Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Apr 8:14:100435.
doi: 10.1016/j.rcsop.2024.100435. eCollection 2024 Jun.

Incidence of drug-related adverse events related to the use of high-alert drugs: A systematic review of randomized controlled trials

Michelle Santos Menezes  1 , Grace Anne Azevedo Doria  1 , Fernanda Valença-Feitosa  2 , Sylmara Nayara Pereira  2 , Carina Carvalho Silvestre  3 , Alfredo Dias de Oliveira Filho  2 , Iza Maria Fraga Lobo  4 , Lucindo José Quintans-Júnior  5   6
Affiliations
Review

Incidence of drug-related adverse events related to the use of high-alert drugs: A systematic review of randomized controlled trials

Michelle Santos Menezes et al. Explor Res Clin Soc Pharm. .

Abstract

Background: High-alert medication (HAM) is more predictable to cause significant harm to the patient, even when used as intended. The damage related to the HAM lead not only suffering to the patient, but also raise the additional costs associated with care.

Objective: Evaluate the incidence of drug-related adverse events related to the use of high-alert medications.

Methods: It was conducted an active search for information through COCHRANE databases, LILACS, SciELO, SCOPUS, PubMed/MEDLINE and WEB OF SCIENCE. The search strategy included the following terms: "Patient safety", "Medication errors" and "Hospital" and "High Alert Medications" or "Dangerous Drugs" in different combinations. Then two reviewers independently conducted a preliminary evaluation of relevant titles, abstracts and finally full-text. Studies quality was evaluated according to PRISMA declaration.

Results: The systematic review evaluated seven articles, which showed that only 11 HAM identified in the literature could have serious events. The most frequently cited were warfarin (22.2%) which progressed from deep vein thrombosis to gangrene, suggesting lower initial doses, followed by cyclophosphamide (22.2%) and cyclosporine (22.2%) which presented invasive fungal infection and death. In addition to these, morphine was compared with its active metabolite (M6G), with M6G causing fewer serious clinical events related to nausea and vomiting, reducing the need for concomitant use of antiemetics.

Conclusions: The most reported drug classes in the articles included that were related to incidence of drug-related adverse events in use of high-alert medications: morphine, M6G-glucuronide, haloperidol, promethazine, ivabradine, digoxin, warfarin, ximelagatran, cyclophosphamide, cyclosporine, and ATG. The formulate protocols for the use of these medications, with importance placed on evaluating, among the classes, the medication that causes the least harm.

Keywords: High-alert medication or dangerous drugs; Hospital; Medication errors; Patient safety.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection.
See this image and copyright information in PMC

References

    1. Aljadhey H., Mahmoud M.A., Mayet A., et al. Incidence of adverse drug events in an academic hospital: a prospective cohort study. International J Qual Health Care. 2013;25(6):648–655. doi: 10.1093/intqhc/mzt075. - DOI - PubMed
    1. Rommers M.K., Teepe-Twiss I.M., Guchelaar H.-J. Preventing adverse drug events in hospital practice: an overview. Pharmacoepidemiol Drug Saf. 2007;16(10):1129–1135. doi: 10.1002/pds.1440. - DOI - PubMed
    1. Maaskant J.M., Vermeulen H., Apampa B., et al. Interventions for reducing medication errors in children in hospital. Cochrane Database Syst Rev. 2015;(March) doi: 10.1002/14651858.CD006208.pub3. - DOI - PMC - PubMed
    1. WHO . 2006. World alliance for patient safety: forward programme 2006-2007.
    1. Suggested definitions and relationships among medication misadventures Medication errors, adverse drug events, and adverse drug reactions. Am J Heal Pharm. 1998;55(2):165–166. doi: 10.1093/ajhp/55.2.165. - DOI - PubMed