List Of High-alert Medications Research Articles

국내 지역사회/일차의료 고위험의약품 목록 도출

Despite the fact that a considerable number of preventable adverse events are managed in primary care settings, medication-related risks have been evaluated mainly through hospital admissions. While interest in high-alert medication management in the community and primary care settings is increasing internationally, Korea does not have accreditation for the same and lacks established standards for high-alert medications. Therefore, this study aimed to develop a nationallevel list of high-alert medications for community and primary care. The candidates for the high-alert medication list included medications recommended by Institute for Safe Medication Practices and those suggested by each guideline of the World Health Organization, Japan and Korea. We analyzed the adverse events related to medication errors reported by the patients' safety reporting system. Seven experts working in the community and primary care settings evaluated the adequacy and priority of the candidate medications. The final list included 20 high-alert medications, including nine essential and eleven optional medications. The national-level list of high-alert medications which we developed may be useful in formulating accreditation guidelines or treatment standards for community and primary care patients.

High-alert medications for hospitalised paediatric patients - a two-step survey among paediatric clinical expert pharmacists in Germany.

Paediatric patients are more vulnerable to be harmed by medication errors compared to adults due to pharmacokinetic and pharmacodynamic changes in their development, individual dosing calculations, and manipulation of ready to-use products intended for adult patients. According to the Institute of Safe Medication Practices, there are some "drugs that bear a heightened risk of causing significant patient harm when they are used in error"; these drugs are called high-alert medications (HAM). The two-step survey among paediatric clinical expert pharmacists presented here aimed to compile a nation-wide HAM list. To provide detailed guidance, this survey followed a drugbased approach, resulting in specific potential drug related problems (DRPs) and associated recommendations for prevention. In contrast to this approach, in the first round of the survey two drug classes were included that both were rated as HAM (i.e.chemotherapy and parenteral nutrition). Twenty single drugs were identified as HAM, 65% of which were cardiovascular or neurological drugs. The paediatric expert pharmacists mentioned in total 216 potential DRPs; in particular, they identified potential administration-related problems (28% of all DRPs), dosing-related problems (26%), and drug-choice-related problems (18%, e.g.drug confusion and drug monitoring). Moreover, they suggested 275 potential interventions to address these DRPs. Two thirds of all interventions dealt with the preparation by the hospital pharmacy, standardisation of processes (e.g.labelling), and education or training. In conclusion, this survey provided a German paediatric high-alert medication list from a paediatric pharmacist point of view. Moreover, the experts mentioned for the first time specific potential DRPs and associated interventions to guide a local multidisciplinary approach for preventing medication-related harm in children.

