Status of Management for High-Alert Medications

다국어 초록 (Multilingual Abstract)

“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.