High-Risk Prescribing and Safety

A high-risk medication is not necessarily one that causes errors frequently. A high-alert medication is one for which an error can produce severe patient harm. That distinction changes the safety response: the goal is not to rely on a prescriber or nurse remembering every detail under pressure, but to design the prescribing and administration process so that a single slip is less likely to reach the patient or cause catastrophic injury. The Canadian high-alert medication list, published by ISMP Canada in 2024, includes antithrombotics such as anticoagulants and thrombolytics, antineoplastic agents, concentrated electrolytes, injectable benzodiazepines, insulins, opioids, cardioplegic solutions, and medications with profound cardiovascular or physiologic effects. The list is a Canadian reference point, not a finished policy. Each organization should use it to create an organization-specific list based on its formulary, care settings, equipment, staffing, and incident history. Risk usually arises from the interaction of three factors: - Medication factors: a narrow margin between benefit and toxicity, complex dose calculations, rapid physiologic effects, or serious consequences from a missed or extra dose. - Patient factors: advanced age, frailty, renal...