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Institute for Safe Medication Practices (ISMP

ISMP List of High-Alert Medications
in Acute Care Settings

We hope you will use this list to determine which medica. oral the types of errors that occur with this concen-trated form of insulin. inhalation. IV thrombolytics (e.g. IV via the website (www. alteplase. oral. general. limiting access to high-alert causing significant patient harm when they are used in error.. to assure relevance and complete-ness. 20% or greater vasopressin.) Classes/Categories of Medications Specific Medications adrenergic agonists. hypertonic. Insulin U-500 has been singled out for special emphasis to bring attention to the need for distinct strategies to prevent hypoglycemics.. subcutaneous adrenergic antagonists. IV (e. IV dextrose. parenteral and oral promethazine.ismp.. IV (e. non-oncologic use anticoagulants (e. subcutaneous and IV Based on error reports submitted to the ISMP National Medication Errors Reporting Program.g. amphotericin B desoxycholate) often involved in harmful errors. tenecteplase) nitroprusside sodium for injection glycoprotein IIb/IIIa inhibitors (e.g. lidocaine. including: methotrexate. neuromuscular blocking agents (e. inotropic medications. propofol. ISMP created and periodically updates a list of potential high-alert medica-tions. sterile water for injection..g. IV (e. EPINEPHrine. This are not always the optimal error-reduction strategy and may not be may include strategies such as standardizing the ordering.. the consequences of an error are clearly more devastating to employing redundancies such as automated or independent double- patients. practitioners responded to an ISMP survey designed to identify which medications were most frequently considered high-alert drugs by individuals and moderate sedation agents. eptifibatide) potassium chloride for injection concentrate cardioplegic solutions potassium phosphates injection chemotherapeutic agents. bivalirudin.. vecuronium) © ISMP 2014. amiodarone) magnesium sulfate injection antithrombotic agents. are considered a class of epidural or intrathecal medications high-alert medica-tions. labetalol) epoprostenol (Flolan). low molecular weight heparin. narcotics/opioids members of the ISMP advisory board.g.g.g. Other reproduction is prohibited parenteral nutrition preparations without written permission from ISMP. storage.9% concentration . preparation. ketamine) insulin U-500 (special emphasis)* antiarrhythmics. Although mistakes may or may not be more common with these medications. rivaroxaban) direct thrombin inhibitors (e. milrinone) Background insulin. the clinical staff at ISMP. IV or intraosseous dialysis solutions. (Note: manual independent double-checks tions require special safeguards to reduce the risk of errors. IV (e. reports of harmful errors in the literature. This list of drugs and drug categories reflects the collective transdermal oral (including liquid concentrates.g. for children (e.g. phenylephrine. apixaban.g. and administration of these products. chloral hydrate) organizations.g. IV (e. metoprolol. Permission is granted to reproduce material with proper attribution for internal use within healthcare organizations.. studies that identify the drugs most liposomal forms of drugs (e. and drugs..g.. liposomal amphotericin B) and conventional counter-parts (e. argatroban. reteplase. and irrigation (excluding pour bottles) in containers of 100 mL or more sodium chloride for injection. using auxiliary labels and automated alerts. norepinephrine) or by calling 1-800-FAIL-SAF(E).. propranolol. subcutaneous and IV.. peritoneal and hemodialysis *All forms of insulin.. improving access H igh-alert medications are drugs that bear a heightened risk of to information about these drugs.g. digoxin.g.. succinylcholine. hypertonic. Report actual and potential medication errors to the ISMP National Medication Errors Reporting Program (ISMP MERP) radiocontrast agents. and input from practitioners and safety experts. dexmedetomidine.g. IV anesthetic agents. oral. inhaled and IV (e.. IV unfractionated heparin) opium tincture Factor Xa inhibitors (e. midazolam) and June 2014. practical for all of the medications on the list. immediate and sustained-release formulations) thinking of all who provided input. Further. warfarin. greater than 0. dabigatran etexilate) oxytocin. rocuronium. fondaparinux.. and safety experts throughout the US were asked IV to review the potential list. During May moderate sedation agents. checks when necessary.

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