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• How-to Guide: Prevent Harm from High-Alert Medications
  This How-to Guide describes key evidence-based care components for preventing harm from high-alert medications, describes how to implement these interventions, and recommends measures to gauge improvement.
• IHI Global Trigger Tool for Measuring Adverse Events
  The use of "triggers", or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm in a health care organization.
• IHI Trigger Tool for Measuring Adverse Drug Events
  A method for using "triggers," or clues, in patient records to identify ADEs that may not have been reported through traditional mechanisms).
• ISMP List of High-Alert Medications
  Based on error reports submitted to the ISMP Medication Errors Reporting Program, reports of harmful errors in the literature, and input from practitioners and safety experts, ISMP created and periodically updates a list of potential high-alert medications.

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• Adjust Anticoagulants with Thrombolytic and G2b/3A Inhibitors
  A system that reminds prescribers to take into account thrombolytic and G2b/3A inhibitors as they set anticoagulant doses can help reduce the risk of bleeding or other adverse drug events.
• Allow Pharmacists to Manage an Anticoagulant Service
  Allow pharmacists to manage an anticoagulation service to improve efficiency and help prevent adverse drug events.
• Conduct Independent Double-Checks on the Unit
  Independent double-checks before administration of high-alert medications can help prevent adverse drug events.
• Continue to Use Anticoagulation Flowsheets after Discharge
  A flowsheet that records all of a patient’s anticoagulation information in one place and goes home with the patient after discharge can help in the coordination and management of therapy.
• Develop a Warfarin Dosing Service or Clinic
  A dosing service or clinic for patients on warfarin can provide coordinated and consistent care and be a benefit to both patients and physicians.
• Develop Weekly Dosing Regimens for Anticoagulants
  Weekly anticoagulant dosing regimens help staff members keep track of medications while patients are in the hospital, and they help patients manage their own anticoagulation therapy after discharge.
• Educate Patients to Manage Warfarin Therapy at Home
  Educated patients on how to properly manage their warfarin therapy at home to reduce their risk of adverse drug events.
• Eliminate Heparin Flush of Peripheral Intravenous Lines
  Using normal saline solution instead of heparin solution for flushing peripheral intravenous lines can reduce the risk of adverse drug events.
• Eliminate the Use of Heparin Solution with Arterial Lines
  Eliminate the use of heparin solution in the pressurized bags attached to arterial lines, a practice known to cause accidental administration of heparin doses that can lead to adverse drug events.
• Implement Patient-Directed Administration of Warfarin
  Having patients administer their own anticoagulant medication in the hospital is a good way to involve them, educate them, and prepare those who need it for long-term anticoagulation therapy.
• Implement Weight-Based Heparin Protocols
  Implement a protocol for using the patient’s weight to determine heparin doses, a method that reliably achieves desired therapeutic effects.
• Prepare All Heparin Doses and Solutions in the Hospital Pharmacy
  Prepare all heparin doses and solutions in the hospital pharmacy rather than on patient care units to decrease the risk of error.
• Provide Coagulation Test Results Within Two Hours or at Bedside
  Proper dosing of anticoagulants requires close monitoring of laboratory coagulation tests, so timely results are essential.
• Reduce Adverse Drug Events Involving Anticoagulants
  Careful monitoring and management of anticoagulant medications can help prevent harm from over-coagulation or under-coagulation.
• Reduce Adverse Drug Events Involving Chemotherapy
  Use extra safety measures with chemotherapy medications to prevent adverse drug events (ADEs), which can be extremely serious due to the toxicity of these drugs.
• Reduce Adverse Drug Events Involving Insulin
  Coordinate care processes and use standardized tools when caring for patients on insulin to reduce the risk of adverse drug events (ADEs).
• Reduce Adverse Drug Events Involving Narcotics and Sedatives
  Careful monitoring and management of narcotics and sedatives can help prevent harm, especially from overdoses.
• Standardize International Normalized Ratio Testing Equipment
  Using one standard type of International Normalized Ratio (INR) testing equipment throughout your organization to set anticoagulant doses will help minimize potentially hazardous variation in results.
• Titrate Anticoagulant Doses
  Titrate doses of anticoagulants based on results of laboratory tests to achieve the desired coagulation levels and allow for more timely adjustments to dosages.
• Use Alarm Devices to Ensure Consistent Anticoagulant Dosing
  Use audible or visible alarms, such as alarm clocks or timers, to alert staff and patients when anticoagulant doses are due.
• Use Anticoagulation Flowsheets
  Recording all of a patient’s anticoagulation information on a flowsheet makes anticoagulation therapy easier for the staff to administer and may reduce the risk of errors.
• Use Dosing Charts for Heparin
  Use dosing charts for heparin to help staff members quickly select the appropriate heparin flow rates.
• Use Guidelines or Pre-Printed Orders for Vitamin K
  Use dosing guidelines or pre-printed orders to reduce the risk of adverse drug events since Vitamin K can have serious side effects, especially when administered intravenously.
• Use Low Molecular Weight Heparin (LMWH)
  Administration of low molecular weight heparin (LMWH) has a lower adverse drug event (ADE) profile than regular heparin and presents significantly less risk of error because it is simpler to use.
• Use Programmable Pumps and Independent Double-Checks for IV Anticoagulants
  Programmable pumps, with independent double-checks of the settings, help ensure that patients receive the correct dose of intravenous (IV) anticoagulant solution.

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• High-Alert Adverse Drug Events per 1,000 Doses
  The total number of ADEs related to a specific high-alert drug or class identified in a sample of patient records, divided by the total number of doses of the high-alert drug or class administered to those patients. Multiply the result by 1,000.
• Measures: Prevent Harm from High-Alert Medications
  Care teams should measure each of the key interventions recommended in the How-to Guide: Prevent Harm from High-Alert Medications.
• Percent of Patients Receiving a Specific High-Alert Medication with a Related Adverse Drug Event
  The total number of patients identified as having experienced any ADE related to a specific high-alert drug or class from a sample of patient records, divided by the total number of records in the sample. Multiply the result by 100 to express as a percentage.

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• How-to Guide: Prevent Harm from High-Alert Medications
  
  This How-to Guide describes key evidence-based care components for preventing harm from high-alert medications, describes how to implement these interventions, and recommends measures to gauge improvement.
• Warfarin-Herbal Interactions List
  
  A reference for prescribers, nurses, and pharmacists listing herbal agents known to interact with warfarin and the types of interactions to expect.
• Guide to Coumadin (Warfarin) Therapy
  
  An educational and reference tool for patients that provides important information about anticoagulation therapy for patients who take warfarin, and answers many common questions about the drug.
• How-to Guide: Prevent Harm from High-Alert Medications — Pediatric Supplement
  
  This How-to Guide specifically tailored for pediatrics describes key evidence-based care components for preventing harm from high-alert medications, describes how to implement these interventions, and recommends measures to gauge improvement.
• How-to Guide: Prevent Harm from High-Alert Medications — Rural Hospitals Supplement
  
  This How-to Guide specifically tailored for rural hospitals describes key evidence-based care components for preventing harm from high-alert medications, describes how to implement these interventions, and recommends measures to gauge improvement.
• Anticoagulant Toolkit: Reducing Adverse Drug Events
  
  ADEs associated with anticoagulants can be reduced by implementing recognized safe practices in high-risk areas, redesigning care processes, partnering with patients and families, and maximizing communications within and across the care continuum.

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• Passport Exclusive: Providing Reliable Perinatal Care by Using Clinical Bundles
  
  In this video, Sue Leavitt-Gullo, MS, RN, Director for IHI, reviews providing reliable perinatal care through usings clinically proven bundles.