Pharmacoepidemiol Risk Manage.  2023 Sep;15(2):165-171. 10.56142/perm.23.0016.

A Cross Sectional Study of High-Alert Medications and Their Potential Harm in Acute Care Settings

• Lee AY
• Han JM
• Jeong J
• Lee S
• Heo KN
• Park S
• Chae H
• Min Si
• Ah YM
• Lee JY

• KMID: 2551233
• DOI: http://doi.org/10.56142/perm.23.0016

Abstract

Objective
In this study, we aimed to analyze national claims data to assess the usage of high-alert medications among hospitalized patients and to identify associated potential harm.
Methods
This study was a cross-sectional analysis based on the Health Insurance Review & Assessment Service National Inpatient Sample (HIRANIS) data for the years 2019 and 2020. All patients with records of hospitalization were included from this data source. We categorized patients into two groups based on the usage of high-alert medications in the acute care setting. The primary outcome of interest was the prevalence of potential harms related to the use of each high-alert medication among hospitalized patients. Each potential harm was then identified based on diagnostic codes, procedure codes, and medication administration recorded in the claims data.
Results
From the HIRA-NIS dataset for the years 2019 and 2020, the patient-hospitalization count was 1,291,922. Out of the total 1,291,922 patient-hospitalizations involving the use of high-alert medications, the prescription rates for the specific medications were as follows: injectable narcotic analgesics (434,328 cases, 33.6%), injectable benzodiazepines (295,775 cases, 22.9%), and injectable anticoagulants (140,989 cases, 10.9%). Regarding the prevalence of potential harm, the top three were bleeding related to thrombolytic therapy (9.5%), hypoglycemia related to insulin vials (4.5%), and bleeding associated with injectable anticoagulant use (3.7%).
Conclusion
High-alert medication usage was identified in over one-third of patients who underwent hospitalization treatment. Bleeding associated with the use of anticoagulants and thrombolytics was the most prevalent potential harm.

Keyword

High-alert medications; Inpatients; Drug-related side effects and adverse reactions