Procedure. AREAS OF RESPONSIBILITY All UNMH staff.

Transcription

1 Page 1 of 8 Title: High Alert, and Look-Alike Sound-Alike Medications Applies To: UNM Hospitals Responsible Department: Pharmacy Procedure Patient Age Group: ( ) N/A (X) All Ages ( )Newborns ( )Pediatric ( )Adult DESCRIPTION/OVERVIEW This procedure lists the high-alert and look-alike/sound-alike medications, the process for reviewing the lists, and measures to implement to prevent errors involving these drugs. AREAS OF RESPONSIBILITY All UNMH staff. REFERENCES The Joint Commission Medication Management Standard MM The Joint Commission Medication Management Standard MM Institute for Safe Medication Practices High-Alert Medications in Acute Care Settings. Institute for Safe Medication Practices High-Alert Medications in Community/Ambulatory Settings Institute for Safe Medication Practices List of Confused Drug Names. Institute for Safe Medication Practices and United Stated Food and Drug Administration (FDA) Lists of Look-Alike Drug Names with Recommended Tall Man Letters PROCEDURE 1. The Medication Safety Committee will make changes to the high-alert and look-alike/soundalike medication lists, when appropriate, based on internal medication error reporting and national lists available through the Institute for Safe Medication Practices (ISMP) and the United States Pharmacopeia (USP). 2. The list of high-alert and look-alike/sound-alike medications and the processes used to manage them will be modified as needed, based on emerging literature and technology. A. High Alert Medications 1. High Alert Medications have a higher risk of causing harm when an error occurs. They must be double checked prior to administration by two licensed caregivers who are authorized to administer or dispense medications. 2. Each licensed individual will perform calculations separately. Calculations and doses will be checked against the order or the Medication Administration Record (MAR) and verified as correct on the medication label. 3. Both the nurse administering and the licensed caregiver responsible for verifying calculations and doses will sign/initial either the MAR or the flow-sheet for designated high alert medications. 4. Verification by a licensed caregiver must be performed and documented again for designated high-alert medications with every bag change and if any of the following changes occur: change in dose or change in rate. 5. High ALerT (HALT) designation will be added to comment section of electronic drug databases. HALT= High Alert Look Twice. High Alert medications are identified based on information provided by ISMP, USP, and Patient Safety Intelligence (PSI) reporting from within the hospital. The Medication Safety Committee

2 Page 2 of 8 updates the list when appropriate and evaluates the list annually. UNMH has identified the drugs on Attachment A and B as high-alert medications. B. Look-Alike Sound-Alike Medications. Prescribing medication errors can occur because of similar medication names or poor handwriting which can make many of these medications look alike. One way to differentiate two similar sounding medications is to know the disease state that is being treated. Many of these lookalike/sound-alike medications are for different disease states. When transcribing a verbal order, always read back to the prescriber what was written or entered. This allows for verification and can prevent a medication error. UNMH has identified the drugs on Attachments C and D as lookalike/sound-alike medications. 1. Annually the Medication Safety Committee reviews ISMP s List of Confused Drug Names and internal medication errors where look-alike sound-alike medications are involved. The Look-alike Sound-alike lists are updated based on this review process. 2. Measures will be taken to prevent medication errors related to the procurement, storage, preparation, distribution, and administration of look-alike sound-alike medications. This will be accomplished by the methods listed below: A. Whenever possible, medications on the look-alike sound-alike lists will be separated in clinics or on units. If these medications are stocked in the Automated Medication Management System (AMMS) machines, they should not be close to each other. B. Pharmacy shelves or areas are labeled with Look Alike Sound Alike stickers. C. Recommend posting this list in all medication rooms. D. Tall man lettering is utilized in the computerized physician order entry (CPOE) system, the pharmacy system, the AMMS, and on medication labels. In CPOE, there are a limited number of medication choices and order sentences available to decrease the likelihood of selecting incorrectly. E. Staff will demonstrate familiarity with the lists and where they are located. DEFINITIONS High-alert medications: Agents that bear a heightened risk of causing significant harm when they are used in error. Medication Safety Committee: A subcommittee of the Pharmacy and Therapeutics Committee Tall man lettering: Mixed cased letters (upper and lower case) used to draw attention to the dissimilarities in look-alike drug names. SUMMARY OF CHANGES Removed Sections B.2.G Attachments updated 4/2018 RESOURCES/TRAINING Resource/Dept Contact Information DOCUMENT APPROVAL & TRACKING Item Contact Date Approval Owner Medication Safety Committee Chair Consultant(s) Director of Pharmacy Operations, Executive Director of Pharmaceutical Services, Medication Safety & Compliance Manager, ED Clinical Services Med/Surg Committee(s) Adult & Pediatric Nurse/Pharmacy Committees; UNMH PPG Committee Y Official Approver Administrator, Professional Services Y Official Signature On SharePoint Date: 05/24/2018 Effective Date 05/24/2018

