1. AFAMS EO 011.02 Storage of ISMP High Alert Medications (Dari) 01/09/2013

2. AFAMS Importance of Lesson (Dari) The Institute of Safe Medication Practices has identified medications as High Alert medications. These medications carry with them the ability to cause serious harm to patients if used incorrectly. The medications are important in the treatment of many medical conditions therefore, the Pharmacy must assist in ensuring that these medications are used properly. AFAMS Insert Dari

3. AFAMS Overview EO 011.02 (Dari) Define High Alert Medication Identifying High Alert Medications Storage requirements Identifying and notifying Ward and Pharmacy Staff of deficiencies. Lesson Review Quiz (not graded) AFAMS Insert Dari

4. AFAMS Definition Dari High Alert Medications (ISMP 2012) “High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error.” “Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients.” AFAMS Insert Dari

5. AFAMS High Alert Medications Dari AFAMS Insert Dari ISMP 2012

6. AFAMS Specific High Alert Medications Dari AFAMS Insert Dari ISMP 2012

7. AFAMS Methods to Reduce Errors Dari AFAMS Insert Dari Removal high concentrate electrolytes (e.g. potassium chloride, potassium phosphate and sodium chloride) from all nursing units. Stop using dangerous abbreviations such as “u”, and the trailing zero on a dosage (e.g. 5.0 mg). Use of a leading zero before a decimal place (e.g. 0.1mg) Review the hospital formulary for sound-alike and look-alike medications Use of “tall man” letters for sound-alike and look-alike names (e.g. DOBUTamine and DOPamine) Careful review of how products are arranged on shelves to avoid similar packaged or sound-alike medications being side by side. Reduce the dosage and volume options for a medication, i.e. default dose/volume/rate for specified dose ranges. Use of visible coloured auxiliary warning labels Enforce independent double checks on dosage calculation, and on the input of settings of infusion pumps being used for high alert drugs Use of pre-printed order forms Perform failure mode and effects analysis on all new protocols, procedures, as well as upon the addition of a new high alert drug or new medication device ISMP 2003

8. AFAMS Storage Requirements Dari AFAMS Insert Dari Storage/Stock Commercially packaged or pharmacy prepared pre-mixed solutions of high-alert medications will be used when available and when applicable to the patient population. The number of concentrations and/or volume options available for all high-alert medications on patient areas will be limited. Storage bins must be affixed with a “high- alert” label. Look-a-like, sound-a-like products must be segregated. Discontinued, expired, damaged and contaminated products are segregated and isolated until removal from the unit/facility. Where possible, multidose vials are reduced or eliminated. All premixed epidural solutions will be clearly labeled, “For Epidural Infusion Only” and stored separately from all intravenous solutions. Saskatoon Health Region, Saskatchewan, Canada

9. AFAMS Notification of Deficiencies Dari Upon identification of storage deficiencies Pharm Techs should notify a Clinical Pharmacist or the Chief of Pharmacy. Deficiencies should be corrected immediately to ensure patient safety. Staff should be educated by the Clinical Pharmacist on the proper handling and storage of High Alert Meds.

10. AFAMS Questions? Dari

11. AFAMS Review Dari

12. AFAMS Quiz Dari

13. AFAMS Quiz (Assessment) Dari Formative Assessment: Not marked Used to assess the students understanding of technical versus clinical questions. Students must correctly identify High Alert Medications from a list. The Instructor will provide the answers and debrief. Insert Dari

14. AFAMS List of Medications Dari 1.Ramipril 2.Epinephrine 3.Amiodarone 4.Clotrimazole 5.Midazolam 6.Morphine 7.Naproxen 8.Potassium Chloride 9.Warfarin 10.Heparin 11.Ibuprofen 12.Paracetamol 13.Digoxin 14.Sodium Chloride greater than 0.9% Insert Dari

15. AFAMS List of Medications Dari 1.Ramipril 2.Epinephrine 3.Amiodarone 4.Clotrimazole 5.Midazolam 6.Morphine 7.Naproxen 8.Potassium Chloride 9.Warfarin 10.Heparin 11.Ibuprofen 12.Paracetamol 13.Digoxin 14.Sodium Chloride for injection 0.9% Insert Dari

16. AFAMS End of EO Dari