High-Alert Medications (Refer to Policystat) Drugs that bear a heightened risk of causing significant patient harm when they are used in error.
Class/Categories of “High Alert Medications” that may result in death or serious injury including
specific medications of concern:
Adrenergic agonists, IV (e.g. epinephrine)
Inotropic medication, IV (e.g. digoxin)
Adrenergic antagonists, IV (e.g. propranolol)
Liposomal forms of drugs
Anesthetic agents, general, inhaled and IV
Moderate sedation agents, IV (e.g. midazolam)
Cardioplegic solutions
Methotrexate, oral (non-oncologic use)
Chemotherapeutic agents, parenteral and oral
Narcotics/Opiates, IV and oral
Colchicine injection
Neuromuscular blocking agents
Concentrated Electrolytes (potassium chloride,
potassium phosphate, sodium phosphate)
Oxytocin
Dextrose, hypertonic, 20% or greater
Sodium Chloride solutions, conc. > 0.9%
Dialysis solutions for Continuous Renal
Replacement Therapy
Thrombolytics/Fibrinolytics, IV
Epidural or intrathecal medications
Tikosyn
Glycoprotein IIb/IIIa inhibitors
Total Parenteral Nutrition solutions
Heparin and Low Molecular Weight Heparins
Warfarin
Hypoglycemics, oral and Insulin IV and SQ
New “High-Alert” medications may be added to this as identified through the Failure Mode and Effects Analysis formulary procedure conducted by the Pharmacy and Therapeutics Committee Restricting availability of “h igh - risk” m edicat ions The availability of “high-risk” medications is restricted. There is a heightened awareness and
appropriate safeguard policies are followed in the ordering, storage and administration of the
identified “high-risk” medications.
Medication Reconciliation Medication reconciliation is performed to clarify any discrepancies between the patient’s actual
medications and the most recent record of prescribed medications. This will allow the physician to
review the information and order the appropriate medications and dosages for patients on
admission to CHI Saint Joseph Health.
This process will also reduce adverse drug events (ADE) and potential adverse drug events
(PADE), which may cause harm or potential harm to patients. The admission medication
reconciliation process will be completed by the nurse and will be used to perform medication
reconciliation. Medication reconciliation is an interdisciplinary process between the patient,
physician, pharmacy and nursing designed to decrease ADEs and PADEs on all nursing units and
provide the most therapeutic outcome for the patients.
The medication history may be obtained and validated from the patient and/or family member
who are present at the time of admission. The nurse taking the admitting history should
determine if they are reliable historians. If the patient or family is able to provide accurate data,
the nurse will document this information.