Hospitals can improve high-alert med safety procedures with self-assessment

ISMP releases new tool

Hospitals in the United States are required to identify and maintain active lists of high-alert medications, which isn’t hard to do. But when it comes to the next step of developing safety procedures for high-alert medications, the task can become more challenging.

For example, double-checks are usually a standard intervention for high-alert medications, according to Dan Degnan, PharmD, CPPS, FASHP, senior project manager at the Center for Medication Safety Advancement at Purdue University College of Pharmacy in West Lafayette, IN. But too often, not enough attention is given to the quality, documentation, and structure associated with double-checks of high-alert medications.

The Institute for Safe Medication Practices (ISMP) knows about these concerns and others and released a new tool to help hospitals, long-term care facilities, and certain outpatient facilities evaluate best practices related to high-alert medications, as well as identify opportunities for improvement and track experiences over time. After completing the assessment, participants are encouraged to submit their findings to ISMP anonymously via a secure internet portal and in turn see how they compare to demographically similar organizations through a weighted score—in essence giving hospitals a means for improvement.

“It has to be an interdisciplinary process, and any procedure needs to be performed in a reliable way,” said Degnan. “It seems that the assessment from ISMP embraces this concept.”

Feedback on navigating the self-assessment

The tool, called the ISMP Medication Safety Self Assessment for High-Alert Medications, focuses on general high-alert medications and 11 specific medication categories—including opioids, insulin, neuromuscular blocking agents, chemotherapy, and moderate and minimal sedation.

“I found the most interesting section to be the one on opioids,” said Degnan. “It asks the most questions and seems to cover a variety of topics regarding patient setting, prescribing, reversal agents to addiction, and abuse. Given the focus on opioids in our country today, this seems to be a particularly relevant area of attention.”

Degnan also pointed out the glossary used at the end of the tool.

“My thought is that this could be helpful for not only filling out the survey, but for everyday use as well,” he said.

Hospitals might have to spend some time gathering the information to accurately answer each of the questions in the self-assessment. Degnan said the survey seems to be designed to be answered as a facility.

High-alert medication list

High-alert medications have the ability to cause the most harm to patients, and resources have been available for some time to help hospitals and other facilities compile high-alert medication lists.

Currently, high-alert medications are identified subjectively through national safety organizations, error reporting, expert consensus, and current literature. Some safety experts, such as Natalie Washburn, PharmD, and Todd Walroth, PharmD, BCPS, BCCCP, believe this process can be improved.

“While many health care systems have adopted their own high-alert medication list based on internal medication incidents, a standardized approach to high-alert medication identification could result in a more robust method for improving patient safety surrounding these medications,” said Washburn, a critical care pharmacist at Bronson Methodist Hospital in Michigan. Washburn would like to see consistency across institutions to allow for focused research about safety concerns with the use of these medications. Along with Walroth, who is a clinical pharmacy specialist at Eskenazi Health in Indiana, Washburn is part of a team conducting a High Alert Medication Stratification Tool–Revised (HAMST-R) multicenter study that assesses not only global patient safety concerns, but also potential safety concerns in each stage of the medication use process.

What to look out for

Participants have until February 28, 2018, to submit their findings to ISMP via the secure portal. Michael Cohen, RPh, FASHP, president of ISMP, said results should be ready by mid to late spring in 2018.

“Groups of hospitals or other practice locations can contact us about aggregating data for their organizations so they can compare themselves against others,” said Cohen. “Individual organizations will already be able to compare themselves to organizations in similar demographic categories.”

Error reports involving high-alert medications, published articles, and input from providers all went into the development of ISMP’s new self-assessment tool.


For the full article, please visit for the upcoming December 2017 issue of Pharmacy Today