Ismp/'s List Of High Alert Medications
Institute for Safe Medication Practices
ISMP’s List of High-Alert Medications
igh-alert medications are drugs that bear a heightened risk of
these drugs; limiting access to high-alert medications; using
H causing significant patient harm when they are used in error.
auxiliary labels and automated alerts; standardizing the ordering,
Although mistakes may or may not be more common with these
storage, preparation, and administration of these products; and
drugs, the consequences of an error are clearly more devastating to
employing redundancies such as automated or independent double-
patients. We hope you will use this list to determine which medica-
checks when necessary. (Note: manual independent double-checks
tions require special safeguards to reduce the risk of errors. This
are not always the optimal error-reduction strategy and may not be
may include strategies like improving access to information about
practical for all of the medications on the list).
Classes/Categories of Medications
Specific Medications
adrenergic agonists, IV (e.g., epinephrine, phenylephrine, norepinephrine)
colchicine injection***
adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol)
epoprostenol (Flolan), IV
anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine)
insulin, subcutaneous and IV
antiarrhythmics, IV (e.g., lidocaine, amiodarone)
magnesium sulfate injection
antithrombotic agents (anticoagulants), including warfarin, low-molecular-weight
methotrexate, oral, non-oncologic use
heparin, IV unfractionated heparin, Factor Xa inhibitors (fondaparinux), direct
thrombin inhibitors (e.g., argatroban, lepirudin, bivalirudin), thrombolytics (e.g.,
opium tincture
alteplase, reteplase, tenecteplase), and glycoprotein IIb/IIIa inhibitors (e.g., eptifi-
batide)
oxytocin, IV
cardioplegic solutions
nitroprusside sodium for injection
chemotherapeutic agents, parenteral and oral
potassium chloride for injection concentrate
dextrose, hypertonic, 20% or greater
potassium phosphates injection
dialysis solutions, peritoneal and hemodialysis
promethazine, IV
epidural or intrathecal medications
sodium chloride for injection, hypertonic (greater than 0.9% concentration)
hypoglycemics, oral
sterile water for injection, inhalation, and irrigation
(excluding pour bottles) in containers of 100 mL or more
inotropic medications, IV (e.g., digoxin, milrinone)
***Although colchicine injection should no longer be used, it will remain on the list until
shipments of unapproved colchicine injection cease in August 2008. For details,
liposomal forms of drugs (e.g., liposomal amphotericin B)
please visit: www.fda.gov/bbs/topics/NEWS/2008/NEW01791.html.
Background
moderate sedation agents, IV (e.g., midazolam)
Based on error reports submitted to the USP-ISMP Medication Errors Reporting
moderate sedation agents, oral, for children (e.g., chloral hydrate)
Program, reports of harmful errors in the literature, and input from practitioners and
narcotics/opiates, IV, transdermal, and oral (including liquid concentrates, immediate
safety experts, ISMP created and periodically updates a list of potential high-alert
and sustained-release formulations)
medications. During February-April 2007, 770 practitioners responded to an ISMP
survey designed to identify which medications were most frequently considered
neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium)
high-alert drugs by individuals and organizations. Further, to assure relevance and
08
radiocontrast agents, IV
completeness, the clinical staff at ISMP, members of our advisory board, and safety
20
experts throughout the US were asked to review the potential list. This list of drugs
MP
S
total parenteral nutrition solutions
and drug categories reflects the collective thinking of all who provided input.
I
©
© ISMP 2008. Permission is granted to reproduce material for internal newsletters or communications with proper attribution. Other
Institute for Safe
reproduction is prohibited without written permission. Unless noted, reports were received through the USP-ISMP Medication Errors
Reporting Program (MERP). Report actual and potential medication errors to the MERP via the web at www.ismp.org or by calling
Medication Practices
1-800-FAIL-SAF(E). ISMP guarantees confidentiality of information received and respects reporters’ wishes as to the level of detail
www.ismp.org
included in publications.
