High-risk drugs What are they?

Undoubtedly, when we are inside a hospital room, we fully entrust our health to the nurses and doctors who work there, however, cases have been confirmed in which the application methodology of some medicines has been neglected, thus becoming high-risk drugs for the health of patients.

The indication of drugs with side effects in different groups of patients has motivated in-depth investigation of drug components and their effects in combination with others, resulting in the identification of drugs that have been designated as high risk, which require greater care and attention when being handled or stored.

What is a high risk drug?

High-risk drugs are all those drugs capable of causing serious injuries in patients, and can consequently reach the state of fatality.

A high-risk drug is a drug that commonly represents a solution to an injury or disorder, however, for its effective operation, a correct application is necessary, otherwise it may cause severe and irreversible injuries in some cases.

Therefore, we place special emphasis on a correct application over the treatment time, to avoid adverse effects..

Main errors identified

The attention that deserves the correct execution of the professional practice is extremely important to avoid falling into the medication error.

The professional judgment covers the following:

• Misuse of the products.
• Failure to follow processes faithfully.
• Unidentified errors within the work and control system.

Errors in the area of ​​prescription

Doctors are not exempt from making errors in the indication of medications, many times the reason for this is that the poorly communicative patient omits information during their consultation.

However, a large percentage of side effects that occur in patients could be avoided with a correct application of health standards and procedures..

Among these errors we find:

• Lack of communication or unclear communication.
• Product labeling.
• Wrong packaging.
• The denomination.
• The wrong preparation.
• Dispensing.
• The distribution.
• The administration.
• The lack of education.
• Lack of monitoring.

Safety in handling medications

The beginning of the study for the knowledge of high-risk drugs is given by the narrow margin that these leave to the minimal application error and the serious consequences to the health of patients.

A study carried out by the Institute for Safe Medication Practices (ISMP) in 1995 and 1996 managed to collect information from a total of 161 hospitals in the United States..

Consequently, from the research carried out, said institution found the existence of a low number of high-risk drugs and of which it was necessary to pay very high attention to their control..

Know the list of high-risk drugs by the ISPM

Once the analyzes were completed, the list of high risk medications that has been kept in force in all health centers in addition to its constant updating with each drug that generates reports for dangerous reactions.

The following list published by the ISPM, reflects all high-risk drugs with their respective examples, is detailed by a division of two groups as follows:

Therapeutic groups

• Contrast agents IV
• Inotropic Agents IV: Digoxin, milrinone.
• Adrenergic Agonists IV: Adrenaline, dopamine, L-noradrenaline.
• Inhaled and IV General Anesthetics: Ketamine, Propofol.
• IV adrenergic antagonists: Esmolol, labetalol, propranolol.
• IV antiplatelet agents: Abciximab, eptifibatide, tirofiban.
• IV antiarrhythmics: Amiodarone, lidocaine.
• Oral anticoagulants: Acenocoumarol.
• Oral antidiabetics: Glibenclamide.
• Neuromuscular Blockers: Suxamethonium, Rocuronium, Vecuronium
• IV and oral cytostatics.
• Heparin and other antithrombotics: Antithrombin III, enoxaparin, heparin sodium, fondaparinux, lepirudin.
• Medications for epidural or intrathecal route.
• Medicines that have a conventional presentation and in liposomes: Amphotericin B
• Opioids IV, transdermal and oral (all presentations).
• Moderate sedatives IV: Midazolam.
• Moderate Oral Sedatives for Children: Chloral Hydrate.
• Cardioplegic solutions.
• Hypertonic glucose solutions (≥20%).
• Dialysis Solutions: Peritoneal and Hemodialysis.
• Parenteral nutrition solutions.
• Thrombolytics: Alteplase, drotrecogin alfa, tenecteplase.

Specific medications

• Sterile water for injection, inhalation and irrigation in containers ≥100 mL (excluding bottles).
• Potassium chloride IV (concentrated solution).
• Hypertonic sodium chloride (≥0.9%).
• Epoprostenol IV.
• Potassium phosphate IV.
• Insulin SC and IV.
• Oral methotrexate (non-cancer use).
• Sodium nitroprusside IV.
• IV oxytocin.
• Promethazine IV.
• Magnesium Sulfate Solution IV.

Recommendations offered for a safe procedure

Within the field of medicine, the conscious and correct use of high-risk drugs is directly linked to the following responsible:

• Applicators: He is part of the medical, nurse and pharmacist union.
• Supervisors: Nuclei, committees or referents of patient safety.

For those directly responsible for its application, we can name a series of recommendations to minimize errors and that the activities are carried out in a safe and controlled manner, for example:

• Use protocols and printed sheets to notify.
• Review the safety of the specialties available in the hospital.
• Centralize for greater close control of the processes most vulnerable to errors.
• Use double review strategies and process certification.
• Generate standardized lists of dosages.
• Facilitate information channels.

Educate patients

It is important to maintain the active and constant education of all the actors in the medicinal field, from the doctor, the supervisor and the patient, since there must be a free way of information and understanding of the knowledge of all these high risk medications, since a minimum error by someone responsible for this process can have severe consequences for a patient.

We know that the workers who make their lives within the health centers carry a very great burden, such as saving and maintaining the lives of patients every day, however, the support of the institutions in charge of ensuring the safety of patients , is present to develop the necessary strategies that allow a constant and stable procedure to be carried out in any case.