Background High alert medications are drugs that bear a heightened risk of causing significant patient harm when used in error. The Institute for Safe Medication Practices (ISMP) and other organisations, worried about safe medication practices, insist on specific procedures to reduce the risk of adverse events when these drugs are handled.
Purpose To assess the degree of compliance with the standards of high alert medications in different nursing units in a secondary hospital.
Material and methods This was an observational, descriptive, transversal study carried out in a secondary hospital. The items studied were:
Knowledge of the list of high alert medications.
Standardisation storage, preparation and administration.
Number of limited presentations and concentrations of heparin, morphine and insulin, among others.
Double checking practices in preparations and administrations.
No storage of concentrated solutions.
Protocols to prescribe and simplify processes.
Standardisation infusion dosage, especially morphine, insulin, heparin and inotropic solutions.
Results 12 hospitalisation units were reviewed. Regarding the ISMP standards: all units had knowledge of the high alert medications list and they were prescribed using protocols; 7 had standardised storage, preparation and administration; 8 had established electronically maximum doses and automated alerts; 4 had limited the number of presentations and concentrations of heparin, 10 of morphine and 2 of insulin. Preparation and administration double-checking practices was not used. Every unit stored solutions of potassium chloride, 1 stored potassium phosphate and 7 sodium chloride. 8 used established protocols to simplify processes and so reduce dependence on memory. Finally, all had standardised infusion dosage, especially morphine solutions, insulin, heparin and inotropics used for adults, in a single concentration in at least 90% of cases.
Conclusion In general, hospitalisation units achieved most of the ISMP objectives about safe medication practices. However, further standards should be implemented in order to accomplish ISMP requirements, especially insisting on double checking in high alert medication preparation and administration by nurses, and avoiding the storage of concentrated solutions.
No conflict of interest
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