P25 Incidents involving paediatric parenteral nutrition

AimParenteral nutrition (PN) is one of the medications most frequently reported to be involved in medication errors in hospital.1 PN is a class of high alert medications listed by The Institute for Safe Medication Practices.2 Medication errors involving PN may have potentially serious consequences especially in infants.3 The purpose of this study was to determine the type of incidents reported, who reported it, severity of incidents and the part of the process involved in the error with the aim of ensuring quality and safety in PN processes.MethodThe incidents involving PN reported on the Ulysses system in a specialist children’s hospital were surveyed between April 2018 and March 2019. Incidents were assigned to different error-type categories. We focused on the whole process of prescribing, transcription, preparation, and administration of PN. Severity classification was based on the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index.4ResultsThere were 34 incidents involving PN ranging from 1 to 8 per month. Job titles who reported these incidents were nurses (16 incidents), pharmacists (14 incidents), dieticians (2 incidents) and unknown (2 incidents). The most common types of incidents were omitted medicine/dose (7 incidents), labelling error (6 incidents), wrong quantity supplied (4 incidents) and wrong/unclear dose (4 incidents). The processes during which the incident had occurred were administration/supply of a medicine (14 incidents), preparation of medicines/dispensing in a pharmacy (13 incidents) and prescribing (7 incidents). The majority of incidents (82.4%, 28/34) were assigned category C (no harmful consequences), while 14.7% (5/34) and 2.9% (1/34) were assigned to category B (an error occurred but the error did not reach the patient) and category D (an error occurred that reached the patient and required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude harm) respectively. The following actions have been taken to try to prevent error with PN: training, providing information, introduction of new labels, changes to the profiles on infusion pumps, reinforcing independent checking and the increased use of standard PN solutions.ConclusionNurses and pharmacists are the main reporters of incidents of PN. Omitted medicine/dose is the most common incident reported. The majority of errors involved administration of PN. The majority of all incidents did not cause harm to patients.ReferencesRinke ML, Bundy DG, Velasquez CA, et al. Interventions to reduce pediatric medication errors: a systematic review[J]. Pediatrics, 2014, 134(2):338–60.Institute for Safe Medication Practices. ISMP List of High-Alert Medications in Acute Care Settings. Horsham, PA. Available from: http://www.ismp.org/Tools/institutionalhighAlert.asp (accessed January 15, 2017)NHS/PSA/W/2017/005,Risk of severe harm and death from infusing total parenteral nutrition too rapidly in babies. Available from: https://improvement.nhs.uk/news-alerts/infusing-total-parenteral-nutrition-too-rapidly-in-babies/National Coordinating Council for Medication Error Reporting and Prevention. NCC MERP Index for Categorizing Medication Errors. Available from http://www.nccmerp.org/sites/default/files/indexColor2001-06-12.pdf (accessed March 10, 2017)

The Impact of Telepharmacy Services on the Identification of Medication Discrepancies, High-Alert Medications, and Cost Avoidance at Rural Healthcare Institutions

Telepharmacy, remote reviewing and profiling of medication orders by an offsite pharmacist, has been shown to be an effective method for reducing medication order inaccuracy rates, but there is a lack in studies examining harm reduction and potential cost avoidance by such services. Methods: Retrospective data, collected over a one-year period, were examined for medication order deficiencies; a deficiency was defined as the telepharmacist being required to advocate for clinical action. Based on published rates of adverse drug reactions and expenses related to their treatment, a potential cost avoidance was calculated. Results: Over the course of the one-year study period over 218,000 orders were reviewed by a telepharmacist with 2,292 orders flagged as deficient which included 16,224 individual medication deficiencies. The most common deficiencies included patient allergy to medication, or class of medications, (31.2% of deficiencies) and medication dose adjustment via renal and/or hepatic guidelines (24.1% of deficiencies). There were also a number of deficiencies for specific medications found on the Institute for Safe Medication Practices’ high-alert medication list for ambulatory/community healthcare settings such as insulins and heparinoids. Based on adverse drug reaction incidence rates and treatment expenses, potential cost avoidance was calculated to be as high as over $1.4 million US dollars. Telepharmacists aided in enhancement of pharmacy services by continuing to review medication orders and provide clinical interventions even when an onsite pharmacist was unavailable. Conclusions: Use of the telepharmacist service provided a large cost avoidance by the prevention of potential adverse drug reactions.

Medication Use by Alternate Level of Care Patients: A Descriptive Analysis

The population of patients designated as alternate level of care (ALC) consists predominantly of frail older adults who are medically stable and awaiting discharge from hospital. They have complex medication regimens, often including potentially inappropriate medications (PIMs). There has been increasing emphasis on managing the burden that ALC patients place on the health care system, but little is known about their health care needs. To characterize the medication regimens, including use of PIMs, of ALC patients at the study institution. A cross-sectional chart audit of ALC patients was conducted between May and July 2017. For all patients in the sample, each medication was categorized by therapeutic class, and PIMs were categorized according to the Beers criteria, the STOPP/START criteria, and an established list of high-alert medications. A total of 82 patients met the audit criteria, for whom the mean number of chronic conditions was 6.4 (standard deviation [SD] 3.3) and the mean number of prescribed medications was 12.8 (SD 6.9). Twenty-four (29%) of the patients were receiving at least 1 drug from 7 different drug classes. All but one of the patients had PIMs in their regimen; the frequency of PIMs was highest according to the Beers criteria (mean 3.9 [SD 2.6] medications per patient). At the study institution, ALC patients had on average more than 6 chronic conditions managed with at least 12 medications, of which one-quarter were PIMs. These data will be used to inform next steps in making recommendations to simplify, reduce, or discontinue medications for which there is an unclear indication, lack of effectiveness, or evidence of potential harm.

