Status of Management for High-Alert Medications

한수연,최경숙,이정화,이은숙,이병구 한국병원약사회 2007 病院藥師會誌 Vol.24 No.4

“High-alert medications”, the agents that have higher risk for the adverse reaction when the medications were given to patients by mistake, require special attention during the dispensing. Although extreme care has been exercised for the prescription and administration of these medications in the departments of pharmacy and nursing of the Seoul National University Bundang Hospital, a consolidated guideline has not been prepared currently for the management and the use of these agents. The objective of this study, therefore, is to establish a safer pharmacotherapy of the high-alert medications by assessing the handling of these agents in practice. The definition of high-alert medication and key improvements were based on 'High-alert medication Problems and key improvements' proposed by the American Hospital Association. Among the medications used in this hospital, 202 medications may be categorized to “high-alert medications”; these agents could be classified into 18 categories(e.g., adrenergic agent, hypertonic saline, and benzodiazepine). Limit availability of medication, independent double check, and the use of caution label and others were consolidated as key improvement items. By visiting the wards that frequently prescribed “high-alert medication”(e.g., operating room, emergency room, and SICU) during the September and the October of 2005, the checklist items for the key improvement items were reviewed and evaluated in the wards. Among the total number of checklists of 100, the rate for the applicable items ranged from 41.0% to 62.0%(i.e., 41.0% for pharmacy, 48.0% for operating room, 56.0% for SICU, 58.0% of MICU and 62.0% for emergency room). Performance rate of the checklists ranged from 47.9% to 58.5%(i.e., 58.5% for pharmacy, 47.9% for operating room, 50.0% for SICU, 50.0% for MICU, and 54.8% for emergency room). The medications with high performance rate were narcotics/opiates, insulin, heparin, and benzodiazepines while the agents having a low performance rate were high concentration electrolytes(IV calcium, phosphate salts, potassium chloride magnesium). The rates were found similar to other hospitals in the United States, indicating that key improvements proposed by the American hospital system and the checklist for high-alert medication was readily applicable in practice in Korea. Further implementations, e.g., protocol establishment of low performance rate checklist, and standardization of medication use process, are necessary to fully realize the optimum pharmacotherapy in this hospital.

Status of Management for High-Alert Medications

Han, Su yeun,Choi, Kyung Suk,Lee, Jeong Hwa,Lee, Eun Sook,Lee, Byung Koo 韓國病院藥師會 2007 병원약사회지 Vol.24 No.3

“High-alert medications”, the agents that have higher risk for the adverse reaction when the medications were given to patients by mistake, require special attention during the dispensing. Although extreme care has been exercised for the prescription and administration of these medications in the departments of pharmacy and nursing of the Seoul National University Bundang Hospital, a consolidated guideline has not been prepared currently for the management and the use of these agents. The objective of this study, therefore, is to establish a safer pharmacotherapy of the high-alert medications by assessing the handling of these agents in practice. The definition of high-alert medication and key improvements were based on 'High-alert medication Problems and key improvements' proposed by the American Hospital Association. Among the medications used in this hospital, 202 medications may be categorized to“ high-alert medications”; these agents could be classified into 18 categories(e.g., adrenergic agent, hypertonic saline, and benzodiazepine). Limit availability of medication, independent double check, and the use of caution label and others were consolidated as key improvement items. By visiting the wards that frequently prescribed “high-alert medication”(e.g., operating room, emergency room, and SICU) during the September and the October of 2005, the checklist items for the key improvement items were reviewed and evaluated in the wards. Among the total number of checklists of 100, the rate for the applicable items ranged from 41.0% to 62.0%(i.e., 41.0% for pharmacy, 48.0% for operating room, 56.0% for SICU, 58.0% of MICU and 62.0% for emergency room). Performance rate of the checklists ranged from 47.9% to 58.5%(i.e., 58.5% for pharmacy, 47.9% for operating room, 50.0% for SICU, 50.0% for MICU, and 54.8% for emergency room). The medications with high performance rate were narcotics/opiates, insulin, heparin, and benzodiazepines while the agents having a low performance rate were high concentration electrolytes(IV calcium, phosphate salts, potassium chloride magnesium). The rates were found similar to other hospitals in the United States, indicating that key improvements proposed by the American hospital system and the checklist for high-alert medication was readily applicable in practice in Korea. Further implementations, e.g., protocol establishment of low performance rate checklist, and standardization of medication use process, are necessary to fully realize the optimum pharmacotherapy in this hospital.

