Medication errors and their negative consequences, drug-related adverse events, are today a serious public health problem. They have important repercussions not only on humans, but also because of their mistrust among patients, as well as concerns in the health system that affects medical professionals and institutions. According to medtruth.com, the clinical consequences of medication errors in the hospital are much more important than in ambulatory outcomes due to the complexity and aggressiveness of hospital therapies.
High-risk medicines have a high risk of causing serious or fatal harm when an error occurs during their use. This definition does not indicate that errors associated with these medications would be more frequent, but that, in the event of an error, the consequences for patients might be more severe. For all these reasons, high-risk medicines should be a priority objective in all clinical safety programs established in hospitals.
In 1995-1996, the Institute for Safe Medicine Practices (ISMP) conducted a study in 161 US hospitals to find more medicated pharmaceuticals and drugs to cause adverse events to patients and concluded that the number of these drugs was limited, which is why it was also possible and convenient for patient safety measures to focus on these drugs. Starting from this study and notified cases in the voluntary medication error notification systems, the ISMP has established a list of high-risk medicines, which is the world-wide reference list. This list has been updated according to new medicines released and new information has been generated about serious medication errors. See here more.
High Risk Medicines are also a priority objective of recommendations or strategies to improve clinical safety developed by patient safety bodies and organizations. The Council of Europe in the document included the standardization of high-risk medicines among the safe practices recommended to be implanted in priority hospitals and insisted on the need to establish programs at the local level explicit multidisciplinary focused procedures on the prevention of errors with these drugs.
In the US, the National Quality Forum included “improving the safety of high-risk medicines” among the 30 core practices that need to be implemented in all hospitals.
More than the general recommendation to improve the safety of all high-risk medicines, campaigns directed at specific drug-handling or drug group management have developed in different countries. For example, the first measure undertaken by the National Patient Safety Agency, Canada’s Australian Council for Safety and Quality and the Institute for Safe Medicine Practices in Canada, was aimed at reducing errors derived from the use of intravenous potassium. The same bodies as well as others have planned strategies focused on preventing errors with oral methotrexate, vincristine, opiates, oral anticoagulants and insulin. Among these, it is worth mentioning the “5 million lives” campaign by the Institute for Health Improvement, which includes an intervention to improve the safety of high-risk medicines, particularly opioid, anticoagulated and sedating.
When developing a program of practices to reduce medication errors with high-risk medicines in a hospital, it is first and foremost a matter of recognizing the extraordinary complexity of the system of drug use in a hospital. In this context, it is to be assumed that no practice, by itself, will guarantee the safety of the use of high-risk medicines, but that it is necessary to introduce more practice at all and at each of the steps that configures the system of drug use. For this purpose, it is recommended to implement specific practices aimed at reducing errors in the packaging, storage, prescription, release, preparation and administration of medicinal products.
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