Improving

Alertness of
Emergency
Drugs
Khusnul Fitri Hamidah
Instalasi Farmasi RS Universitas Airlangga
 Introduction
Alertness of emergency drugs
Drugs with narrow therapeutic index

Concentrated electrolyte solutions

Narcotic and psychotropic drugs

Antithrombotics agents ; etc

High Alert Medications

(Dosage) (Storage) (Preparation) (Compatibility) (Administration)

(ISMP List of High-Alert Medications in Acute Care Settings, 2018) Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021
 Safety Factors in the Emergency Department (ED)

Interprofessional
Collaboration

(Farmer, B.M., 2016. Strategies aimed at improving medication safety, transitions of care, health
(Klotz, U., 2009. Pharmacokinetics and drug metabolism in the elderly.
information technology, and other factors in the ED can significantly decrease the risks of
Drug Metab. Rev. Vol. 41)
adverse events. Emerg. Med. Vol. 48)
 Pharmacist in the ED

(Morgan et al, 2018. Clinical pharmacy services in the emergency department. Am. J. Emerg. Med. Vol.36.) Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021
(Farmer, 2016 ; Klotz, 2009)
 Emergency Drugs Administration
IV Admixture Compatibility

+
(Nicardipine) (Furosemide)

https://www.medicines.org.uk/emc/product/3322/smpc#gref Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021

(National Center for Biotechnology Information, 2021)
 Emergency Drugs Administration
Compatibility of drug solutions in nebulizers

(Kamin et al, 2014. Inhalation solutions - which ones may be mixed? Physico-chemical Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021
compatibility of drug solutions in nebulizers - update 2013. J. Cyst. Fibros.)
 Synergistic effect on the time-dependent
activation of CEBP and GC

Proposed mechanisms of inhaled corticosteroid

and long-acting β2-agonist modulation of airway
smooth muscle cell proliferation

(Tamm et al, 2012. Inhaled corticosteroid and long-acting β2-agonist pharmacological Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021
profiles: Effective asthma therapy in practice. Respir. Med.)
 Emergency Drugs Administration
What if syringe pump is not available in the ED?

Drug prescribed →
Norepinephrine 7 mL/hour

(Syringe pump)

(Pediatric Solution Chamber) Calculation :

7 mL/hour x 60 drops
mL/hour = 420 drops/hour
drop/minute
= 7 drops/minute
1 mL = 60 drops

Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021

Emergency Drugs Dispensing
Tailored-IV fluid therapy based on individual needs

D10-1/5 NS 2,775

D10
¼ NS
100
mL

Saline 3% 0,045
+
2,820

Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021

 Emergency Drugs Dispensing
Alteplase preparation
Take the vial with
reconstituted alteplase
and swirl gently to
dissolve any remaining
powder, but do not shake,
as this will produce foam

If there are bubbles, let

the solution stand
undisturbed for a few
minutes to allow them to
disappear.

(Myers, G.J., 2017. Air in intravenous lines: A need to review old opinions. Perfus. (United Kingdom) Vol. 32.) Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021
 High Alert Medications
✓ Drugs that bear a
heightened risk of causing
significant patient harm
when they are used in error

✓ Although mistakes may or

may not be more common
with these drugs, the
consequences of an error
are clearly more
devastating to patients

(ISMP List of High-Alert Medications in Acute Care Settings, 2018)

 Double Checks

(https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used-judiciously-and-properly) Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021

 Does not reach Near Miss
the patient
KNC
Error known, canceled

Patient Safety
Incident No Harm Incident
KTC
Reaches the Take the medication - No Harm incident
patient Take the medication - Incident known - antidote

Harmful Incident Adverse Event

KTD
Sentinel Event

(Permenkes 1691 tahun 2011 tentang keselamatan pasien di rumah sakit) Improving Alertness of Emergency Drugs Khusnul Fitri Hamidah 2021
 TAKE
HOME
MESSAGES

Safety checks for

preventing
medication
errors