High-risk medicines: Multidisciplinary program to improve hospital safety

High-risk medications (HRMs) are those with a high probability of causing severe or fatal harm when errors occur during their use. Enhancing safety in the management of HRMs is a priority for healthcare authorities. This study presents a multidisciplinary program designed to optimize the safe use of HRMs in adult inpatients at a Level 5 hospital.

The objectives of the program are: a) To adapt national and international standards on HRM safety to the local setting. b) To define the competencies and responsibilities of the professionals involved. c) To increase the engagement of stakeholders in HRM safety. d) To establish indicators to evaluate the interventions.

The program was developed in three phases: 1) Initial situation analysis: Assessment using the Institute for Safe Medication Practices' self-assessment questionnaire on medication safety. 2) Protocol development: Creation of a local protocol based on a literature review and multidisciplinary consensus. 3) Action plan implementation: Dissemination, monitoring, and periodic updates of the protocol.

The developed protocol included seven general measures, 29 specific measures, and five indicators to evaluate its impact. After the first year of implementation: 71.5% of HRMs were stored in high-security locations within automated dispensing systems, 71.36% of HRM prescriptions were validated within the first 24 hours and a total of 4,366 pharmaceutical interventions were performed. Additional measures implemented included: Tall Man Lettering across all information systems, automated alerts for maximum doses in prescribing systems and alerts prompting independent double-checking during HRM dispensing.

This program is an effective and transferable model for improving HRM safety in complex hospital settings and fostering a safety culture. Future initiatives should focus on developing a national dashboard with standardized indicators to enable inter-hospital comparisons and identify areas for improvement.