High-risk medication in community care: a scoping review

Area of Science:

• Pharmacovigilance
• Medication Safety
• Community Pharmacy Practice

Background:

• High-risk medications (HRMs) pose significant patient harm risks in community care settings.
• Inconsistent definitions and identification of HRMs complicate safety efforts.

Purpose of the Study:

• To systematically review the literature on high-risk medications (HRMs) in community care.
• To establish a clear definition for HRMs.
• To identify specific medications classified as HRMs in community settings.

Main Methods:

• A comprehensive scoping review of five major databases (MEDLINE, Scopus, CINAHL, Web of Science, Cochrane) and cited references.
• Independent review of 109 retrieved papers by two researchers, with 36 meeting inclusion criteria.
• Quality appraisal and data extraction to analyze definitions and identify recurrent attributes of HRMs.

Main Results:

• Inconsistent definitions of HRMs were identified across the reviewed literature.
• A derived definition for HRMs: 'medications with an increased risk of significant harm to the patient. The consequences of this harm can be more serious than those with other medications'.
• 66 specific medications or categories were identified as HRMs, with opioids, insulin, warfarin, heparin, and chemotherapeutics being most common.

Conclusions:

• The literature on HRMs in community care exhibits significant inconsistency in definitions and reported medications.
• A proposed definition is offered to promote consistent use in future research and policy.
• Further research is recommended to refine the classification and understanding of HRMs in community care.