Geriatrics Medication Safety On the Wards Patient Safety

APINCHS – High Risk Medications

High risk medicines (HRMs) are medicines that have an increased risk of causing significant patient harm or death if they are misused or used in error.

HRMS include:

  • Medicines with a narrow therapeutic index
  • Medicines that present a high risk when
    • Administered via the wrong route
    • Other medication management system errors occur
    • Prescribed by phone order
    • Proper clinical assessment of the patient is not performed and documented
AAntimicrobialsAminoglycosides: gentamicin, tobramycin and amikacin vancomycin amphotericin – liposomal formulation
PPotassium and other electrolytesInjections of concentrated electrolytes: potassium, magnesium, calcium, hypertonic sodium chloride
IInsulinAll insulins  
NNarcotics (opioids) and other sedativeshydromorphone, oxycodone, morphine, fentanyl, alfentanil, remifentanil and analgesic patches   Benzodiazepines: diazepam, midazolam   thiopentone, propofol and other short term anaesthetics
CChemotherapeutic agentsvincristine, methotrexate, etoposide, azathioprine Oral chemotherapy
HHeparin and other anticoagulantswarfarin, enoxaparin, heparin   Direct oral anticoagulants (DOACs): dabigatran, rivaroxaban, apixaban
S  Systems  Medication safety systems such as independent double checks, safe administration of liquid medications, standardised order sets and medication charts etc

Some of the medications here are frequently prescribed in hospital practice. Extra care must be taken when prescribing these medications as a phone order, especially to elderly and/or unwell patients. It is strongly recommended that junior doctors do not give phone orders for opioids or sedatives.

If you administer strong sedatives, such as haloperidol or droperidol, you must physically assess the patient as soon after as is possible. You must also document in the clinical notes that you have assessed the patient for any exacerbating factors, such as sepsis and head injury

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