Background Medicines are major causes of adverse events in hospitalised patients, which can be serious. However, not all drugs carry the same risks.

Purpose The purpose of the study was to identify a list of High Risk Medicines (HRMs) and increase their safety of use in a hospital (25 Care Units (CUs)) where an electronic drug process is in place.

Materials and Methods A multidisciplinary team was formed. Its task was to:

• conduct a literature review in order to identify HRMs

• perform an audit to assess drug processes in all CUs

• set up measures to improve the safety of HRMs

Results The literature review led us to establish an HRM list of 14 drugs (including oral/parenteral anticoagulants, anti-arrhythmics, insulins, parenteral hypertonic solutions, adrenergic agonists, opioids and digoxin).

Results of a clinical audit performed in 2011 revealed that 50% of the 391 referenced oral drug tablets are not fully identifiable until the administration stage; at least one error of storage in medicine cabinet was found in 32% of CUs; parenteral hypertonic KCl and MgSO₄ solutions were present in 76% and 28% of CUs respectively.

Measures taken to improve safety of HRMs were:

• ensure recognition with an alert pictogram for their storage in the pharmacy and CUs

• attribute an electronic HRM alert in prescription software

• re-label blister packs for non-unit packaging HRMs (relevant to 3/15 drugs on the list)

• rationalise keeping hypertonic solutions in CUs

• implement good clinical practise for HRMs and distribute a newsletter about HRM use

• develop a systematic statement of HRM errors

• provide information about relevant HRMs to patients

• arrange training for healthcare professionals

Conclusions Corrective actions should help to improve HRM safety by preventing medication errors. An evaluation of the efficacy of these measures in practise is needed. This work will allow us to meet the requirements of French legislation.

No conflict of interest.