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High-Alert Medication Independent Double-Check Audit
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Audit of independent double-check practices and additional safeguards for high-alert medications such as insulin, anticoagulants, opioids, and concentrated electrolytes.
ISMP High-Alert Medications ListTJC NPSG.03.05.01TJC MM.01.01.03
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High-Alert Identification
- Does the facility maintain a high-alert medication list based on the ISMP list and internal error data? *
- Are high-alert medications clearly identified in storage areas and in the electronic record? *
- Are concentrated electrolytes (e.g., KCl, hypertonic saline) removed from patient-care unit floor stock? *
Independent Double-Check
- Is an independent double-check performed by two clinicians before administering designated high-alert medications? *
- Does the double-check independently verify drug, dose, concentration, rate, route, and patient? *
- Is the second-verifier check documented in the medication record? *
Standardization & Technology
- Are standardized concentrations and dosing limits used for high-alert IV infusions? *
- Are smart infusion pumps with drug libraries and hard dose limits used for high-alert infusions? *
- Are anticoagulant management protocols and monitoring in place per NPSG.03.05.01? *
Monitoring & Review
- Are high-alert medication errors and near misses reported and analyzed for system causes? *
- Is the high-alert list reviewed at least annually using internal error data? *
- Are double-check compliance and effectiveness audited periodically?
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