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:
|
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
|
|
|
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
