title: Developing a list of high-alert medications for patients with chronic diseases.
abstract: BACKGROUND
  Patients with chronic diseases often receive multiple medications and are associated with increased vulnerability to medication errors. Identifying high-alert medications for them would help to prioritize the interventions with greatest impact for improving medication safety. The aim of this study was to develop a list of high-alert medications for patients with chronic illnesses (HAMC list) that would prove useful to the Spanish National Health Service strategies on chronicity.
  
  
  METHODS
  The RAND/UCLA appropriateness method was used. Drug classes/drugs candidates to be included on the HAMC list were identified from a literature search in MedLine, bulletins issued by patient safety organizations, incidents recorded in Spanish incident reporting systems, and previous lists. Eighteen experts in patient/medication safety or in chronic diseases scored candidate drugs for appropriateness according to three criteria (evidence, benefit and feasibility of implementing safety practices). Additionally they rated their priority of inclusion on a Likert scale.
  
  
  RESULTS
  The final HAMC list includes 14 drug classes (oral anticoagulants, narrow therapeutic range antiepileptics, antiplatelets - including aspirin -, antipsychotics, β-blockers, benzodiazepines and analogues, corticosteroids long-term use, oral cytostatics, oral hypoglycemic drugs, immunosuppressants, insulins, loop diuretics, nonsteroidal anti-inflammatory drugs, and opioid analgesics), and 4 drugs or pairs of drugs (amiodarone/ dronedarone, digoxin, oral methotrexate and spironolactone/eplerenone).
  
  
  CONCLUSIONS
  An initial list of high-alert medications for patients with chronic diseases has been developed, which can be built into the medication management strategies for chronicity to guide the implementation of efficient safety strategies and to identify those patients at greater risk for preventable adverse drug events.
authors.affiliation: ISMP-España, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain. Electronic address: mjotero@telefonica.net.
authors.forename: María José
authors.initials: MJ
authors.lastname: Otero
authors.affiliation: ISMP-España, Servicio de Farmacia, Hospital Santos Reyes, Aranda de Duero, Burgos, Spain. Electronic address: ammoreno@saludcastillayleon.es.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Moreno-Gómez
authors.affiliation: Unidad de Farmacia, Área de Gestión Sanitaria Sur de Sevilla, Spain. Electronic address: bernardo.santos.sspa@juntadeandalucia.es.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Santos-Ramos
authors.affiliation: Dirección General de Salud Pública, Calidad e Innovación, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain. Electronic address: yagra@msssi.es.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Agra
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000638:Amiodarone / Q000009:adverse effects / Q000031:analogs & derivatives; D000701:Analgesics, Opioid / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects; D001569:Benzodiazepines / Q000009:adverse effects; D002908:Chronic Disease / Q000188:drug therapy*; D054697:Cytostatic Agents / Q000009:adverse effects; D004077:Digoxin / Q000009:adverse effects; D000077764:Dronedarone; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D000077545:Eplerenone; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007328:Insulin / Q000009:adverse effects; D008727:Methotrexate / Q000009:adverse effects; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000009:adverse effects; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000305:Adrenal Cortex Hormones; D000319:Adrenergic beta-Antagonists; D000701:Analgesics, Opioid; D000889:Anti-Arrhythmia Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D014150:Antipsychotic Agents; D054697:Cytostatic Agents; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin; D000451:Mineralocorticoid Receptor Antagonists; D010975:Platelet Aggregation Inhibitors; D049994:Sodium Potassium Chloride Symporter Inhibitors; D001569:Benzodiazepines; D013148:Spironolactone; D000077545:Eplerenone; D004077:Digoxin; D000077764:Dronedarone; D000638:Amiodarone; D008727:Methotrexate
keywords: Chronic patient; High-alert medications; Medication errors/prevention and control; Patient safety; Safety management/organization and administration