Copyright © 2008 by F. A. Davis.
181 High-Alert Medications High-alert medications are those medications that have a high risk of causing injury or death when improperly handled or administered. Many of these drugs are used commonly in the general population or are used frequently in urgent clinical situations. The Joint Commission monitors the five most often prescribed high-alert medications: insulin, opiates and narcotics, injectable potassium chloride (or phosphate) concentrate, IV anticoagulants (heparin); and sodium chloride solutions above 0.9%. Exercise extreme caution when administering these medications: ■ Adrenergic agonists (e.g., epinephrine, isoproterenol, norepinephrine). ■ Cardioplegic solutions. ■ Chemotherapeutic agents. ■ Chloral hydrate (in pediatric patients). ■ Colchicine injection. ■ High-concentration dextrose (greater than 10% dextrose). ■ Hypoglycemic agents (oral). ■ Hypertonic sodium chloride injection (⬎0. 9% concentration). ■ Insulin. ■ IV adrenergic antagonists (propranolol, esmolol, metoprolol). ■ IV calcium. ■ IV digoxin. ■ IV magnesium sulfate. ■ IV potassium (phosphate and chloride). ■ Lidocaine/benzocaine; other topical anesthetics. ■ Midazolam. ■ Neuromuscular blocking agents. ■ Opiates (opioids). ■ Thrombolytics, heparin, warfarin.
Safe Medication Administration ■ Carefully read product packaging to note strength of solution, dosage, and/or route of administration. ■ Double-check with a pharmacist about dose range. ■ Have a colleague double-check dosage calculations and infusion pump programming. ■ Use the Five Rights (right drug, right dose, right patient, right route, right time) as a guide.
MEDS/LABS