From the Guidelines
High alert medications are drugs that carry a heightened risk of causing significant patient harm when used incorrectly, and examples include insulin, opioids, anticoagulants, neuromuscular blocking agents, chemotherapeutic agents, concentrated electrolytes, and hypoglycemic agents, as well as digoxin, adrenergic agonists and antagonists, anesthetic agents, and sedatives like midazolam and propofol, which require special safeguards to reduce the risk of errors, as noted in the most recent guidelines 1.
Key Characteristics of High Alert Medications
- Narrow therapeutic index, meaning a small difference between therapeutic and toxic doses
- Can cause rapid physiological changes
- Misuse can lead to catastrophic outcomes, including permanent disability or death
Examples of High Alert Medications
- Insulin
- Opioids (such as morphine, fentanyl, and hydromorphone)
- Anticoagulants (like heparin, warfarin, and direct oral anticoagulants)
- Neuromuscular blocking agents (such as vecuronium and rocuronium)
- Chemotherapeutic agents
- Concentrated electrolytes (particularly potassium chloride injection)
- Hypoglycemic agents (like oral sulfonylureas)
- Digoxin
- Adrenergic agonists and antagonists
- Anesthetic agents
- Sedatives like midazolam and propofol
Special Precautions for High Alert Medications
- Independent double-checks before administration
- Standardized ordering, preparation, and administration protocols
- Restricted access
- Special labeling
- Staff education
Importance of Protocols for Handling High Alert Medications
Healthcare facilities should implement specific protocols for handling these medications to minimize the risk of medication errors, as emphasized in recent guidelines 1, which highlight the need for careful management of high alert medications to prevent adverse outcomes.
From the FDA Drug Label
High alert medications are those that bear a heightened risk of causing significant patient harm when they are misused or used in error. Examples of high alert medications include opioids, such as morphine 2 and fentanyl 3, and anticoagulants, such as warfarin 4.
- Opioids: Morphine and fentanyl are examples of high alert medications due to their potential for overdose, dependence, and abuse.
- Anticoagulants: Warfarin is a high alert medication because of its narrow therapeutic index and the risk of bleeding complications if not properly monitored and managed. These medications require special attention and caution when prescribing, dispensing, and administering to minimize the risk of adverse events.
From the Research
High Alert Medications
High alert medications are those that can cause significant harm to patients if used incorrectly. Examples of high alert medications include:
- Antineoplastic agents
- Antithrombotics
- Opioids
- Insulins
- Anticoagulants such as warfarin and non-vitamin K oral anticoagulants (NOACs) like apixaban and rivaroxaban 5, 6
- Vincristine, an antimitotic compound used in cancer treatment regimens 7
- Amphotericin B, which had the highest number of medication errors causing severe/moderate harm or unexpected reactions relative to its consumption 5
Characteristics of High Alert Medications
High alert medications often have a narrow therapeutic index, meaning that small errors in dosage or administration can lead to significant harm. They may also have a high risk of adverse drug reactions or interactions with other medications. Hospital-specific safety data should be used to customize high-alert medication lists to fit the local context 5.
Examples of High Alert Medication Errors
Medication errors involving high alert medications can have serious consequences, including:
- Adverse drug reactions (ADRs)
- Medication errors (MEs)
- Severe or moderate harm
- Unexpected reactions Examples of high alert medication errors include errors involving antineoplastic agents, antithrombotics, opioids, and insulins 5.