An introduction to High Risk Medications

Transcription

1 An introduction to High Risk Medications Une politique sure des médicaments : déjà deux approches 25 octobre 2013 Danguy Christine Hôpital A. Vésale

2 An introduction to High Risk Medications 1. High Risk Medications 2. Identifying High Risk Medications 3. High Risk Medications List 4. Reducing harm 5. Conclusion

3 High Risk Medications

4 High Risk Medications JCAHO began tracking sentinel events in 1995 ISMP conducted a study to determine drugs and situations most likely to cause harm to patient «A majority of medication errors resulting in death or serious injury involved a small number of specific medications» Insulin Opiates and narcotics Injectable potassium chloride (or phosphate) concentrate Intravenous anticoagulants (heparin) Sodium chloride solutions above 0.9% Elizabeth A. Shlom et al,hospital Pharmacy 2006; 41:

5 High Risk Medications JCAHO described a high-alert medication as one that has the highest risk of causing injury when misused. IOM report, To err is human in 1999 have documented the need to implement a system approach when managing the safe use of high-risk medications. Regular newsletter ISMP Medication Safety Alert JCAHO Sentinel Event Alert Elizabeth A. Shlom et al,hospital Pharmacy 2006; 41:

6 High Risk Medications Hight risk medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. Special safeguards reduce the risk of errors Identifying look-a-like and sound-a-like as HRM High Alert Medication - ISMP 2012

7 Identifying High Risk Medications

8 Identify high risk medications Which medications require special safeguards to reduce the risk of errors? National or regional database programs for cataloging and trending medications errors MEDMARX data- base program (United States Pharmacopeia s) NRLS in England and Wales Reports of harmful errors in the literature Practioners and safety experts

9 Clinical outcome of medication incidents Review of medication incidents reported to the National Reporting and Learning System in England and Wales Objective : Review all medication incidents reported Design & Method : - Clinical validation of death and severe harm - Clinical outcome changed - Second extraction 2011 Results : medication incidents medication incidents with outcomes of death and severe harm Cousins DH et al,br J Clin Pharmacol 2012;74:

10 High Risk Medication : therapeutic groups Review of medication incidents reported to the National Reporting and Learning System in England and Wales Objective : Review all medication incidents reported Design & Method : - Clinical validation of death and severe harm - Clinical outcome changed - Second extraction 2011 Results : Medicines/therapeutic groups identified in incident reports with clinical outcomes of death and severe harm Cousins DH et al, Br J Clin Pharmacol 2012;74:

11 Adverse drug reactions as cause of admission to ICU Objective : to determine the prevalence of ICU admissions due to an ADR Design & Method : - Prospective study. - Causality was assessed - Severity : serious - Preventability not determined Results : admissions cases included Schwake L et al, Intensive Care Med 2009;35:266-74

12 High-alert medications in the pediatric intensive care unit. Objective : - To identify the perceptions of pediatric intensive care unit clinicians about HRM - - To Develop a PICU-specific HRM list. Design & Method : PICU-specific multisite, institution-based survey of clinicians perceptions of HRM Results : - PICU-specific medications - Medications not identified on the ISMP list Franke HA, Pediatr Crit Care Med 2009;10:85-90.

13 High-alert medications in the pediatric intensive care unit. Results : Difference of perception among clinician types - Nurse - Physician - Pharmacist Franke HA, Pediatr Crit Care Med 2009;10:85-90.

14 High Risk Medications LIST

15 ISMP s List of High-Alert Medications Based on error reports submitted to the ISMP National Medication Errors Reporting Program Reports of harmful errors in the literature Input from practitioners and safety experts ISMP survey (October 2011-February 2012) ISMP s List of Hight-Alert Medication Updated 2012 High Alert Medication - ISMP 2012

16 ISMP s List of High-Alert Medications Classes/Categories of Medications antithrombotic agents, including: anticoagulants (e.g., warfarin, low-molecular-weight heparin, IV unfractionated heparin) Factor Xa inhibitors (e.g., fondaparinux) direct thrombin inhibitors (e.g., argatroban, bivalirudin, dabigatran etexilate, lepirudin) thrombolytics (e.g., alteplase, reteplase, tenecteplase) glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide) insulin, subcutaneous and IV moderate sedation agents, IV (e.g., dexmedetomidine, midazolam) moderate sedation agents, oral, for children (e.g., chloral hydrate) narcotics/opioids IV transdermal oral (including liquid concentrates, immediate and sustained-release formulations) sodium chloride for injection, hypertonic, greater than 0.9% concentration High Alert Medication - ISMP 2012

17 ISMP s List of High-Alert Medications Classes/Categories of Medications adrenergic agonists, IV (e.g., EPINEPHrine, phenylephrine, norepinephrine) adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol) anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine) antiarrhythmics, IV (e.g., lidocaine, amiodarone) cardioplegic solutions chemotherapeutic agents, parenteral and oral dextrose, hypertonic, 20% or greater dialysis solutions, peritoneal and hemodialysis epidural or intrathecal medications hypoglycemics, oral inotropic medications, IV (e.g., digoxin, milrinone) liposomal forms of drugs (e.g., liposomal amphotericin B) and conventional counterparts (e.g., amphotericin B desoxycholate) neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium) parenteral nutrition preparations radiocontrast agents, IV sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100 ml or more High Alert Medication - ISMP 2012

18 Hospital-Specific Lists of HRM Identify medications that pose an elevated risk of harm within their own institution Difference among hospital s list of HRM, and the number of HRM Size of the institution Type of patients Other factors Elizabeth A. Shlom et al,hospital Pharmacy 2006; 41:

19 Reducing Harm from High Risk Medications

20 Leading causes of medications errors National Study on the Distribution, Causes, and Consequences of Voluntarily Reported Medication Errors Between the ICU and Non- ICU Settings Objective: To compare the distribution, causes, and consequences of medication errors in the ICU with those in non-icu settings. Design & Method : A cross-sectional study of all hospital ICU and non-icu medication errors reported to the MEDMARX system between 1999 and Latif A, Crit Care Med 2013;41:389-98

21 Actions taken as a result of the errors National Study on the Distribution, Causes, and Consequences of Voluntarily Reported Medication Errors Between the ICU and Non-ICU Settings Latif A, Crit Care Med 2013;41:389-98

22 Reducing Harm from HRM Policies and guidance Make organisation level changes Standardisation Monitoring and controlling usage Reduce harm from high risk medicines Prevent Identify Mitigate Make clinical area level changes Labelling and storage Monitor compliance Education and training Prescription and administration Make patient level changes Monitoring effects Record keeping NHS

23 Conclusion

24 Conclusion Patient safety climate National and regional Medication Errors Reporting data-base National infrastructure to oversee and promote safe medication practice Review medication report data Co-ordinated medication safety guidance

25 Conclusion Identify HRM Practioners Standardizing HRM handling practices Improving access to information Multidisciplinary medication safety group Communicate HRM risk To the patient To the practioners