Background High-alert medications (HAM) are medicines that have a heightened risk of causing significant patient harm when used in error. Errors associated with HAM are not the most frequent, but their consequences tend to be more serious, leading to permanent injuries or death. Questionnaires to define a HAM list based on health professionals’ (HP) opinion have been used, focusing attention on risk management programs related to HAM. However, available knowledge about paediatric HAM is limited. Because children are particularly susceptible to medication errors, a specific paediatric HAM list may help in developing effective strategies to prevent patient harm.
Purpose To identify specific paediatric HAM, create a list and identify safety measures to be used in CHLO paediatric inpatient wards, based on HP opinion.
Material and methods Observational study, with questionnaire application to physicians, nurses and pharmacists from hospital paediatric services, between June and September 2016. SPSS 23.0 statistical software was used for statistical descriptive analysis with a level of significance of 5%.
Results Questionnaires were answered by 66 HP (30% physicians, 59% nurses and 12% pharmacists), 70% from the paediatric ward and 30% from paediatric cardiology. An extensive bibliographic review was carried out to define the criteria for the drugs to be included in the final list of HAM. Medicines perceived as HAM by more than 50% of HP were IV KCl (95%), opioid analgesics (91%), IV adrenergic agonists (86%), IV antiarrhythmics (85%), anticoagulants (80%), antiepileptics/anticonvulsants (77%), IV hypertonic NaCl (77%), insulins (77%), IV inotropics (76%), IV and inhaled general anaesthetics (73%), IV hypertonic glucose (68%), neuromuscular blockers (68%); IV moderate-acting sedatives(67%), IV adrenergic antagonists (64%), IV magnesium sulphate (61%), IV anti-infective (55%), parenteral nutrition solutions (52%) and non-opioid analgesics (50%). For HP, the most important safety measures to implement for HAM were: report of all HAM adverse events (98%), having for each HAM an antidote administration procedure (94%), prescribing/administration standard information and double-check administration (92%).
Conclusion The paediatric HAM list revealed some differences compared to published lists for the general population. Drugs not usually included were identified by paediatric HP as paediatric HAM, namely anticonvulsants/antiepileptics, anti-infectives and non-opioid analgesics. Questionnaire use, in addition to literature review, allowed the elaboration of a specific paediatric HAM list, based on HP opinion.
No conflict of interest
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