Implementation of safe practices for the use of high-risk medications in Spanish hospitals

To evaluate the implementation of safe practices for the use of high-risk medications in Spanish hospitals and to identify priority areas for improvement.

A multicenter descriptive study was conducted to assess the degree of implementation of safe practices included in the Spanish Medication Safety Self-Assessment® for High-Alert Medications. Included were Spanish hospitals that voluntarily completed the questionnaire between April and June 2025. The questionnaire comprises 186 assessment items, some with multiple components (254 in total), organized into eight sections: general practices and specific practices for neuromuscular blocking agents, intravenous potassium, insulins, methotrexate (non-oncological use), antineoplastics, anticoagulants and opioids. Mean scores and the percentages of the maximum possible score were analyzed for the overall questionnaire, each section, and each item or its components.

A total of 82 hospitals from 13 autonomous communities participated, most of them public (93.9%), general (97.6%) and teaching hospitals (98.8%). The overall implementation of safe practices was 52.7%, with wide variability among centers (29.7%-81.1%). General practices showed a low level of implementation (41.9%). Among therapeutic groups, the highest scores were observed for antineoplastics (80.5%), followed by neuromuscular blocking agents (64.7%), anticoagulants (61.3%) and insulins (54.8%). Values below 50% were found for opioids (49.8%), intravenous potassium (35.6%) and methotrexate (33.8%). The most widely implemented practices were related to storage (except potassium), dose expression and clinical monitoring. Those with the lowest level of implementation included several high-effectiveness technologies, such as clinical decision support alerts and barcode verification during medication preparation, dispensing and administration, as well as the integration of pharmacists into clinical units, preparation of standardized intravenous solutions in the pharmacy, and medication reconciliation at discharge. Low implementation was also observed in practices related to staff training.

The implementation of safe practices for high-risk medications in Spanish hospitals is moderate and heterogeneous, with notable variability across therapeutic groups and processes. These findings provide a useful reference at both national and local levels to prioritize improvement initiatives and to assess the impact of future interventions aimed at reducing medication errors associated with these drugs.