High Alert Medication Monitoring and Error Prevention
IV Medications Requiring Additional Monitoring
100
Define Look-Alike/Sound-Alike Medication
Medications that are visually similar in physical appearance or packaging and names of medications that have spelling similarities and/or similar phonetics.
100
Define a high alert medication.
A medication that bears a heightened risk of causing
significant patient harm when used in error.
100
The do not use abbreviation for Units is:
U (this can be mistaken for 0)
100
These are some steps to prevent medication errors with insulin:
a. Use of approved insulin order sets.
b. Use “units” instead of “u”.
c. Insulin drips will be prepared in a standard concentration and smart-pump infusion technology will be utilized for administration.
d. Insulin and heparin will be stored separately.
100
Floors which can administer IV Hydralazine.
ICU, IMCU, PACU, and Telemetry
200
This is the practice of writing part of a medicine's name in upper case letters to help distinguish from one another.
(Example: metFORMIN and metoPROLOL)
Tallman lettering
200
A list of high alert medications can be found here.
On the Rx Focus board near your Pyxis or in the high alert medication policy on the intranet.
200
The Do Not Use Abbreviation for Daily
QD (This can be mistaken for QID)
200
This is a tool for monitoring opiate/narcotic induced sedation.
Pasero Opioid Sedation Scale (POSS)
200
Patients on this medication are monitored on telemetry and up as it can cause respiratory depression.
Fentanyl
300
This is where the Look-Alike Sound-Alike list can be found on your floor.
The Rx Focus board (located by the Pyxis machine)
300
Improper dose, administration, or monitoring of anticoagulants such as warfarin or heparin can lead to:
Bleeding due to overdose or thrombotic events due to underdosing.
300
1.0 mg would be an example of this.
Trailing zero (can be mistaken for 10 mg)
300
These are some steps to prevent medication errors with Concentrated Injectable Sodium Chloride Solutions (greater than 0.9%):
a. Concentrated sodium chloride solutions for IV use in concentrations greater than 0.9% shall only be stored in the pharmacy.
b. Solutions greater than 0.9% shall be stored in a distinctly different location in the pharmacy.
c. When concentrations greater than 0.9% sodium chloride are dispensed, a message shall print on the pharmacy label alerting the nurse that this is a concentrated electrolyte and that infusion in a large vein is recommended.
d. An order set is available for ordering hypertonic saline (3% NaCl) for use in adult patients.
300
These are 2 IV beta blockers that can be used on telemetry and higher
Metoprolol and Labetalol
400
This is where Tallman lettering is found.
Epic, Pyxis, Medication labels, Unit dosed medication wrappers, Pharmacy bins
400
Improper dose, administration, or monitoring of narcotics/opiates can lead to:
Injury due to falling, respiratory depression, coma, and death from overdose.
Uncontrolled pain and anxiety from underdosing.
400
.1 mg would be an example of this.
Lack of leading zeros (Can be mistaken for 1 mg)
400
These labs are available to assure appropriate monitoring of anticoagulants.
This anti-arrhythmic medication can only be administered in IMCU or ICU
Dofetilide (Tikosyn)
500
If you notice a Look Alike Sound Alike product, what can be done by the pharmacy in order to prevent any errors?
A different product can be purchased to avoid medicines with similar packaging and appearance.
500
This percentage of emergency admissions for adverse medication reactions are related to warfarin, insulin, oral antiplatelets, and oral hypoglycemics.
66%
500
Do not use abbreviations for Morphine include:
MS, MSO4
500
Name some labs that are used in monitoring chemotherapy.
WBCs (assess for neutropenia), Hgb/Hct (assess for myelosuppression), Platelets (assess for myelosuppression), SrCr & CrCl (assess kidney function), and LFTs (assess for hepatotoxicity)
500
These two medications can only be administered in ICU or to patients in Hospice care