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Enhancing High Alert Medication Knowledge Among Pharmacy, Nursing, and Medical Staff

Sullivan, Karyn M. PharmD*; Le, Phuoc Lynsey PharmD; Ditoro, Michael J. PharmD; Andree, Jason T. PharmD; Charest, Diane J. CPhT§; Tuiskula, Kristin A. PharmD

doi: 10.1097/PTS.0b013e3182878113
Original Study: PDF Only

Objectives Limited data exist regarding staff’s knowledge and perceptions of high alert medications (HAMs) and associated procedures. Objectives of this study were to conduct an initial assessment of institution-specific HAM knowledge among pharmacy, nursing, and medical staff; implement interventions to enhance staff knowledge of HAMs; and conduct a similar assessment 1 year later to determine if interventions successfully enhanced HAM knowledge.

Methods A 6-question electronic survey was distributed to 1006 pharmacy staff, nurses, and physicians in June 2009. In response to results achieved, HAM-related interventions were implemented over a 6-month period. A similar electronic survey was distributed to hospital staff 1 year later to determine any change in HAM knowledge.

Results A total of 203 staff completed the presurvey (20% response rate), whereas 170 completed the postsurvey (17% response rate). Before the HAM interventions, 42.9% of respondents expressed confidence in their knowledge of HAMs and the procedures defined by the institution. This increased to 73.5% after the interventions (P < 0.001). More respondents correctly identified HAMs and safety procedures on postsurveys: insulin IV bolus (83.3% vs. 92.4%; P < 0.01), neonatal medications (79.3% vs. 88.2%; P < 0.05), total parenteral nutrition (57.1% vs. 73.5%; P = 0.001), and “documentation of 2 independent registered nurse checks for HAM IV infusion rate changes” (76.4% vs. 92.9%; P < 0.001).

Conclusions An assessment of staff HAM knowledge and handling procedures allows for customized interventions for institution-specific HAM improvements. Hospital staff knowledge of HAMs increased 1 year after implementing interventions.

From the *Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts; †Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ‡Vanguard Health Chicago, Chicago, Illinois; §Saint Vincent Hospital, Worcester, Massachusetts; and ∥The University of Chicago Medicine, Chicago, Illinois.

Correspondence: Karyn M. Sullivan, PharmD, Massachusetts College of Pharmacy and Health Sciences 19 Foster Street Worcester, MA 01608 (e-mail:

The authors disclose no conflict of interest.

Disclosure of funding: No funding was received for this project.

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