Utilizing a two nurse timeout process to eliminate errors during chemotherapy administration.

237 Background: Chemotherapeutic agents are listed as high risk medications at Cleveland Clinic, and have long been included on the Institute for Safe Medication Practices (ISMP) List of High Alert Medications due to the heightened risk of causing significant patient harm if they are used in error. Following a series of significant adverse events involving chemotherapy administration in 2012 at Cleveland Clinic, a two nurse timeout process (modeled after surgical and procedural timeout practices) was established to eliminate interruptions and decrease the risk of error. Methods: A written protocol was established to formalize a two nurse timeout process which must be completed prior to administration of chemotherapy. In order to eliminate unnecessary distractions during order review and medication administration, nurses hand off their phone and/or pager and coverage is provided for the nurses who are checking in the chemotherapy. A designated distraction-free area is utilized chemotherapy verification and order review. Following comparison of the chemotherapy agents to the orders, the nurses proceed to the patient’s room with the chemotherapy and the order pulled up on a computer. A procedure stop sign is placed on the door and the door is closed to eliminate interruptions. During the in-room timeout process, each step in the chemotherapy documentation flow sheet is reviewed by both nurses. After proper patient identification, one nurse will read the chemotherapeutic agent label and the other nurse will program the infusion pump. The two nurses will then switch roles with re-verification of the label and the infusion pump. The tubing set-up is then verified and the infusion is initiated. Results: Since the two nurse timeout process was established in 2013, there have been zero serious chemotherapy errors resulting in patient harm. Conclusions: Results have shown that implementation of the chemotherapy timeout process has increased the safety of administration of chemotherapeutic agents. It has now been more than five years since the last significant adverse event involving chemotherapy has occurred at Cleveland Clinic.

How to Identify Organizational High-Alert Medications.

High-alert medications may cause significant patient harm when used in error. Hospital-specific safety data should be used to customize high-alert medication lists to fit the local context. The aim of this study was to identify organizational high-alert medications by evaluating university hospital's data on adverse drug reaction (ADR) and medication error (ME). The Anatomical Therapeutic Chemical (ATC) codes and top active substances in ADR (n = 401) and ME (n = 11,668) reports of Helsinki University Hospital from 2015-2016 were analyzed and compared with hospitals' drug consumption and the Institute for Safe Medication Practices' (ISMP) list of high-alert medications. The top ATC groups and active substances in ADR and ME reports were not similar. The most numerous ATC groups were L, antineoplastic and immunomodulating agents (30%) in ADRs and N, nervous system (26%) in MEs. According to ADR and ME reports, several high-alert medications from Institute for Safe Medication Practices' lists, such as antineoplastic agents, antithrombotics, opioids, and insulins, should be considered high-alert medications also in Helsinki University Hospital. Although no ADR reports of amphotericin B existed, it had the highest number of MEs causing severe/moderate harm or unexpected reactions relative to its consumption. To identify organizational high-alert medications, both drug safety information and medication safety information should be used. Adverse drug reaction and ME data are needed to recognize high-alert medications, but these should also be combined with a literature search and local expert opinions.

Identifying High-alert Medications in a University Hospital by Applying Data From the Medication Error Reporting System.

