Safe Practices for Error-Prone Medications

The Institute for Safe Medicine Practices (ISMP) recently outlined safe practices for certain error-prone medications.

ISMP president Michael Cohen, RPh, MS, ScD, DPS, FASHP, previously told Pharmacy Times in an exclusive interview that pharmacists are “the right people” to communicate potential safety issues to patients taking these complicated drug therapies.

“One thing I’d love to see pharmacists do more of is…not just educating patients about the drug, but also how to use the drug safely...and make follow-up calls to patients,” he said. “I don’t think [pharmacists] do that enough.”

The following high-alert medications are considered safe and effective treatments, but their potential for error could cause serious harm:

1.Warfarin

Too little warfarin can lead to a blood clot, while too much warfarin can lead to excessive bleeding. For these reasons, the anticoagulant should be taken exactly as directed.

2.Enoxaparin (Lovenox)

This blood thinner carries many of the same risks as warfarin, but as an injection, the drug also has potential for administration error. Syringes should be disposed of properly.

3.Fentanyl patch

Exposure to residual fentanyl on patches has proven fatal for children, so proper storage and disposal are crucial. A fentanyl patch should only be used to treat long-term pain in patients who have previously tried other prescription opioids without success.

4.Methotrexate (Trexall)

This cancer drug is sometimes used to treat other conditions, such as rheumatoid arthritis and psoriasis. For these conditions, the dosing is lower and the drug should be taken no more than once or twice a week. In light of this, the label should always be checked for particular dosing instructions.

5.Hydrocodone and acetaminophen

This combination opioid has many brand names, some of which could be mistaken for another drug at the pharmacy. Examples cited by the ISMP include Lorcet for Fioricet (a tension headache treatment) and Vicodin for Hycodan (an antitussive). Long-term use of hydrocodone and acetaminophen can also lead to drug dependence.

6.Oxycodone and acetaminophen

Just like hydrocodone and acetaminophen, this combination opioid has brand names that could be mistaken for another medication at the pharmacy. Examples cited by ISMP include Endocet for Indocin (a rheumatoid arthritis treatment) and Percocet for Percodan (aspirin and oxycodone). Long-term oxycodone and acetaminophen use also has high potential for abuse.

7.Insulin lispro (Humalog) and insulin aspart (NovoLog)

Both of these fast-acting types of insulin should never be mixed with insulin glargine (Lantus). If a pen or external pump is used, then it should never be mixed with other insulin types. If a syringe is used, then it can be mixed with Neutral Protamine Hagedorn (NPH) insulin. Frequency and dose are unique to each individual and subject to change.

8.Insulin glargine (Lantus)

This long-acting insulin is injected just once daily and often prescribed alongside short-acting insulin, though it should never mix with NovoLog or Humalog. Different insulin vials and pens should be distinct from one another to avoid mix-ups. Frequency and dose are unique to each individual and subject to change.

9. Insulin glusine (Apidra)

This rapid-acting insulin should not be co-administered with any other type of insulin, with the exception of NPH insulin. Like Lantus, different insulin vials and pens should be distinct from one another to avoid mix-ups. Frequency and dose are unique to each individual and subject to change.

10. Insulin detemir (Levemir)

Sometimes, this long-acting insulin is also considered intermediate acting. Like Lantus and Apidra, different insulin vials and pens should be distinct from one another to avoid mix-ups. As is the case for all insulin described here, frequency and dose are unique to each individual and subject to change.