Medication Safety in High-risk Situations

World Health Organization (WHO). Medication Safety in High-risk Situations (WHO/UHC/SDS/2019.10). Geneva. Licence: CC BY-NC-SA 3.0 IGO.

High-risk situations are important because they are more often associated with significant harm due to unsafe medication practices or medication errors. There are three main factors contributing to high-risk situations: medication, provider and patient, and systems factors (work environment).

Medication factors include the use of high-risk (high-alert) medications, often medicines with a low therapeutic index (a low ratio of the maximally tolerated dose of a medication to the minimal curative or effective dose). The development of local high-risk (high-alert) medication lists that are regularly updated help health care professionals focus on particular risks in their own workplace. This report seeks to highlight some of the medications which have been identified globally as being high-risk (high-alert). However, such lists need to be developed locally to reflect the medications most commonly associated with medication error and adverse drug events in different countries and health care settings. Merely creating a high-risk (high-alert) medication list is of little use without associated risk reduction strategies.

Provider and patient factors may be related to the health care professional providing patient care or the patient being treated. Poor prescribing practices by health care professionals include overprescribing, underprescribing and misprescribing. However, errors may occur at any stage of the medication process, including dispensing and administration.

Systems factors (work environment) include the setting (such as hospitals) and high-risk situations within those settings (e.g. risks associated with perioperative or neonatal care).

Medication errors are often caused by a combination of medication, provider and patient, and systems factors; therefore, a range of sustainable strategies of proven efficacy should be developed and implemented in conjunction.

These strategies form part of a systems approach to reduce the risk of medication errors, supported by a strong safety and reporting culture, alongside education and feedback.

Each country participating in the third WHO Global Patient Safety Challenge: Medication Without Harm needs to clearly define its own objectives for improving medication safety by convening a group of experts, including for instance physicians, pharmacists, patient representatives, regulators and health system leaders; to select a small number of high-risk (high-alert) medications and high-risk situations for action that are applicable to their situation and achievable within the resources available.

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