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Peningkatan Keamanan High-Alert Medication

High-Alert Medication atau obat dengan kewaspadaan tinggi adalah obat-obat yang secara signifikan berisiko membahayakan pasien bila digunakan dengan salah atau pengelolaan yang kurang tepat. Di Indonesia, pada Peraturan Menteri Kesehatan RI Nomor 58 Tahun 2014 Tentang Standar Pelayanan Kefarmasian di Rumah Sakit mengharuskan rumah sakit untuk mengembangakan kebijakan pengelolan obat untuk meningkatkan keamanan khususnya obat yang perlu diwaspadai (high-alert medications). Obat ini sering menyababkan kesalahan serius (sentinel event) dan dapat menyababkan reaksi obat yang tidak diinginkan (ROTD). Berdasarkan study yang dilakukan oleh Institute for Safe Medication Practices (ISMP) di US, obat yang paling sering menyebabkan ROTD dan sentinel event adalah insulin, opium dan narkotik, injeksi potassium chloride (phospate) concentrate, intravenous anticoagulants (hepari) dan sodium chloride solution lebih besar dari 0,9%.

Berikut adalah ketagori dan spesifikasi obat yang termasuk ke dalam high alert medication .

List of High Alert Medication in Acute Care Setting

-Kategori/ kelas obat-obatan

Spesifikasi Obat

adrenergic agonists, IV (e.g., EPINEPHrine, phenylephrine, norepinephrine)

EPINEPHrine, subcutaneous

adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol)

epoprostenol (Flolan), IV

anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine)

insulin U-500 (special emphasis) : *All forms of insulin, subcutaneous and IV, are considered a class of high-alert medications.

Insulin U-500 has been singled out for special emphasis to bring attention to the

need for distinct strategies to prevent the types of errors that occur with this concentrated

form of insulin

antiarrhythmics, IV (e.g., lidocaine, amiodarone)

magnesium sulfate injection

antithrombotic agents, including:

  • anticoagulants (e.g., warfarin, low molecular weight heparin, IV unfractionated heparin)
  • Factor Xa inhibitors (e.g., fondaparinux, apixaban, rivaroxaban)
  • direct thrombin inhibitors (e.g., argatroban, bivalirudin, dabigatran etexilate)
  • thrombolytics (e.g., alteplase, reteplase, tenecteplase)
  • glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide)

methotrexate, oral, non-oncologic use

cardioplegic solutions

opium tincture

chemotherapeutic agents, parenteral and oral

oxytocin, IV

dextrose, hypertonic, 20% or greater

nitroprusside sodium for injection

dialysis solutions, peritoneal and hemodialysis

potassium chloride for injection concentrate

epidural or intrathecal medications

potassium phosphates injection

hypoglycemics, oral

promethazine, IV

inotropic medications, IV (e.g., digoxin, milrinone)

vasopressin, IV or intraosseous

insulin, subcutaneous and IV

 

liposomal forms of drugs (e.g., liposomal amphotericin B) and conventional counterparts

(e.g., amphotericin B desoxycholate)

 

moderate sedation agents, IV (e.g., dexmedetomidine, midazolam)

 

moderate sedation agents, oral, for children (e.g., chloral hydrate)

 

narcotics/opioids

  • IV
  • Transdermal
  • oral (including liquid concentrates, immediate and sustained-release formulations)

 

neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium)

 

parenteral nutrition preparations

 

radiocontrast agents, IV

 

sterile water for injection, inhalation, and irrigation

(excluding pour bottles) in containers of 100 mL or more

 

sodium chloride for injection, hypertonic, greater than 0.9% concentration

 

List of High Alert Medications in Ambulatory Healtcare

-Kategori/ kelas obat-obatan

Spesifikasi Obat

antiretroviral agents (e.g., efavirenz, lamiVUDine, raltegravir, ritonavir,

combination antiretroviral products)

carBAMazepine

chemotherapeutic agents, oral (excluding hormonal agents)

(e.g., cyclophosphamide, mercaptopurine, temozolomide)

chloral hydrate liquid, for sedation of children

 

hypoglycemic agents, oral

heparin, including unfractionated and low molecular weight heparin

immunosuppressant agents (e.g., azaTHIOprine, cycloSPORINE,

tacrolimus)

metFORMIN

insulin, all formulations

methotrexate, non-oncologic use

opioids, all formulations

midazolam liquid, for sedation of children

pediatric liquid medications that require measurement

propylthiouracil

pregnancy category X drugs (e.g., bosentan, ISOtretinoin)

warfarin

Dengan adanya daftar obat di atas, diharapkan bisa mengurangi kesalahan dalam pemberian high alert medications. Pemberian high-alert medications harus teliti. Hal-hal yang dilakukan untuk meningkatkan keamanan high alert medications adalah perawat harus melakukan pengecekan ganda (double check) terhadap semua high alert medications sebelum diberikan kepada pasien. Selain itu, persiapan dan penyimpanannya pun harus jelas. High alert medications harus disimpan di pos perawat di dalam troli atau kabinet yang terkunci dan diberi label yang jelas.

Oleh: Eva Tirtabayu Hasri S.Kep.,MPH
Sumber:
_____(2011). List of High-Alert Medications in Community/Ambulatory Healthcare. ISMP
_____(2014). L is t o f High-Alert Medicationsin Acute Care Settings. ISMP

http://www.ismp.org/tools/highalertmedications.pdf 
http://www.ismp.org/communityRx/tools/ambulatoryhighalert.asp