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How to Identify Organizational High-Alert Medications

Schepel, Lotta MSc, Pharm*†; Lehtonen, Lasse MD, PhD; Airaksinen, Marja PhD†§; Lapatto-Reiniluoto, Outi MD, PhD

doi: 10.1097/PTS.0000000000000512
Original Article: PDF Only

Objectives High-alert medications may cause significant patient harm when used in error. Hospital-specific safety data should be used to customize high-alert medication lists to fit the local context. The aim of this study was to identify organizational high-alert medications by evaluating university hospital's data on adverse drug reaction (ADR) and medication error (ME).

Methods The Anatomical Therapeutic Chemical (ATC) codes and top active substances in ADR (n = 401) and ME (n = 11,668) reports of Helsinki University Hospital from 2015–2016 were analyzed and compared with hospitals' drug consumption and the Institute for Safe Medication Practices' (ISMP) list of high-alert medications.

Results The top ATC groups and active substances in ADR and ME reports were not similar. The most numerous ATC groups were L, antineoplastic and immunomodulating agents (30%) in ADRs and N, nervous system (26%) in MEs. According to ADR and ME reports, several high-alert medications from Institute for Safe Medication Practices' lists, such as antineoplastic agents, antithrombotics, opioids, and insulins, should be considered high-alert medications also in Helsinki University Hospital. Although no ADR reports of amphotericin B existed, it had the highest number of MEs causing severe/moderate harm or unexpected reactions relative to its consumption.

Conclusions To identify organizational high-alert medications, both drug safety information and medication safety information should be used. Adverse drug reaction and ME data are needed to recognize high-alert medications, but these should also be combined with a literature search and local expert opinions.

From the *HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital;

Specialization Program of Hospital and Health Center Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki;

University of Helsinki and Helsinki University Hospital; and

§Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.

Correspondence: Lotta Schepel, MSc, Pharm, HUS Pharmacy, Helsinki University Hospital, Stenbäckinkatu 9, 00029 HUS, Helsinki Finland (e-mail:

L.L. has received the Finnish Governmental Study Grant for Helsinki University Hospital (TYH2014224).

The authors disclose no conflict of interest.

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