3 Page 3 of 8 ATTACHMENTS Attachment A: High Alert Medications Acute Care Settings Attachment B: High Alert Outpatient Pharmacy Medications Attachment C: Inpatient Pharmacy Look Alike, Sound Alike Medication (LASA) List Attachment D: Outpatient Pharmacy Look Alike, Sound Alike Medication (LASA) List

4 Page 4 of 8 HIGH ALERT MEDICATIONS ACUTE CARE SETTING UNMH has identified the following drugs as high-alert medications Classes/Categories of Medication 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) *antithrombotic agents, including: anticoagulants (e.g., warfarin, low molecular weight heparin, IV unfractionated heparin) Factor Xa inhibitors (e.g., fondaparinux, apixaban, rivaroxaban) direct thrombin inhibitors (e.g., bivalirudin, dabigatran etexilate) thrombolytics (e.g., alteplase, tenecteplase) glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide) 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) *insulin, subcutaneous and IV liposomal forms of drugs (e.g., liposomal amphotericin B) and conventional counterparts (e.g., amphotericin B desoxycholate) moderate sedation agents, IV (e.g., dexmedetomidine, *lorazepam, *midazolam) moderate sedation agents, oral, for children (e.g., chloral hydrate) narcotics/opioids *IV transdermal oral (including liquid concentrates, immediate and sustained release formulations) *neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium) parenteral nutrition preparations: *TPN, PPN,Intralipid *prostacyclins (epoprostenol, treprostinil) radiocontrast agents, IV sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100 ml or more sodium chloride for injection, hypertonic, greater than 0.9% concentration Specific Medications **digoxin (oral/iv) **furosemide (oral/iv)

5 Page 5 of 8 **electrolyte doses (oral/iv) epinephrine, subcutaneous *insulin U-500 magnesium sulfate injection *methotrexate, oral, nononcologic use *opioid continuous intravenous infusion opium tincture oxytocin, IV nitroprusside sodium for injection **pediatric and neonatal continuous medication infusions *potassium chloride for injection concentrate *potassium phosphates injection promethazine, IV vasopressin * High Alert Medications that must be double checked by 2 licensed caregivers prior to administration **High Alert Medications specific for neonatal/pediatric areas that must be double checked by 2 licensed caregivers prior to administration Updated 04/2018

6 Page 6 of 8 HIGH ALERT MEDICATIONS OUTPATIENT PHARMACY UNMH has identified the following drugs as high-alert medications Classes/Categories of Medication antithrombotic agents, including: anticoagulants (e.g., warfarin, low molecular weight heparin, IV unfractionated heparin) Factor Xa inhibitors (e.g., fondaparinux, apixaban, rivaroxaban) direct thrombin inhibitors (e.g., bivalirudin, dabigatran etexilate) antiretroviral agents (e.g., efavirenz, lamivudine, raltegravir, ritonavir, combination antiretroviral products) chemotherapeutic agents, oral (excluding hormonal agents) (e.g., cyclophosphamide, mercaptopurine, temozolomide) hypoglycemic agents, oral immunosuppressant agents (e.g., azathioprine, cyclosporine, tacrolimus) insulin, all formulations opioids, all formulations pediatric liquid medications that require measurement pregnancy category X drugs (e.g., bosentan, ISOtretinoin) Specific Medications carbamazepine chloral hydrate liquid, for sedation of children heparin, including unfractionated and low molecular weight heparin metformin methotrexate, non-oncologic use midazolam liquid, for sedation of children propylthiouracil Updated 04/2018