To facilitate safe use of high-alert medications, lists of medications posing higher risks for medication errors (MEs) and harmful effects have been compiled. These lists can be general or reflect clinical practices in specific settings. Less common has been to compile a hospital-specific list applying data from the organization's ME reporting system. Our objective was to demonstrate a method for compiling such a high-alert medication list in a university hospital. Of the eighteen 136 MEs reported during 2007 to 2013, ME reports with medications coded as a contributing factor to the incident were included (n = 249). The involved medications were identified and compared with the hospital's drug consumption and Institute for Safe Medication Practice's List of High-Alert Medications. The report narratives of MEs with most reported and high-alert medications (120 reports) were qualitatively content analyzed. The included 249 reports concerned 280 medications, of which 33% were classified as high-alert medications by the Institute for Safe Medication Practice. The most common therapeutic groups were antibacterials for systemic use (13%), psycholeptics (10%), analgesics (9%), and antithrombotic agents (9%). The most common high-alert medications were oxycodone (5%), enoxaparin (3%), and noradrenaline (3%). Serious patient harm (3%) was related to cefuroxime, enoxaparin, ibuprofen, midazolam, propofol, and warfarin. A half of the MEs were related to parenteral preparations. The qualitative content analysis revealed the key process safety risks of the most reported and high-alert medications. The method is applicable for compiling a hospital-specific high-alert medication list and related analysis of key process safety risks contributing to MEs.

High-alert medications in a French paediatric university hospital.

High-alert medications (HAMs) are medications that are associated with a high risk of serious harm if used improperly. The objective of this study was to identify paediatric HAM used in our institution and to identify safety measures for their use. The list of HAM and the list of safety measures that were introduced in our department were based on (1) a literature search; (2) a survey of health care professionals in our department including doctors, head nurses, nurses and pharmacists; and (3) the drug steering committee. We found four lists of HAM based on a literature search, including 27 classes of pharmaceutical agents, and 63 common drug names. The response rate of the survey was 20.7% (230 of 1113). Some of the HAMs included in our list were not identified by the literature search. These included neuroleptic drugs, anti-malarial agents, antiviral agents, anti-retroviral agents and intravenous acetaminophen. The drug steering committee selected 17 HAM and highlighted 53 safety measures involving seven broad aspects of pharmacological management. This project was part of the new safety strategies developed in a paediatric hospital. We set out to make a list of HAM relevant to paediatrics with additional safety measures to prevent medication errors associated and a 'joker' system. The various safety measures, such as double-checking of HAM prescriptions, should be reviewed during the year following their implementation. This list, which was developed in our hospital specifically for use in paediatrics, can be adapted for use in other paediatric departments.

Factors associated with medication warning acceptance for hospitalized adults

Computerized provider order entry (CPOE) systems can warn clinicians ordering medications about potential allergic or adverse reactions, duplicate therapy, and interactions with other medications. Clinicians frequently override these warnings. Understanding the factors associated with warning acceptance should guide revisions to these systems. Increase understanding of the factors associated with medication warning acceptance. Retrospective study of all single-medication warnings generated in a CPOE system from October 2009 through April 2010. Academic medical center. All adult non-intensive care unit patients hospitalized during the study period. A total of 40,391 medication orders generated a single-medication warning during the 7-month study period. Of these warnings, 47% were duplicate warnings, 47% interaction warnings, 6% allergy warnings, 0.1% adverse reaction warnings, and 9.8% were repeated for the same patient, medication, and provider. Only 4% of warnings were accepted. In multivariate analysis, warning acceptance was positively associated with male patient gender, admission to a service other than internal medicine, caregiver status other than resident, parenteral medications, lower numbers of warnings, and allergy or adverse reaction warning types. Older patient age, longer length of stay, inclusion on the Institute for Safe Medication Practice's List of High Alert Medications, and interaction warning type were all negatively associated with warning acceptance. Medication warnings are rarely accepted. Acceptance is more likely when the warning is infrequently encountered, and least likely when it is potentially most important. Warning systems should be redesigned to increase their effectiveness for the sickest patients, the least experienced physicians, and the medications with the greatest potential to cause harm.

