ISMP Survey on High-Alert Medications in Community/Ambulatory Settings

Please take a few minutes to complete this short survey on high-alert medications (see definition below), and submit your responses by August 20, 2006.

High-Alert Medications: Medications that bear a heightened risk of causing significant patient harm when they are used in error. Although errors may or may not be more common with these medications, their direct consequences are often more devastating.

Section A: indicate whether YOU believe these drugs or class of drugs should be considered high-alert medications in community/ambulatory settings.

Section B: indicate whether YOUR PRACTICE SITE considers each drug or class of drugs a high-alert medication, with special precautions in place when using them.

What is your professional designation? Select Pharmacist Nurse Nurse Practitioner Physician Physician Assistant Administrator Other

Medication or Class of Medications: Unless otherwise stated, the intended use for all medications is pediatric and adult patients.	Section A Do YOU believe this is a high-alert medication?		Section B Does YOUR PRACTICE SITE consider this a high-alert medication with special precautions in place?		Comments
Class/Category of Medications	Yes	No	Yes	No
1. anti-retroviral agents
2. chemotherapeutic agents, oral
3. chemotherapeutic agents, parenteral
4. hypoglycemic agents, oral
5. immunosuppressant agents (e.g., cyclosporine, azathioprine)
6. moderate sedation agents, oral (e.g., chloral hydrate)
7. narcotics/opiates (including lozenge, oral, transdermal, liquid concentrates, immediate- and sustained-release formulations)
8. pregnancy category X agents
9. Other classes (specify):
Specific Medications	Yes	No	Yes	No
1. acetaminophen
2. opium tincture
3. heparin, low molecular weight, injection
4. heparin, unfractionated, injection
5. insulin, inhaled
6. insulin, injection
7. methotrexate, non-oncologic use
8. pramlintide (Symlin), injection
9. warfarin
10. Others medications (specify):