High Alert Meds
Acronym for identifying High Alert Meds
What is PINCH
True or False. Coumadin is a High Alert Medication
What is True. Coumadin, Warfarin and other low molecular weight heparins are considered High Alert medications.
True or False. Narcotics substances are stored in a single lock cart.
What is FALSE. Narcotics substances are stored in double locked medication cart and/or locked medication room
True or False. We keep concentrated electrolytes in our stock meds.
False. We do not keep concentrated electrolytes in the stock meds. They are prepared and delivered by pharmacy each time.
True or False. Only the Hospice program has continuous infusion pump for the delivery of medications.
What is True. All other programs have other types of infusion pumps (feeds) but not for the delivery of medications.
Letters in PINCH stand for
P for potassium and other concentrated electrolytes
I Insulin and Oral Hypoglycemics
N Narcotics
C Cytotoxic and other chemotherapy agents
H Heparin, Warfarin and other low molecular weight heparin
True or False. We keep high doses of heparin to ensure that we have them available when our residents need it.
What is FALSE. The availability of heparin is limited, we do not keep heparin in our stock meds to limit the incident of errors.
Process for counting narcotics
Narcotics are counted at every shift change between an outgoing nurse and an incoming nurse
True or False. Our nurses reconstitute concentrated electrolytes onsite.
What is FALSE. Pharmacy prepares concentrated electrolytes and sends them to site.
Number of infusion pumps housed in hospice.
What is 2
Process for Self Double Check
What is:
Step 1: Professional verifies order and 8 Rights
Step 2: Completes calculation (if applicable)
Step 3: Steps away to complete a different task
Step 4: Returns to verify order and 8 Rights and complete calculations if applicable
Step 5: Prepare medications if no discrepancy, 8 Rights before administration
True or False. Coumadin tabs are kept in residents' medication strips.
What is False. Coumadin tabs are kept in separate strips.
True or False. Narcotic waste disposals require two nurse signatures.
What is TRUE. Narcotic wastes are logged in the narcotic count sheet and signed off by two nurses.
True or False. Concentrated electrolytes are High Risk meds.
What is True.
Name of 2 medications used for the CADD Solis pumps what they are used for.
What are: Fentanyl and Midazolam (Versed), and they are used for the management of End of Life symptoms.
Examples of High Alert Medications in your area
What are:
Narcotics (opiods), cytotoxic medications, warfarin, coumadin, insulin, Metformin)
True or False. Residents on long term warfarin therapy are managed with warfarin protocol.
What is TRUE. Warfarin protocols are managed by pharmacy, pharmacists review INR results and adjust dosages accordingly. Residents must meet criteria to be on the Warfarin Protocol.
Process for returning narcotics to pharmacy.
What is
1- Filling out Narcotic pharmacy return form
2- Fax form to pharmacy
3- Store narcotic in lock box with form
4- Return to pharmacy courier.
Frequency of preventive maintenance for the CADD Solis pumps.
Preventive maintenance on pumps are done on a yearly basis by a contracted service provider.
Examples Safety practices when administering High Alert meds
- Independent and self double checks
- 8 Rights, 3 checks
- Proper PPE and signage
- No sharing of insulin pens
- Flagging High Alert meds in PCC and in MAR
Signs of symptoms to watch for if a resident is on an anti-coagulant.
Signs of bleeding in the gums, bruising, hematuria, hemoptysis etc.
Process for missing narcotic
1. Look for missing narcotic. Review narcotic count sheet, MAR, and medication strip for investigation
2. Report to manager
3. Fill incident report
True or False. Hospice nurses get education on infusion pump competency.
What is True. On hire, yearly and after a extended leave.