7 Page 7 of 8 Inpatient Pharmacy Look Alike, Sound Alike Medication (LASA) List UNMH has identified the following drugs as LASA medications ALPRAZolam amiloride Amphotericin B lipid based products bupropion carbamazepine CARBOplatin cefazolin CeleXA chlordiazepoxide CISplatin clonidine clomiphene DAUNOrubicin DEPO-Medrol diazepam Diflucan DOBUTamine DOXOrubicin DTaP DULoxetine ephedrine fentanyl fluphenazine glyburide guaifenesin HumaLOG hydralazine HYDROcodone HYDROmorphone HYDROXYprogesterone infliximab LaMICtal lamivudine metformin medroxyprogesterone methimazole NovoLOG mifepristone morphine oral liquid concentrate nicardipine OxyCONTIN penicillamine PHENobarbital prednisolone PriLOSEC QUEtiapine rifampin risperidone SandIMMUNE SOLU-Medrol TEGretol tramadol valacyclovir vinblastine ZyPREXA Updated 04/2018 LORazepam clonazepam amlodipine Amphotericin B conventional products buspirone OXcarbazepine CISplatin cefotetan cefoxitin ceftazidime ceftriaxone CeleBREX chlorpromazine CARBOplatin clonazepam clozapine KlonoPIN clobazam clomipramine DOXOrubicin SOLU-Medrol diltiazem Diprivan DOPamine IDArubicin Tdap FLUoxetine PARoxetine EPINEPHrine SUFentanil fluvoxamine glipizide guanfacine HumuLIN hydroxyzine HYDROmorphone oxycodone morphine medroxyprogesterone rituximab LamISIL lamotrigine metronidazole methylprednisolone metolazone NovoLIN misoprostol morphine non-concentrated oral liquid nimodipine NIFEdipine oxycodone penicillin PENTobarbital prednisone PROzac OLANZapine rifaximin ropinirole - RisperDAL SandoSTATIN Solu-CORTEF TRENtal trazodone valganciclovir vincristine ZyrTEC

8 Page 8 of 8 Outpatient Pharmacy Look Alike, Sound Alike Medication (LASA) List UNMH has identified the following drugs as LASA medications ALPRAZolam amiloride ARIPiprazole bupropion carbamazepine cefazolin CeleXA chlordiazepoxide clomiphene DEPO-Medrol diazepam DULoxetine ephedrine glyburide guaifenesin HumaLOG hydralazine HYDROcodone HYDROXYprogesterone ISOtretinoin LaMICtal lamivudine leucovorin levetriacetam metformin medroxyprogesterone Metadate methimazole mifepristone morphine oral liquid concentrate nicardipine Nitrofurantoin macrocrystal PHENobarbital prednisolone PriLOSEC QUEtiapine ranitidine rifampin risperidone saxagliptin SEROquel sulfadiazie TEGretol tiagabine tramadol valacyclovir ZyPREXA Updated 4/2018 LORazepam clonazepam amlodipine RABEprazole buspirone OXcarbazepine cefotetan cefoxitin ceftazidime ceftriaxone CeleBREX chlorpromazine clomipramine SOLU-Medrol diltiazem FLUoxetine PARoxetine EPINEPHrine glipizide guanfacine HumuLIN hydroxyzine HYDROmorphone oxycodone medroxyprogesterone tretinoin LamISIL lamotrigine LEVOleucovorin levocarnitine metronidazole methylprednisolone Methadone-Methadose metolazone misoprostol morphine non-concentrated oral liquid nimodipine NIFEdipine Nitrofurantoin monohydrate PENTobarbital prednisone PROzac OLANZapine rimantadine rifaximin ropinirole - RisperDAL SITagliptin SINEquan sulfsalazine TRENtal tizaniine trazodone valganciclovir ZyrTEC