication containers, product packages and loose vials or
ampoules stored must be labeled as ‘HIGH ALERT MEDICATION’
All personnel should read the High Alert Medication labels carefully
before storing to ensure medications are kept at the correct place
All High Alert Medications should be kept in individual labeled containers.
Whenever possible, avoid sound-alike and look-alike drug or different
strengths of the same drug being stored side by side.
Use TALL-man lettering to emphasize differences in medication name
(eg: DOPamine and DOBUTamine)
STRATEGIES TO AVOID ERRORS INVOLVING
HIGH ALERT MEDICATION
9. CON’T:
Do not use abbreviations when prescribing High Alert
Medications
Specify the dose, route, and rate of infusion for High
Alert Medications prescribed (eg: IV Dopamine
5mcg/kg/min over 1 minutes)
Prescribe oral liquid medications with the dose
specified in miligrams
Do not use trailing zero when prescribing (eg: 5.0mg
can be mistaken as 50mg)
STRATEGIES TO AVOID ERRORS INVOLVING
HIGH ALERT MEDICATION
10. CON’T:
The following particulars shall be independently counter checked
against the prescription or medication chart at the bedside by two
appropriate persons before administration:
Patient’s name and RN
Name and strength of medication
Dose
Route and rate
Expiry date
Return all unused medication to pharmacy when no longer
required
Avoid ordering High Alert Medications verbally. In cases of
emergency, phone orders have to be repeated and verified
STRATEGIES TO AVOID ERRORS INVOLVING
HIGH ALERT MEDICATION
11. CON’T:
Closely monitor vital signs, laboratory data,
patient’s response before and after
administration of medication
Keep antidotes and resuscitation equipment
in wards
STRATEGIES TO AVOID ERRORS INVOLVING
HIGH ALERT MEDICATION
12. CON’T:
All personal shall be trained prior to handling
of High Alert Medication and documentation
kept.
Staff must be trained to prevent potential
errors and enable them to response promptly
when mistakes do occur
STRATEGIES TO AVOID ERRORS INVOLVING
HIGH ALERT MEDICATION
13. CON’T:
References or dilution guide should be made
available in the wards
Monitor adverse drug reaction and
medication errors related to High Alert
Medications
STRATEGIES TO AVOID ERRORS INVOLVING
HIGH ALERT MEDICATION
14.
15. Strength/unit 100 units/ml (1000 units/vial)
Diluents for
infusion
NS
Method of
administration
1) Slow IV bolus: administer undiluted solution over 3-5 minutes
2) Continuous IV infusion: dilute 50 units insulin in 50 ml NS ( 1
units/ml)
Remarks Monitor sign and symptoms of hypoglycemia
If hypoglycemia occurs, stop infusion. For conscious patient, give
sweetened drink. For unconscious patient, administer D50% or glucagon.
Check blood glucose after 15 minutes
MAY CAUSE NEUROHYPOGLYCEMIA AND CAN BE FATAL
Overlap with IV infusion for 1 hour with SC insulin (when converting IV
infusion to SC insulin)
16. Strength/unit 10% W/V, 10mL
Diluents for
infusion
NS
Max recommended concentration (peripheral line): 80mmol/L or 6g/L
Max recommended concentration (central line): 150mmol/L or 11g/L
Method of
correcting
hypokalemia
1) Normal, slow and safe correction of hypokalemia in open wards
1g KCl should be diluted in 500ml NS and transfused over 2-3 hours in a
peripheral line. (infusion rate not exceeeding 20mmol/hr)
2) Rapid correction of hypokalemia
1g KCl should be diluted in the desired concentration of NS in an infusion
pump through central line at rate of 1 hour or less under continuous
ECG monitoring (in an ICU setting)
Remarks Caution in pt with cardiac disease
Do not administer undiluted or iv push
1g KCL = 13.4mEq KCl
17. Strength/unit 0.5mg/2ml
Diluents for
infusion
NS
D5%
Method of
administration
1) Dilution: dilute 0.5mg (1 ampoule) in 50ml for IV infusion
2) Slow infusion is preferred over bolus administration (at least 5
minutes or longer)
3) IV infusion should be given over 10-20 minutes
Remarks Arrhytmias may be precipitated by digoxin toxicity. So, monitoring of
HR is necessary before, during, and after digoxin administration
IM route is not recommended due to painful and a/w muscle
necrosis
Rapid injection is not recommended as it may cause systemic and
coronary arteriolar constriction
Digitalized patient with hypoalcemia should be given IV calcium slowly
and in a small amount to avoid serious arrythmias
18. Strength/unit 25,000iu/5ml
Diluents for
infusion
NS
Method of
administration
1) Dilution: 1 vial diluted with 50ml
2) CONVERSION FROM IU/HOUR TO ML/HOUR
BY DIVIDING WITH 500IU
Eg: from 700IU/hour 1.4ml/hour
MODERATELY HIGH DOSE CAN CAUSE EXCESSIVE INTERNAL BLEEDING
THAT MAY LEAD TO PARALYZING OR LETHAL STROKES
19. REFERENCES
• Dilution Guide for High Alert Medications,
Pharmaceutical Services Division
• Guideline On Safe Use of High Alert
Medication
• Injectable Drugs Dilution 2010
