Safety First Blog

Do You Have A High Alert List And Can Users Easily Access It?

Posted by Laura Paxton on Apr 12, 2022 9:57:01 AM
Laura Paxton
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The popularity of our most-read blog from 2021 - “From Our Customers: The Top 8 Questions To Expect In Joint Commission Inspections” - indicates that hospitals and healthcare systems continue to hustle to ensure all i’s are dotted and t’s are crossed before a visit from Joint Commission, accreditation or state board of pharmacy inspectors. 

In this latest blog series, we’ll unpack several of the “Top 8 Questions” to better prepare you for these high-stakes visitors. To start, we’ll expand on high alert medications and what inspectors are looking for in the initial list of medications, what the list looks like, how it is communicated and more. 

As we wrote in the original blog, the Joint Commission requires that high-alert and hazardous medications used in a facility are identified in writing to prevent potential errors and improve patient and healthcare worker safety. The high alert list also must be available to all nurses, doctors, pharmacy staff, and others who come into contact or administer these medications.

Now let’s dig in …

How do you determine your high alert medication list? 

Our customers go about the creation and maintenance of their high alert list in several ways:

  1. Some determine which medications make the high alert list based on how the meds are used in their hospital or healthcare system. Looking at hospital-specific safety data on adverse drug reactions (ADR) and medication error (ME), they create a list to fit their unique organization. 
  2. Others import or directly link to the ISMP List of High Alert Medications which classifies potentially harmful drugs into 11 categories. Since 1989, the Institute for Safe Medication Practices (ISMP) has maintained a list of high alert medications which they update every few years with practitioner input. That first list included six medications that are still on ISMP’s list today. 
  3. Hospitals also use the ISMP list as a starting point and customize their own list from there. Some organizations find ISMP’s list too long and others find it limited, but it provides a solid starting point. 

WHAT INSPECTORS EXPECT: The key to passing an accreditation inspection is to include all medications in use at your organization that could “cause significant harm to patients when used in error” and to be able to explain why these medications were identified as “high alert.” 

What do you do once you’ve determined your high alert list? 

The next step is to decide the most useful format for your high-alert medication list. The Joint Commission does not specify what the list should look like, only that it exists and can be accessed by clinicians, nurses and pharmacists. Many hospital pharmacies create and maintain a list in a spreadsheet shared on their intranet. 

While inspectors aren’t concerned about the format of the list, they are closely looking at strategies used to prevent medical error and patient harm. According to, these may include “standardizing the ordering, storage, preparation, and administration of these products; improving access to information about these drugs; limiting access to high alert medications; using auxiliary labels; employing clinical decision support and automated alerts, and using redundancies such as automated or independent double checks when necessary.”

WHAT INSPECTORS EXPECT: In addition to the list of high-alert medications in use at your organization, inspectors want to see the safe management of these drugs. How do you document or show inspectors the methods you are using to prevent med error and protect patients? 

How is your list communicated to clinicians, pharmacists and nurses? 

Communication plays a vital role in the safe management of these medications. Inspectors must see communication around the basic list of medication categories and specific medication names, but they will also require evidence that drug safety information is easily accessible to all who administer the medication. 

Many healthcare systems we speak with are still providing their high alert medication list in a spreadsheet on SharePoint. Nurses and clinicians must exit out of the EHR and interrupt their workflow to access this vital information. Not only does this cost time, but it results in errors. We can see through FormWeb analytics that there’s a correlation between the steps taken to reach critical medication safety information and the likelihood this information is used when needed. If it’s difficult to access, the chances of med error and patient harm increase. This defeats the purpose the high alert medication list was created to serve. 

An alternative to the SharePoint spreadsheet is a cloud-based medication safety database that encompasses all of the necessary medication safety information. This tool improves patient outcomes by simply making vital information easily available. 

WHAT INSPECTORS EXPECT: One of the key safety management strategies is communication. You must not only document the required medication safety information, but you must also ensure that all those administering high alert medications can access this documentation. Data proves that the fewer clicks it takes to reach medication safety information the more likely it is to be utilized therefore improving patient outcomes. 

We realize the vital role medication safety communication plays in patient outcomes, which is why we developed Formweb. Available at the point of care, Formweb is the only one-stop medication resource center. 

With Formweb, health systems can create and maintain their high alert medication list and provide it within the EHR, dramatically increasing the probability that the list and safety information will be used and therefore prevent patient harm. 

Formweb (1)

Stay tuned as the series unpacking the most common queries from inspectors continues. Next up, we’ll discuss Look Alike, Sound Alike Drugs. 

In the meantime, check out how this customer at a State Department of Corrections implements Formweb in unique ways to care for a unique patient population. 

Topics: Policy, Formweb, Formulary

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