Developing a list of high-alert medications for patients with chronic diseases

BackgroundPatients with chronic diseases often receive multiple medications and are associated with increased vulnerability to medication errors. Identifying high-alert medications for them would help to prioritize the interventions with greatest impact for improving medication safety. The aim of this study was to develop a list of high-alert medications for patients with chronic illnesses (HAMC list) that would prove useful to the Spanish National Health Service strategies on chronicity. MethodsThe RAND/UCLA appropriateness method was used. Drug classes/drugs candidates to be included on the HAMC list were identified from a literature search in MedLine, bulletins issued by patient safety organizations, incidents recorded in Spanish incident reporting systems, and previous lists. Eighteen experts in patient/medication safety or in chronic diseases scored candidate drugs for appropriateness according to three criteria (evidence, benefit and feasibility of implementing safety practices). Additionally they rated their priority of inclusion on a Likert scale. ResultsThe final HAMC list includes 14 drug classes (oral anticoagulants, narrow therapeutic range antiepileptics, antiplatelets – including aspirin –, antipsychotics, β-blockers, benzodiazepines and analogues, corticosteroids long-term use, oral cytostatics, oral hypoglycemic drugs, immunosuppressants, insulins, loop diuretics, nonsteroidal anti-inflammatory drugs, and opioid analgesics), and 4 drugs or pairs of drugs (amiodarone/ dronedarone, digoxin, oral methotrexate and spironolactone/eplerenone). ConclusionsAn initial list of high-alert medications for patients with chronic diseases has been developed, which can be built into the medication management strategies for chronicity to guide the implementation of efficient safety strategies and to identify those patients at greater risk for preventable adverse drug events.

High-alert medications for pediatric patients: an international modified Delphi study

Background: The available knowledge about high-alert medications for children is limited. Because children are particularly vulnerable to medication errors, a list of high-alert medication specifically for children would help to develop effective strategies to prevent patient harm. Therefore, we conducted an international modified Delphi study and validated the results with reports on medication incidents in children based on national data.Objective: The objective of this study was to generate an internationally accepted list of high-alert medications for a pediatric inpatient population from birth to 18-years old.Results: The rating panel consisted of 34 experts from 13 countries. In total, 14 medications and 4 medication classes were included with the predefined level of consensus of 75%. The high-alert medications were: amiodarone, digoxin, dopamine, epinephrine, fentanyl, gentamycin, heparine, insulin, morphine, norepinephrine, phenytoin, potassium, propofol and tacrolimus. The high-alert medication classes included in the final list were: chemotherapeutic drugs, immunosuppressive medications, lipid/total parenteral nutrition and opioids.Conclusion: An international group of experts defined 14 medications and 4 medication classes as high-alert for children. This list might be helpful as a starting point for individual hospitals to develop their own high-alert list tailored to their unique situation.

A Multicenter, Multidisciplinary, High-Alert Medication Collaborative to Improve Patient Safety: The Singapore Experience

High-alert medications can cause significant patient harm when used in error. A multicenter, multidisciplinary, high-alert medication collaborative was established in Singapore in 2009 to identify and maintain a current list of high-alert medications and to create systematic approaches for preventing and reducing the risk of medication errors and adverse drug events (ADEs) for high-alert medications. The collaborative was led by a core multidisciplinary team consisting of pharmacists, nurses, and physicians, as well as clinical services and quality personnel, from six primary and acute care institutions. Multidisciplinary work groups were formed to drive the improvement efforts using the Plan-Do-Study-Act (PDSA) cycles. Tracking of improvement work was conducted with an adaptation of the Institute for Healthcare Improvement Trigger Tool method. A localized high-alert medication list was developed through local ADE reports, literature review, an online survey of health care professionals, and expert opinion. Some 130 interventions were proposed to prevent, detect, and mitigate harm from the use of high-alert medications for 10 drug classes/drugs. A significant number of these interventions were tested and revised during the PDSA cycles before implementation throughout the institution and subsequent spread to other institutions. Outcome audits identified areas for improvement. The interventions, which were subsequently incorporated into the change packages, led to a 50% and 67% decline in the ADE rates for radiocontrast agents and heparin, respectively. The collaborative has provided a sound framework for ongoing development and refinement of high-alert medication change packages and for sharing of ADE data and best practices across the participating institutions.

