This policy is derived from Pharmacy and can also be found in the Pharmacy Formulary.

In order to promote patient safety and provide a consistent level of care within the hospital and clinics at UAMS, the Pharmacy and Therapeutics Committee shall identify drugs considered to be high risk.   Their scope of use will be defined on an ad hoc basis for current formulary products and on addition to the formulary for new drug products.  The committee shall set protocols, guidelines and scope of practice considerations for use of high risk drugs.

DEFINITION: 

High-risk drugs are those drugs that require special handling due to a narrow therapeutic index, multiple drug/disease reactions, severe life-threatening side effects, or require special monitoring before, during or after the administration of the drug.

DETERMINATION OF QUALIFICATIONS FOR HIGH RISK DRUGS:

1. Any health care practitioner may request that qualifications for use be considered for a particular drug.
2. The risk potential for a drug will be reviewed in the literature so that appropriate measures for patient safety may be instituted.
3. All drugs added to the high risk drug policy will have consensus of the P&T committee and the Nursing Scope of Practice Council.

PROCEDURE:

1. Any high risk drug addressed in this policy may be administered in any patient care area where the administration criteria may be met.  Drugs used in the in-patient or out-patient surgical suites during surgery are not covered in this policy.
2. Any practitioner administering a high risk drug will be familiar with dosing, expected outcomes, potential adverse effects and monitoring requirements.  If prolonged monitoring is required, competent staff must be present to provide it.
3. Additions and deletions of drugs may be made ONLY at the discretion of the Pharmacy and Therapeutics committee.
4. Absence of a drug from this list shall not imply lack of risk of using it in a patient care area.
5. Drugs which cannot meet requirements defined in this policy must be administered in a critical care area.  Critical Care areas at UAMS are defined as the ED, 4E, 6B, PACU, CCN, ICN, and surgical areas with full service anesthesia care.
6. In situations where ACLS or NALS protocols are in effect, restrictions of this policy will not apply.
7. Drugs requiring double checks will apply to all patient care areas, including the critical care units.

ADMINISTRATION GUIDELINES AND QUALIFICATION CRITERIA:

1. Administration of the following drugs requires:

• A double check of the drug with the order by two licensed individuals together prior to administration
• A double check of any pump setting with the order prior to administration if a pump is used to administer the drug.
• Documentation of double checks by both licensed individuals in the patient's record.

• Continuous narcotics
• Blood products
• PCA pumps
• Total Parenteral Nutrition
• Insulin
• Heparin
• Any cancer themotherapeutic agent
• Eptifibitide
• Abciximab
• Any drug used in epidural drips
• All intrathecal preparations

 

2. Intravenous administration of the following drugs may occur in any patient care area if:

• The rate is constant
• The upper dosage limit defined is not exceeded.

• Dopamine - 5mcg/kg/min
• Dobutamine 15 mcg/kg/min - 6C only
• Dobutamine - 10 mcg/kg/min
• Milrinone - 0.5 mcg/kg/min

3. Administration of the following drugs requires the presence of an experienced attending physician, continuous bedside cardiac monitoring and immediate availability of resuscitative equipment:

• Amiodarone injection
• Ibutilide
• Dofetilide

4. The following drugs may only be administered in intubated, mechanically ventilated patients:

• Propofol
• Neuromuscular blocking agents - no more than the immediate dose is to be drawn up.

5. The following drugs require personnel or patient protection:

• All cancer chemotherapeutic agents
• Thalidomide
• Ribavirin inhalation

6. The following drugs are to be administered only under special criteria as defined specifically for a drug:

• Neuromuscular blocking agents - Used for induction only when physician administers the drug and patient requires intubation.  Life support facilities and code team, or equivalent, are present.  Dose must be double checked against vial by two licensed individuals and documented in the patient's medical chart.

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