title: High-alert medications in the pediatric intensive care unit.
abstract: OBJECTIVE
  To identify pediatric intensive care unit (PICU) clinicians' perceptions of high-alert medications and to develop a PICU-specific, high-alert medications list. We hypothesize that a PICU-specific list will include medications not identified on the Institute for Safe Medications Practices list and that the high-alert medications identified will differ by PICU clinician type (physicians, nurses, pharmacists).
  
  
  METHODS
  PICU-specific multisite, institution-based survey of clinicians' perceptions of high-alert medications.
  
  
  METHODS
  The PICU in each of five institutions participating in the Chicago Pediatric Patient Safety Consortium.
  
  
  METHODS
  Nurses, physicians, and pharmacists working in the PICU.
  
  
  METHODS
  None.
  
  
  RESULTS
  PICU clinicians identified their top ten high-alert medications and their perceptions of each medication's risks and frequency of misuse. Weighted responses were calculated and compared to the Institute for Safe Medications Practices list and by clinician type. Results are based on 112 surveys collected from 56 nurses (response rate: 29%), 26 physicians (79%), and 30 pharmacists (71%), with 90 different medications or medication classes named. The top high-alert medications identified included intravenous potassium (weighted response: 72%), heparin (63%), and insulin (48%). PICU-specific high-alert medications (e.g., calcium [27%], phenytoin [21%], aminoglycosides [15%]) were not reported on the Institute for Safe Medications Practices list. Nurses more often cited medications with administration error risk (e.g., adenosine, calcium, p < 0.01), while physicians reported those with narrow therapeutic windows (e.g., aminoglycosides, diuretics, p < 0.01), and pharmacists identified medications with both administration and narrow therapeutic window risks (e.g., insulin, digoxin, p < 0.01). Clinicians perceived the frequency of risk of misuse of the most common high-alert medications to be at least once a year.
  
  
  CONCLUSIONS
  PICU clinicians identified high-alert medications not identified on the Institute for Safe Medications Practices list. Risks of the identified high-alert medications were attributed to a wide range of different stages in the medication process as well as clinicians' varying experiences in the medication process.
authors.affiliation: Department of Pediatrics, Pediatric Critical Care Medicine, University of Arizona Health Sciences Center, USA. hfranke@peds.arizona.edu
authors.forename: Hillary A
authors.initials: HA
authors.lastname: Franke
authors.forename: Donna M
authors.initials: DM
authors.lastname: Woods
authors.forename: Jane L
authors.initials: JL
authors.lastname: Holl
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007400:Interprofessional Relations; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008510:Medication Systems, Hospital; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000008:administration & dosage* / Q000145:classification* / Q000494:pharmacology; D011336:Probability; D011786:Quality Control; D018570:Risk Assessment; D017751:Safety Management; D012680:Sensitivity and Specificity
chemical_list: D055553:Prescription Drugs