How you view the risks of drugs that bear a heightened risk of causing significant patient harm when used in error may depend on your profession. A recent survey to which 363 nurses, 210 pharmacists, and 34 risk managers responded showed trends in how each profession identifies high-alert drugs.

Risk and safety managers commonly saw things differently than nurses and pharmacists. For example, 95% of pharmacists and 93% of nurses rated I.V. insulin and neuromuscular blocking agents as high-alert. Among risk managers, 100% rated I.V. insulin high-alert, while 90% placed neuromuscular blocking agents in this category.

Nurses and pharmacists differed greatly in identifying three drugs as high-alert:

* I.V. radiocontrast agents: nurses 65%; pharmacists 34%

* oxytocin: nurses 73%; pharmacists 38%

* epoprostenol: nurses 68%; pharmacists 45%.

Overall, most professionals who responded to the survey considered the following drugs riskiest:

* parenteral and oral chemotherapeutic agents

* neuromuscular blocking agents

* I.V. insulin, unfractionated heparin, and adrenergic agents

* epidural/intrathecal and anesthetic agents

* potassium chloride concentrate and potassium phosphates for injection

* thrombolytics/fibrinolytics

* sodium chloride injection greater than 0.9% strength

* oral moderate sedation agents for children

* subcutaneous insulin.

Review the full survey results at http://www.ismp.org/survey/Survey200702W.asp Discuss high-alert drugs with other professionals in your facility and join collaborative efforts to develop appropriate safeguards for using them.