Insulin Use in Hospitalized Patients With Diabetes: Navigate With Care

“ A man walks into a bar …” These classic words introduce countless humorous situations. “ A man enters a hospital …” Unfortunately, these words introduce distinctly serious situations that occur at the rate of > 35 million per year across the United States.1 These words introduce a story in people's lives that all too often includes mistakes, misadventures, and even preventable deaths. The hospital is a dangerous place. Approximately one-third of all deaths in this country occur in hospitals.2,3 On any given day, up to 30% of all hospitalized patients have diabetes, placing almost one-third of inpatients at greater risk for complications that may adversely affect their hospital stay. The majority of these hospitalized patients with diabetes are treated with insulin, a medication that occupies a prominent place on the list of high-alert medications of the Institute for Safe Medication Practices.4 It is the leading medication implicated in adverse events requiring treatment in a hospital emergency department.5 Moreover, insulin is responsible for more drug errors during acute hospital care than other commonly used hospital medications.6 What is the best approach to using insulin in the hospital setting? What skills and knowledge must providers have to make the most effective use of insulin and yet minimize the danger of hypoglycemia? There are no simple answers for these questions. As depicted in Figure 1, a single hospitalization often involves multiple transitions, each requiring a careful approach to insulin therapy. The transitions begin when patients enter the hospital. Patients may be admitted to a ward or to the intensive care unit (ICU), proceed directly to the operating room, or undergo various invasive procedures. Patients then move within the hospital among different levels of care with overlapping or sequential interventions such as nothing-by-mouth (nil per …

Intravenous Acetaminophen and Overdoses in Children Epinephrine: It's Happened Again Updated High-Alert Medication List

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

Increasing the Use of ‘Smart’ Pump Drug Libraries by Nurses

The use of infusion pumps that incorporate "smart" technology (smart pumps) can reduce the risks associated with receiving IV therapies. Smart pump technology incorporates safeguards such as a list of high-alert medications, soft and hard dosage limits, and a drug library that can be tailored to specific patient care areas. Its use can help to improve patient safety and to avoid potentially catastrophic harm associated with medication errors. But when one independent community hospital in Massachusetts switched from older mechanical pumps to smart pumps, it neglected to assign an "owner" to oversee the implementation process. One result was that nurses were using the smart pump library for only 37% of all infusions.To increase pump library usage percentage-thereby reducing the risks associated with infusion and improving patient safety-the hospital undertook a continuous quality improvement project over a four-month period in 2009. With the involvement of direct care nurses, and using quantitative data available from the smart pump software, the nursing quality and pharmacy quality teams identified ways to improve pump and pump library use. A secondary goal was to calculate the hospital's return on investment for the purchase of the smart pumps. Several interventions were developed and, on the first of each month, implemented. By the end of the project, pump library usage had nearly doubled; and the hospital had completely recouped its initial investment.

Stamping Out Tachysystole: Implementation of an Oxytocin Protocol to Improve Patient Safety

Oxytocin has been the subject of many recent patient safety initiatives. The Institute of Safe Medication Practices (ISMP) added oxytocin to the list of high-alert medications in 2007. Evidence suggests that high-alert medications warrant heightened surveillance. Utilizing current evidence, our hospital system implemented a standardized oxytocin protocol to ensure early recognition and management of tachysystole.

Calculation skills for nurses: using antithrombotic agents

Nurse PrescribingVol. 9, No. 5 Calculation skillsCalculation skills for nurses: using antithrombotic agentsAlison G EggletonAlison G EggletonSearch for more papers by this authorAlison G EggletonPublished Online:16 Aug 2013https://doi.org/10.12968/npre.2011.9.5.218AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articlewebInstitute for Safe Medication Practices (2008)ISMP’s List of High-Alert Medications. Available at:www.ismp.org/Tools/highalertmedications.pdf (accessed 25 February 2011) Google ScholarJoint Formulary Committee (2011) British National Formulary 61. British Medical Association and Royal Pharmaceutical Society of Great Britain, London Google Scholar FiguresReferencesRelatedDetails 1 May 2011Volume 9Issue 5ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 16 August 2013 Published in print 1 May 2011 Information© MA Healthcare LimitedPDF download

