Background Patients' growing interest in maintaining their own health and quality of life can certainly be linked to a significant increase in their knowledge of their rights. The Italian Ministry has published a series of documents that makes recommendations to support the management of drug treatment to reduce the risk of accidental exchange of one drug with another.

Purpose At the European Institute of Oncology it has been decided to participate fully in the appreciation of the processes of prescribing, preparing and administering high-alert drugs, starting with an assessment regarded as central: the perception of the operator, which is at the forefront of having to deal with the drug in his/her department, with the aim of better understanding the day-to-day problems with which he/she has to cope.

Materials and methods A questionnaire was written within an audit, which was designed to investigate nurses' knowledge of high-alert drugs and their training in handling. The questions sent to nurses evaluated what nurses considered high-risk medicines, investigated the sites where the drugs were reconstituted, and asked for suggestions for practical and hypothetical solutions to the definition of a common management procedure.

Results 216 questionnaires were sent to nurses of all hospital units (medical oncology, intensive care, surgery, etc.). The survey concluded that the main issues to which attention should be paid were: proper storage in separate places (12%), drugs should be easily recognisable with the help of alert signals (15%), care should be taken with the procurement of materials that were LASA (look-alike/sound-alike) high-alert drugs so that packaging was not similar whichever pharmaceutical companies were involved (11%), physician prescriptions should be clear and readable and always active and specialties, dedicated sites should be created for the preparation of treatments (14%) without distractions/discomfort (6%), shift work and workload patterns should be reviewed (26%) in order to introduce double checks in the preparation and administration of drugs.

Conclusions In the light of these opinions a procedure was defined that governs the management of EIO high alert drugs in order to reduce the occurrence of medication errors, improve the quality of service provided and patient quality of life.