국내 요양병원 고위험의약품 목록 도출

이수현,한지민,허규남,이아영,민상일,김아정,김성환,조윤희,조윤숙,아영미,이주연 한국병원약사회 2022 병원약사회지 Vol.39 No.4

Background : High-alert medications (HAMs), the prominent cause of medication harm, can have serious consequences for patients. They should be developed and managed according to institutions. However, HAMs for long-term care (LTC) hospitals presented in hospital accreditation standards in Korea are based on the list of HAMs of acute care hospitals. The aim of this study was to develop a national-level list of high-alert medications for LTC hospitals. Methods : A combined strategy of literature review, epidemiological data analysis of medication error-related incidents, medication utilization, and a survey of expert opinions was applied. We identified candidates of HAMs for LTC from the Institute for Safe Medication Practices (ISMP) and the list of Korean hospital accreditation standards. We analyzed the following database to identify medication error and utilization: the Korea Patients Safety Reporting & Learning System (KOPS) and Korea Adverse Event Reporting System (KAERS), and sample data from national claims. Seven experts working in LTC hospitals evaluated the adequacy and priority of candidate medications. Results : We derived a final list of 16 high-alert medications, including six essential medications (insulin vials, heparin and low molecular weight heparins, hypertonic sodium chloride solutions, concentrated potassium injections, concentrated magnesium injections, and oral chemotherapeutic agents) and 10 optional medications (insulin pens, oral anticoagulants, immunosuppressants, parenteral nutrients for central veins, parenteral chemotherapeutic agents, parenteral benzodiazepines, contrast agents, phenytoin, epinephrine injections, and oral digoxin). Conclusion : We developed a list of high-alert medications for LTC settings at the national level, which may improve medication use and safety in patients who receive LTC.

국내 지역사회/일차의료 고위험의약품 목록 도출

이수현(Suhyun Lee),아영미(Young-Mi Ah),허규남(Kyu Nam Heo),이아영(Ah Young Lee),민상일(Sang il Min),김아정(A Jeong Kim),김성환(Sung Hwan Kim),조윤희(Yun Hee Jo),조윤숙(Yoon-Sook Cho),한지민(Ji Min Han),이주연(Ju-Yeun Lee) 대한약학회 2022 약학회지 Vol.66 No.5

Despite the fact that a considerable number of preventable adverse events are managed in primary care settings, medication-related risks have been evaluated mainly through hospital admissions. While interest in high-alert medication management in the community and primary care settings is increasing internationally, Korea does not have accreditation for the same and lacks established standards for high-alert medications. Therefore, this study aimed to develop a nationallevel list of high-alert medications for community and primary care. The candidates for the high-alert medication list included medications recommended by Institute for Safe Medication Practices and those suggested by each guideline of the World Health Organization, Japan and Korea. We analyzed the adverse events related to medication errors reported by the patients' safety reporting system. Seven experts working in the community and primary care settings evaluated the adequacy and priority of the candidate medications. The final list included 20 high-alert medications, including nine essential and eleven optional medications. The national-level list of high-alert medications which we developed may be useful in formulating accreditation guidelines or treatment standards for community and primary care patients.

급성 의료기관에서 고위험 의약품 사용과 관련 잠재적 위해에 대한 단면 연구

아영미,이주연,이아영,한지민,정종현,이수현,허규남,박소영,채현우,민상일 대한약물역학위해관리학회 2023 약물역학위해관리학회지 Vol.15 No.2