Calculation skills for nurses: injectable medicines

T is the third article in this series featuring calculation skills for nurses. The topic this time is calculating doses of injection solutions required to provide a defined dose for a patient. The Institute for Safe Medication Practices (ISMP, 2007) published a list of high-alert medications associated with a heightened risk of causing significant harm to a patient if a mistake is made while using them. Mistakes with these drugs may not be more common than with other drugs, but if they occur, the consequences can be devastating for the patient. Some injectable medicines from this list, such as midazolam, potassium, magnesium sulphate, insulins and lowmolecular-weight heparins, have already featured in safety alerts from the National Patient Safety Agency. A full list of alerts can be found online (see Resources). A medicine from the high-alert list will also feature in this alerts list, because calculation errors are obviously one of the many possible risks with their use. However, practitioners should always use standard intravenous drug monographs available in hospitals to assist them with intravenous drug administration.

Calculation skills for nurses: palliative care

Nurse PrescribingVol. 9, No. 2 Calculation SkillsCalculation skills for nurses: palliative careAlison G EggletonAlison G EggletonSearch for more papers by this authorAlison G EggletonPublished Online:16 Aug 2013https://doi.org/10.12968/npre.2011.9.2.62AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Anon (2000) Boots pharmacist and trainee cleared of baby's manslaughter, but fined for dispensing a defective medicine. PJ 264: 390–2 Google Scholar Hutton M, Gardner H (2005) Calculation skills. Paediatric Nursing 17(2): 1–17. Available at: www.cf.ac.uk/mathssupport/learningresources/mathsforhealth/pncalculationskills.pdf (accessed 10 January 2011) Google Scholar Institute for Safe Medication Practices (2003) Double checks for endogenous and exogenous errors. ISMP Medication safety alert: Acute Care. Available at: www.ismp.org/Newsletters/acutecare/articles/20031030.asp (accessed 10 January 2011) Google Scholar Institute for Safe Medication Practices (2007) ISMP's List of High-Alert Medications. Available at: www.ismp.org (accessed 10 January 2011) Google Scholar Joint Formulary Committee (2010) British National Formulary 60. British Medical Association and Royal Pharmaceutical Society, London Google Scholar Kohn LTCorrigan JMDonaldson MSEds (2000) To Err is Human: Building a Safer Health System. Institute of Medicine. Committee on Quality of Health Care in America. National Academy Press, Washington, DC Google Scholar Lesar S (1998) Errors in the use of medication dosage equations. Arch Pediatr Adolesc Med 152(4): 340–4 Crossref, Google Scholar National Patient Safety Agency (2007) Patient Safety Alert 20: Promoting safer use of injectable medicines. National Patient Safety Agency, London Google Scholar Nursing and Midwifery Council (2006) Standards of proficiency for nurse and midwife prescribers. Available at: www.nmc-uk.org/aArticleaspx?ArticleID=2021 (accessed 10 January 2011) Google Scholar Sabin M (2003) Competence in Practice-Based Calculation: Issues for Nursing Education.Occasional paper number 3. Learning and Teaching Support Network, London. Available at: www.health.heacademy.ac.uk/publications/occasionalpaper/occasionalpaper03.pdf (accessed 10 January 2011) Google Scholar Smith J (2004) Building a safer NHS for Patients:Improving medication safety. Department of Health, London Google Scholar Wheeler DW, Remoundos DD, Whittlestone KD, et al. (2004) Doctors’ confusion over ratios and percentages in drug solutions: the case for standard labelling. J R Soc Med 97: 380–3 Crossref, Google Scholar Wheeler DW, Wheeler SJ, Ringrose TR (2007) Factors influencing doctors’ ability to calculate drug doses correctly. Int J Clin Pract 61(2): 189–94 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 February 2011Volume 9Issue 2ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 16 August 2013 Published in print 1 February 2011 Information© MA Healthcare LimitedPDF download