Preventing High-Alert Medication Errors in Hospital Patients (Part 2)

In the previous blog post an overview of high-alert medications was provided. The term “high-alert medications” was defined, four classes of drugs commonly included in high-alert medication lists were identified, and general prevention strategies were outlined. Knowledge and awareness regarding the consequences of high-alert medication errors is valuable. However, it may be even more important to develop an understanding regarding specific medication management principles hospitals should be implementing to decrease the incidence of medication errors. The practices described today can help to reduce the potential for harm and adverse events, and thus decrease the high costs associated with medication errors.1


The “Five Rights” Checklist and Independent Double-Checking

Research indicates that nurses intercept 50-86% of medication errors made by the physician or pharmacist before these errors reach the patient. Nevertheless, errors made by nurses are much more likely to reach a patient due to their role in directly administering drugs to patients.2A simple checklist known as the “five rights” of drug administration has been established to assist nurses and other health professionals in ensuring safe drug administration—rightpatient, right drug, rightdosage, right route,right time3; and the most recent sixth rightof documentation. This checklist provides a solid starting point to prevent medication errors.

In addition to the “five rights” nurses should also be performing independent double-checks. Conducting independent double-checks is a process that entails a second nurse verifying the “five rights” to ensure a drug error has not occurred. According to the Institute for Safe Medicine Practices (ISMP) double-checks may be able to prevent up to 95% of errors before reaching the patient.4


Reducing Distractions and Interruptions

Research has also shown that reducing distractions and interruptions aids in decreasing the incidence of medication errors. In one study, the chance of a medication error occurring rose 12% with each interruption that occurred during a single administration episode.2To combat this phenomenon hospitals have created no-interruption zones, established visuals such as colored vests or warning signs to signify a person shouldn’t be interrupted, and screened incoming calls while nurses are administering medications.


Eliminating Confusion Regarding Drug Names

Drugs with names that look or sound similar can lead to confusion and are one of the leading causes of medication errors.1,3Adopting tall-man lettering (such as DOPamine and DOBUTamine) for pharmacy-produced labels to differentiate drug names with the potential for mix-up helps to lower the probability of medication error.1


The Importance of Risk-Reduction Strategies

The Institute for Safe Medicine Practices asserts that high-alert medication lists are relatively useless without associated risk-reduction strategies.5If all hospitals implemented and educated their employees on prevention strategies for prescribing, dispensing, and administering high-alert medications the incidence of medication errors and patient harm would decrease significantly. In effect this would ultimately lower the total number of cases regarding serious harm to clients caused by medication errors.



  1. How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: Institute for Healthcare Improvement; 2012. Accessed October 14, 2018.


  1. Anderson P, Townsend T. Preventing high-alert medication errors in hospital patients. Am Nurse Today. 2015;10(5). Published May, 2015. Accessed October 14, 2018.


  1. Karch AM. Preventing medication errors by empowering patients. Am Nurse Today. 2015;10(9). Published September 2015. Accessed October 14, 2018.


  1. Independent Double Checks: Undervalued and Misused: Selective Use of This Strategy Can Play an Important Role in Medication Safety. Published June 13, 2013. Accessed October 14, 2018.


  1. Your High-Alert Medication List—Relatively Useless Without Associated Risk-Reduction April 4, 2013. Accessed October 14, 2018.