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Ismp list of high-alert medications in community/ambulatory healthcare
ISMP List of High-Alert Medications in
igh-alert medications are drugs that bear a heightened risk of
This may include strategies like providing mandatory patient education;
causing significant patient harm when they are used in error.
improving access to information about these drugs; using auxiliary
Although mistakes may or may not be more common with these drugs,
labels and automated alerts; employing automated or independent
the consequences of an error are clearly more devastating to patients.
double checks when necessary; and standardizing the prescribing,
We hope you will use this list to determine which medications require
storage, dispensing, and administration of these products.
special safeguards to reduce the risk of errors and minimize harm.
antiretroviral agents (e.g., efavirenz, lamiVUD
ine, raltegravir, ritonavir,
chemotherapeutic agents, oral (excluding hormonal agents)
chloral hydrate liquid, for sedation of children
(e.g., cyclophosphamide, mercaptopurine, temozolomide)
heparin, including unfractionated and low molecular weight heparin
immunosuppressant agents (e.g., azaTHIO
midazolam liquid, for sedation of children
pediatric liquid medications that require measurement
pregnancy category X drugs (e.g., bosentan, ISO
Based on error reports submitted to the ISMP Medication Errors Reporting Program (ISMP MERP), reports of harmful errors in the literature, and input frompractitioners and safety experts, ISMP created a list of potential high-alert medications. During June-August 2006, 463 practitioners responded to an ISMP surveydesigned to identify which medications were most frequently considered high-alert drugs by individuals and organizations. In 2008, the preliminary list and surveydata as well as data about preventable adverse drug events from the ISMP MERP, the Pennsylvania Patient Safety Reporting System, the FDA MedWatch database,databases from participating pharmacies, public litigation data, literature review, and a small focus group of ambulatory care pharmacists and medication safetyexperts were evaluated as part of a research study funded by an Agency for Healthcare Research and Quality (AHRQ) grant. This list of drugs and drug categoriesreflects the collective thinking of all who provided input. This list was created as part of the AHRQ funded project “Using risk models to identify and prioritizeoutpatient high-alert medications” (Grant # 1P20HS017107-01).
Copyright 2011 Institute for Safe Medication Practices (ISMP). This document may be freelyredistributed without charge in its entirety provided that this copyright notice is not removed.
It may not be sold or distributed for a charge or for profit or used in commercial documentswithout the written permission of ISMP. Any quotes or references to this document must beproperly cited. This document is provided “as is” without any express or implied warranty. Thisdocument is for educational purposes only and does not constitute legal advice. If you require
legal advice, you should consult with an attorney.
0300-7995 Vol. 22, No. , 2006, 731–737 doi:10.1185/030079906X100096 All rights reserved: reproduction in whole or part not permittedrecommendationsIvor Cavill a, Michael Auerbach b, George R. Bailie c, Peter Barrett-Lee d, Yves Beguin e, Peter Kaltwasser f, Tim Littlewood g, Iain C Macdougall h and Keith Wilson i a Medical School, Cardiff University, UKb Georgetown University
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