High Alert Medications – Do you know what they are?

High alert medications are medications that may be associated with heightened risk and safety concerns in an event of a medication incident or error. Hence, there is a need to provide more awareness and education to all care providers handling these medications. It is also important to understand their unique needs and monitoring requirements.

However, there are way more medications than one can remember. As such, ISMP Canada has developed three specific lists of High Alert Medications pertaining to three different types of settings:

  1. Acute Care Settings
  2. Community & Ambulatory Healthcare Settings
  3. Long Term Care Settings

Of the three settings, the list for acute care settings has the most drug categories and specific drugs. See the attached highalertmedications_ acute care settings for more details.

In community and ambulatory healthcare settings, the following are consider high risk medications / categories:

Slide1In long term care settings, the following are considered high risk medications or categories:


These lists have been designed to help different healthcare organizations to determine which medications may require special safeguards to reduce the risk of errors.

Some examples of strategies include:

  • Standardizing the process for medication use including ordering, storage, preparation and administration.
  • Improve access to information
  • Limit access to high alert medications
  • Use auxillary label and automated alerts
  • Employ redundancies (automated or independent double check if necessary)

These strategies may or may not be the solution to minimize the risk of errors. It is important that each organization develops its own unique strategies or action plans to manage the risks of handling high alert medications in the organization.

Have you thought about what high alert medications you deal with everyday? Are sufficient safeguards implemented to protect your patients?

Thank you for reading my post.


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My name is Cynthia Leung and I am a practicing pharmacist in Kingston Ontario, Canada. This blog is for me to share my ideas, opinions and perspectives on how medications are used in our health care system. Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to. Any possible case scenarios described in my posts would be modified to maintain patient confidentiality. This blog is not a platform for professional advise for patients or health care providers and the content is not meant to support any clinical decisions or replace professional opinions. Also the images are either taken or created by the author, or adapted with permission. I hope you will enjoy reading my posts!

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