High-alert medications in the pediatric intensive care unit

Area of Science:

• Pediatric Intensive Care
• Medication Safety
• Clinical Pharmacy

Background:

• High-alert medications pose significant risks in pediatric intensive care units (PICUs).
• Existing lists of high-alert medications may not fully capture PICU-specific concerns.
• Understanding clinician perceptions is crucial for developing targeted safety interventions.

Purpose of the Study:

• To identify high-alert medications perceived by PICU clinicians.
• To develop a PICU-specific list of high-alert medications.
• To compare clinician perceptions of high-alert medications across different professional roles (physicians, nurses, pharmacists).

Main Methods:

• A multisite, institution-based survey was conducted among PICU clinicians (nurses, physicians, pharmacists).
• Clinicians identified their top ten high-alert medications and perceptions of associated risks and misuse frequency.
• Weighted responses were analyzed and compared to the Institute for Safe Medications Practices (ISMP) list and by clinician type.

Main Results:

• PICU clinicians identified intravenous potassium, heparin, and insulin as top high-alert medications.
• PICU-specific high-alert medications, such as calcium and phenytoin, were identified that are not on the ISMP list.
• Nurses, physicians, and pharmacists differed in their identification of high-alert medications based on risk type (administration errors vs. narrow therapeutic windows).

Conclusions:

• PICU clinicians identified high-alert medications not recognized by the ISMP.
• Perceived risks associated with high-alert medications varied by medication and clinician type.
• Developing a PICU-specific high-alert medication list is essential for enhancing patient safety.