ISMP Survey on High-Alert Medications

Please take a few minutes to complete this short survey on high-alert medications (see definition below), and submit your responses by September 25, 2003, via our website or by faxing to 215-914-1492 if Internet access is unavailable).

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 consequences are often more devastating.

For Section A, indicate whether YOU believe these drugs or class of drugs should be considered high-alert medications. For 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.

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?



Class/Category of Medications Yes No Yes No  
1. IV adrenergic agonists (e.g., epinephrine)
2. IV adrenergic antagonists (e.g., propranolol)
3. Parenteral chemotherapeutic agents
4. Oral chemotherapeutic agents
5. Neuromuscular blocking agents (e.g., succinylcholine)
6. IV thrombolytics/fibrinolytics (e.g., tenecteplase)
7. Liposomal forms of drugs (e.g., amphotericin B)
8. Glycoprotein IIb/IIIa inhibitors (e.g., tirofiban)
9. IV conscious sedation agents (e.g., midazolam)
10. Oral conscious sedation agents for children (e.g., chloral hydrate)
11. Oral/IM narcotics/opiates
12. IV narcotics/opiates
13. Dialysate
14. Cardioplegic solutions
15. Total parenteral nutrition
16. Inhaled and IV general anesthetic agents (e.g., propofol)
17. IV inotropic medications (e.g., digoxin, milrinone)
18. Benzodiazepines in patients over 65 (e.g., alprazolam)
19. Oral hypoglycemic agents (e.g., glipizide)
20. Low molecular weight heparin
21. Others:
Specific Medications Yes No Yes No  
22. Warfarin
23. IV heparin
24. Subcutaneous insulin
25. IV insulin
26. IV magnesium sulfate
27. IV calcium gluconate
28. IV calcium chloride
29. IV potassium phosphate
30. IV potassium chloride
31. Hypertonic sodium chloride injection
32. High concentration dextrose injection
33. IV theophylline
34. Others:

Choose the option that best describes your professional designation:


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