title: A multicenter, multidisciplinary, high-alert medication collaborative to improve patient safety: the Singapore experience.
abstract: BACKGROUND
  High-alert medications can cause significant patient harm when used in error. A multicenter, multidisciplinary, high-alert medication collaborative was established in Singapore in 2009 to identify and maintain a current list of high-alert medications and to create systematic approaches for preventing and reducing the risk of medication errors and adverse drug events (ADEs) for high-alert medications.
  
  
  METHODS
  The collaborative was led by a core multidisciplinary team consisting of pharmacists, nurses, and physicians, as well as clinical services and quality personnel, from six primary and acute care institutions. Multidisciplinary work groups were formed to drive the improvement efforts using the Plan-Do-Study-Act (PDSA) cycles. Tracking of improvement work was conducted with an adaptation of the Institute for Healthcare Improvement Trigger Tool method.
  
  
  RESULTS
  A localized high-alert medication list was developed through local ADE reports, literature review, an online survey of health care professionals, and expert opinion. Some 130 interventions were proposed to prevent, detect, and mitigate harm from the use of high-alert medications for 10 drug classes/drugs. A significant number of these interventions were tested and revised during the PDSA cycles before implementation throughout the institution and subsequent spread to other institutions. Outcome audits identified areas for improvement. The interventions, which were subsequently incorporated into the change packages, led to a 50% and 67% decline in the ADE rates for radiocontrast agents and heparin, respectively.
  
  
  CONCLUSIONS
  The collaborative has provided a sound framework for ongoing development and refinement of high-alert medication change packages and for sharing of ADE data and best practices across the participating institutions.
authors.affiliation: Pharmacy and Therapeutics Office, National Healthcare Group, Singapore. Ai_Leng_Khoo@nhg.com.sg
authors.forename: Ai Leng
authors.initials: AL
authors.lastname: Khoo
authors.forename: Monica
authors.initials: M
authors.lastname: Teng
authors.forename: Boon Peng
authors.initials: BP
authors.lastname: Lim
authors.forename: Hwei Yee
authors.initials: HY
authors.lastname: Tai
authors.forename: Tang Ching
authors.initials: TC
authors.lastname: Lau
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D003299:Cooperative Behavior; D006302:Health Services Research; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D061214:Patient Safety; D058996:Quality Improvement; D012846:Singapore