High Alert Drug Policies & Protocols

“High-alert medications are more likely to be associated with harm than other medications—they cause harm more commonly, the harm they produce is likely to be more serious, and they ‘have the highest risk of causing injury when misused.’ The harm leads not only to patient suffering but also to additional costs associated with the care of these patients.

“Winterstein et al. suggested that 50% of the preventable ADEs identified in the review of an adverse drug reaction database fell into the following three categories:

1. Overdoses of anticoagulants or insufficient monitoring and adjustments (according to laboratory test values) were associated with hemorrhagic events.
2. Overdosing or failure to adjust for drug-drug interactions of opiate agonists was associated with somnolence and respiratory depression.
3.  Inappropriate dosing or insufficient monitoring of insulin was associated with hypoglycemia.” *

* “Preventing Harm from High-Alert Medications”,The Joint Commission Journal on Quality and Patient Safety, 2007, www.ihi.org/NR/rdonlyres/3601F5AB-8EEF-4FDD-BDCB-46FC91F18F70/0/PreventingHarmfromHighAlertMeds.pdf

High Alert Medications General Resources (click here)
High Alert Medications Florida CAH Resources (click here)

High Alert Medications Links:

• Sample High-Alert Medication Policy

Insulin Links:

• Insulin Orders & Protocols: IV Insulin Infusions
• Implementation of a Safe & Effective Insulin Infusion Protocol in a Medical Intensive Care Unit
• IV Insulin/Insulin Drip Protocols & Forms
• Hospital Management of Diabetes: Beyond the Sliding Scale
• American Diabetes Association, Clinical Practice Recommendations
• United Kingdom Insulin Protocols
• Sliding Scale Regular/Novolog Insulin Protocol

DVT Links:

• Prevention of Venous Thromboembolism
• Quality Improvement Efforts in the Intensive Care Unit: Development of a New Heparin Protocol