Medications are the most common intervention in health care and are also most commonly associated with adverse events in hospitalized patientsi. Older hospitalized patients are at higher risk of adverse drug eventsii, in part due to their increased use of medications and co-morbid conditions such as kidney and liver disease. An increase in the number of medications increases the likelihood of drug-drug and drug-disease interactions.iii

Not all medications in clinical use are of equal risk to patients. Serious adverse events appear to be caused by relatively small number of medications.iv The Institute of Medication Practice has identified a number of medications that they consider to be “high-alert medications.” v These are defined by The Joint Commission as those medications which are more likely to be associated with harm than other medications—they cause harm more commonly, the harm they produce is likely to be more serious, and they “have the highest risk of causing injury when misused.”vi

Because of the complexity of attempting to identify and prevent all ADE’s, focusing surveillance and prevention of high alert medications may be a more prudent approach. The Institute for Healthcare Improvement’s 5 Million Lives campaign found that focusing on a few groups of high alert medications: anticoagulants, narcotics and sedatives, and insulin would have the greatest impact. These medications, due to their high volume of use coupled with their inherent risks and, are responsible for the majority of harm due to all high-alert medications. viii


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i Leape, et al, The nature of adverse events in hospitalized patients, Results of the Harvard Medical Practice     Study II. Tew England Journal of Medicine, 323, 377 – 384.

ii Classen, et al, Adverse drug events in hospitalized patients: Excess length of stay, extra cost, and attributable mortality. JAMA 277:301 – 306, Jan. 22 – 29, 1997.

iii Thomas and Brennan, The incidence and types of preventable adverse events in elderly population-based review of medical records. BMJ 320:741 – 744, Mar. 18, 2000.

iv Budnitz, et al, Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med, 147:755 – 765, Dec. 4, 2007.

v Smetzer, et al, Findings from the IIS MP medication safety self-assessment for hospitals, Jt. Comm J Qual Saf, 29:586-597, Nov. 2003

vi The Joint Commission: The .Joint Commission announces the 2008 National Patient Safety Goals and Requirements. Jt. Comm Perspect. 27:1, 9-22, Jul. 2007.

vii Classen, et al, Adverse drug events among hospitalized Medicare patients: Epidemiology and national estimates from a new approach to surveillance. Jt. Comm J Qual Saf, 36 (1):12-20, Jan. 2010.

viii Getting Started Kit: Prevent Harm from High-Alert Medications How-to Guide. (last accessed March 8, 2012).