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Gastroenterologically relevant high alert medications prescribed to children with chronic diseases-a consensus-driven
Judith Hochrainer1, Rebecca Einspieler1, Andreas Heilos1
1Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
Insights
This study identified 12 High Alert Medications (HAMs) for pediatric gastroenterology home care, highlighting immunosuppressants. Many identified HAMs were not on existing lists, emphasizing the need for localized medication safety protocols.
Area of Science:
- Pediatric Gastroenterology
- Pharmacovigilance
- Medication Safety
Background:
- Children with chronic diseases often manage complex home medication regimens.
- Medication errors in this population pose significant patient and medication-related risks.
- High Alert Medications (HAMs) require special attention due to their potential for severe adverse events.
Purpose of the Study:
- To identify High Alert Medications (HAMs) specifically for pediatric gastroenterology patients on home medication.
- To develop and apply a novel scale for assessing medication risk and potential patient harm.
- To compare identified HAMs with existing international lists.
Main Methods:
- A consensus approach was used by interdisciplinary teams to identify relevant medications.
- A new five-level scale evaluated inherent medication risk and individual patient harm.
- Medications were classified using the Anatomical Therapeutic Chemical (ATC) system and compared to existing HAM lists.
Main Results:
- Twelve medications were identified as HAMs through the intersection of high medication risk and high potential patient harm categories.
- Immunosuppressants constituted the largest therapeutic class among the identified HAMs.
- 50% of identified HAMs appeared on only one other published list, and one-third were not previously classified as High Alert.
Conclusions:
- The study identified specific HAMs crucial for pediatric gastroenterology home care, underscoring the need for localized lists.
- Discrepancies with existing HAM lists highlight variations in methodology and clinical context.
- Further validation studies are recommended to generalize findings and improve medication safety for this vulnerable population.
Introduction:
Children with chronic diseases, including complex gastroenterological patients, often manage complex home medication regimens, where errors pose significant patient- and medication-related risks. High Alert Medications (HAMs) are those with a particularly high potential for adverse consequences if administered incorrectly.
Aim:
This study used a consensus approach to identify HAMs in the pediatric gastroenterological population, using a new scale to measure medication risk and potential patient harms.
Methods:
This secondary analysis included 106 children with chronic diseases discharged from the Medical University of Vienna. Interdisciplinary teams identified relevant medications through a consensus approach and separately evaluated the inherent risk of each medication and the potential harm of its use at the individual patient level using five-level scales. Substances were coded via the Anatomical Therapeutic Chemical classification system (ATC system), ranked, and compared with existing HAM lists.
Results:
Thirty-two medications were categorized into the highest medication risk categories, and 16 into the highest potential patient harm group. The intersection of these categories identified 12 medications defined as HAMs, with immunosuppressants forming the largest therapeutic class. Notably, 50% of the identified HAMs appeared in only one other published list, and one-third were not previously classified as High Alert.
Discussion:
Immunosuppressants carry elevated risk due to narrow therapeutic windows, complex drug interactions, and potential for severe organ dysfunction. Discrepancies between HAM lists stem from varied methodologies and local clinical characteristics. This study distinguishes itself by focusing specifically on home care and by including off-label medications. The findings underscore the need for localized HAM lists to address specific risks within the target population. Validation studies and consideration of empirical data are needed to further generalize our findings.
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