: In this study, we aimed to analyze national claims data to assess the usage of high-alert medications among hospitalized patients and to identify associated potential harm. Methods: This study was a cross-sectional analysis based on the Health Insurance Review & Assessment Service National Inpatient Sample (HIRANIS) data for the years 2019 and 2020. All patients with records of hospitalization were included from this data source. We categorized patients into two groups based on the usage of high-alert medications in the acute care setting. The primary outcome of interest was the prevalence of potential harms related to the use of each high-alert medication among hospitalized patients. Each potential harm was then identified based on diagnostic codes, procedure codes, and medication administration recorded in the claims data. Results: From the HIRA-NIS dataset for the years 2019 and 2020, the patient-hospitalization count was 1,291,922. Out of the total 1,291,922 patient-hospitalizations involving the use of high-alert medications, the prescription rates for the specific medications were as follows: injectable narcotic analgesics (434,328 cases, 33.6%), injectable benzodiazepines (295,775 cases, 22.9%), and injectable anticoagulants (140,989 cases, 10.9%). Regarding the prevalence of potential harm, the top three were bleeding related to thrombolytic therapy (9.5%), hypoglycemia related to insulin vials (4.5%), and bleeding associated with injectable anticoagulant use (3.7%). Conclusion: High-alert medication usage was identified in over one-third of patients who underwent hospitalization treatment. Bleeding associated with the use of anticoagulants and thrombolytics was the most prevalent potential harm.

국내 급성기 의료기관 고위험 의약품 목록 도출

한지민,허규남,이아영,민상일,김현지,백진희,노주현,김수인,김지연,이해원,조은주,아영미,이주연 한국임상약학회 2022 한국임상약학회지 Vol.32 No.2

Background: High-alert medications (HAMs) are medications that bear a heightened risk of causing significant patient harm if usedin error. To facilitate safe use of HAMs, identifying specific HAM lists for clinical setting is necessary. We aimed to develop thenational level HAM list for acute care setting. Methods: We used three-step process. First, we compiled the pre-existing lists referringHAMs. Second, we analyzed medication related incidents reported from national patient safety incident report data and adverseevents indicating medication errors from the Korea Adverse Event Reporting System (KAERS).We also surveyed the assistant staffsto support patient safety tasks and pharmacist in charge of medication safety in acute care hospital. From findings from analysis andsurvey results we created additional candidate list of HAMs. Third, we derived the final list for HAMs in acute care settings throughexpert panel surveys. Results: From pre-existing HAM list, preliminary list consisting of 42 medication class/ingredients wasderived. Eight assistant staff to support patient safety tasks and 39 pharmacists in charge of medication safety responded to thesurvey. Additional 44 medication were listed from national patient safety incident report data, KAERS data and commonmedications involved in prescribing errors and dispensing errors from survey data. A list of mandatory and optional HAMsconsisting of 10 and 6 medication classes, respectively, was developed by consensus of the expert group. Conclusion: We developednational level HAM list for Korean acute care setting from pre-existing lists, analyzing medication error data, survey and expertpanel consensus.

간호사의 투약 안전역량 강화를 위한 고위험 약물 중심의 시뮬레이션 훈련 적용

고은정,김은정 한국간호시뮬레이션학회 2021 한국간호시뮬레이션학회지 Vol.9 No.1

Purpose: This study attempted to enhance the nurses’ safety competence in administering medications by using simulation training focused on high-alert medication. Method: A total of 30 nurses from 14 teams participated in the simulation training using a high-fidelity patient simulator. Medication administration performance and built-in error recovery was observed using a medication administration safety assessment checklist. Medication safety knowledge and confidence were measured before and after simulation training. Data were analyzed using descriptive statistics and a paired t-test. Results: There were numerous variations in safe medication administration. The safety behavior by oral prescription was insufficient compared to that by routine medication prescription. Following simulation training, knowledge of medication safety increased significantly, but confidence did not. Conclusion: Nurse educators may consider simulation to be an effective strategy for enhancing nurses’ medication safety competence.

의료기관의 처방오류 및 조제오류 유발 다빈도 약물 분석: 다기관 설문조사 연구

이주연,아영미,한지민,허규남,이아영,민상일,김현지,백진희,노주현,김수인,김지연,이해원,조은주 대한약물역학위해관리학회 2023 약물역학위해관리학회지 Vol.15 No.1

We aimed to identify medications commonly involved in dispensing and prescribing errors in hospitals, using a survey-based approach. Methods: A cross-sectional questionnaire study was conducted by distributing questionnaires to representative pharmacists in charge of medication error reporting in 99 general or higher-level hospitals with 500 beds or more. Results: Out of the 99 hospitals contacted, 38 hospital pharmacy departments (38.4%) responded. Most frequently reported medications involved in dispensing errors were total parenteral nutrition products (23.7% of respondents) followed by morphine (18.4%), lansoprazole (15.8%), and quetiapine (15.8%). Medications commonly involved in prescribing errors that were categorized as extremely or significant important included antineoplastic agents (platinumbased agents, fluorouracil, paclitaxel), systemic anti-infectives (vancomycin, levofloxacin), amiodarone, ketorolac, metoclopramide and dexamethasone. Conclusion: The medications identified in this study as being frequently involved in hospital medication errors can be used as a reference when developing a high-alert medication list for hospitals in the acute care setting.

