37 medications chosen for new high-alert medication list

ISMP Canada (ISMPC) has created a high-alert medication list for Canada. The list contains 37 medications that need additional safeguards. It includes anesthetic and sedation agents, antithrombotic medications, cancer chemotherapy and antineoplastic medications, electrolyte and related IV solutions, insulins, neuromuscular blockers and paralyzing agents, opioids, medications with profound cardiovascular and physiologic effects, and other specific medications and therapies that don’t fit into a category. ISMPC's list was developed after the institute consulted with healthcare professionals, patients and caregivers, and other stakeholders; reviewed incident reports that led to harm from the last five years; and performed an environmental scan of high-alert lists, medication safety reports, and literature from Canada and other countries. That led to a shortlist of 79 drug classes, which were reviewed by a multidisciplinary advisory panel and shortened to the current list.Read: Changing packaging regulations could reduce acetaminophen overdoses: ISMP CanadaTo prevent errors, extra safety strategies should be implemented around high-alert medications. Those might include automating dispensing or instituting double checks. The list is meant to apply to all healthcare settings, but ISMPC recommends that organizations adapt it to their needs instead of adopting it wholesale. It says organizations should put together a committee to create their own list. They might look at some drugs and realize they are not relevant to them—for example, a pharmacy that does not store or dispense oxytocin could remove that from their list. It also might want to add drugs to its list that are not on ISMPC's list, based on things like an organization’s incident reports or its staff’s familiarity with specific agents. If it adds medications, classes or situations to its list, it should tell ISMP Canada, as that information could help the institute create future versions of the high-alert list. In addition to creating its own list, each organization should teach its teams safety strategies and the high-alert medication list and have a quality-improvement process in place. ISMPC has created posters and a user guide for the medication list that shares more details. Read: Resist temptation to pre-pour medications: ISMP Canada

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