List of High Alert medications and management

High-alert medications are those mediations involved in high percentage errors and/or sentinel events, as well as medications that carry a higher risk for abuse or other adverse outcomes. It is the policy of HEC to obtain monthly vital signs and weight on a monthly basis. The commonly used high-alert medications and the management plans in our population are:
Atypical Antipsychotics: All students on this class of medication are monitored with blood tests. This includes prolactin levels every 6 months, glucose and insulin levels every three months and lipid profile annually unless otherwise ordered by physician
Clozapine – Additional weekly CBC done for evaluation of white blood cells and entered into the national database. Regular EKG with additional testing such as echocardiogram may be ordered.
Risperdal
Zyprexa
Seroquel- Additional eye exam every 6 months
Geodon
Abilify
Mood stabilizers/ antiseizure: All students on this class of medications have levels and various blood tests on a regular basis.
Tegretol-Blood level, CBC and LFT (Liver function tests) every 6 months
Lithium- Blood levels, TSH ( thyroid) and BUN, Creatinine (kidney function) every 3 months
Depakote- Blood level, CBC, LFT every 3 months
Dilantin- Blood level, CBC and LFT every 3 months

The following medications are used in our population for aggression and hyperactivity but may affect blood pressure or heart rate. Baseline EKG is obtained with annual follow up unless otherwise ordered by physician.
Clonidine
Tenex
Effexor (antidepressant)

Stimulants- For all students on this class of medication, family history of underlying heart disease or sudden cardiac death is obtained at time of consent. A baseline EKG is obtained on admission or when stimulant is started with annual follow up.
Adderal
Concerta
Dexadrine
Vyvanse
Ritalin
Focalin
Metadate

Other medications
Wellbutrin – Review of history for seizures
Metformin- Glucose and insulin levels are obtained as ordered by physician. Additional daily testing of blood glucose may also be ordered.

https://www.ismp.org/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf

https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf?id=10.26616/NIOSHPUB2016161

https://www.ismp.org/sites/default/files/attachments/2017-11/tallmanletters.pdf