간호사의 고위험약물 지식에 따른 약물계산 자신감과 임상수행능력

서명자(Myeong-Ja Seo),김계하(Kye-Ha Kim) 한국산학기술학회 2021 한국산학기술학회논문지 Vol.22 No.12

본 연구는 간호사들의 고위험약물 지식에 따른 약물계산에 대한 자신감과 임상수행능력을 파악하고자 시도되었다. 연구의 대상은 G시에 소재한 종합병원 4곳에서 근무하는 137명의 간호사였다. 자료분석은 SPSS 26.0을 사용하여 기술통계, Independent t-test, One-way ANOVA, Pearson’s correlation, 다중회귀분석으로 분석되었다. 연구결과 고위험약물 지식 0.64점, 약물계산에 대한 자신감 3.02점, 임상수행능력 3.54점이었다. 약물계산 자신감에는 성별(여성)과 고위험약물에 대한 낮은 지식이, 임상수행능력에는 직위(책임간호사 이상)와 근무경력(1년 이상에서 3년 미만), 고위험약물에 대한 낮은 지식이 영향을 미치는 것으로 나타났다. 어설픈 지식 수준은 임상현장에서 약물계산 자신감과 임상수행능력에 부정적인 영향을 미치는 것으로 사료된다. 따라서 본 연구 대상자들에게 적합한 교육방법을 찾아 고위험 약물에 대한 지식과 약물계산 자신감을 높일 수 있는 프로그램 개발을 제언한다. This study sought to identify the drug calculation confidence and clinical competency of nurses according to their knowledge of high-alert medications. The subjects were 137 nurses working at four general hospitals in G city. Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson"s correlation, and multiple regression. The knowledge of high-alert medications was 0.64, drug calculation confidence was 3.02, and clinical competency was 3.54. Female and a low level of knowledge of high-alert medications influenced drug calculation confidence, and clinical competency was influenced by the chief nurse or superior staff, work experience (more than 1 year and less than 3 years), and low knowledge of high-alert medications. Poor knowledge may have a negative effect on drug calculation and clinical competency in the clinical field. Therefore, it is suggested that a program be developed to increase the knowledge of high-alert medications and the drug calculation confidence of nurses through a suitable education method.

국내 고위험 의약품 사용 규모

한지민,아영미,정종현,이수현,이아영,허규남,박소영,채현우,이주연,민상일 대한약물역학위해관리학회 2023 약물역학위해관리학회지 Vol.15 No.2

This study aimed to estimate the rate of high-alert medication (HAM) use in nationwide representative claims data and compare the rates by types of healthcare settings. Methods: This cross-sectional study used data obtained from 2019 and 2020 Health Insurance Review and Assessment Service National Patient Sample (HIRA-NPS) and National Inpatient Sample (HIRA-NIS). The study focused on essential HAMs from the HAM list for acute, long-term, and primary care settings. The usage was quantified in terms of the number of patients receiving the medications at least once, the proportion within the entire patient population, and the ratio of prescription days for HAMs to total days. We also analyzed the rate of inpatients who received HAMs in HIRA-NIS. Results: Among 1,888,831 patients included in the database, 480,852 patients (25.5%) received HAMs at least once annually, with oral benzodiazepine derivatives being the most commonly prescribed. Substantial variations were observed in HAM usage across healthcare settings with the highest prevalence observed in long-term care hospitals (32.4%) followed by acute care hospitals (24.8%) and primary care clinics (15.3%). Among inpatient populations, injectable benzodiazepines, anesthetics, and neuromuscular blockers were frequently prescribed. Conclusion: This study offers insights into the utilization of HAMs across various healthcare settings. It highlights the need for targeted interventions and management strategies to ensure the safe use of these medications, particularly in long-term care settings