Incidence of drug-related adverse events related to the use of high-alert drugs: A systematic review of randomized controlled trials

Michelle Santos Menezes; Grace Anne Azevedo Doria; Fernanda Valença-Feitosa; Sylmara Nayara Pereira; Carina Carvalho Silvestre; Alfredo Dias de Oliveira Filho; Iza Maria Fraga Lobo; Lucindo José Quintans-Júnior

doi:10.1016/j.rcsop.2024.100435

Incidence of drug-related adverse events related to the use of high-alert drugs: A systematic review of randomized controlled trials

Explor Res Clin Soc Pharm. 2024 Apr 8:14:100435. doi: 10.1016/j.rcsop.2024.100435. eCollection 2024 Jun.

Authors

Michelle Santos Menezes¹, Grace Anne Azevedo Doria¹, Fernanda Valença-Feitosa², Sylmara Nayara Pereira², Carina Carvalho Silvestre³, Alfredo Dias de Oliveira Filho², Iza Maria Fraga Lobo⁴, Lucindo José Quintans-Júnior^{5

6}

Affiliations

¹ Federal University of Sergipe (UFS), Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil.
² Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil.
³ Federal University of Juiz de Fora - Governador Valadares Campus, Minas Gerais, University Campus, Rua José Lourenço Kelmer, s/n - São Pedro, Juiz de Fora, MG, 36036-900, Brazil.
⁴ Federal University of Bahia (2003). Infectologist, Head of the Risk Management Unit (UGRA) and Risk Manager of the University Hospital of the Federal University of Sergipe, R. Cláudio Batista - Palestine, Aracaju - SE, 49060-676, Brazil.
⁵ Physiology Department, Federal University of Sergipe (DFS/UFS).
⁶ Laboratory of Neurosciences and Pharmacological Tests (LANEF), Federal University of Sergipe, Rua Marechal Rondon, s/n. University City "Prof. José Aloísio Campos ", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil.

Abstract

Background: High-alert medication (HAM) is more predictable to cause significant harm to the patient, even when used as intended. The damage related to the HAM lead not only suffering to the patient, but also raise the additional costs associated with care.

Objective: Evaluate the incidence of drug-related adverse events related to the use of high-alert medications.

Methods: It was conducted an active search for information through COCHRANE databases, LILACS, SciELO, SCOPUS, PubMed/MEDLINE and WEB OF SCIENCE. The search strategy included the following terms: "Patient safety", "Medication errors" and "Hospital" and "High Alert Medications" or "Dangerous Drugs" in different combinations. Then two reviewers independently conducted a preliminary evaluation of relevant titles, abstracts and finally full-text. Studies quality was evaluated according to PRISMA declaration.

Results: The systematic review evaluated seven articles, which showed that only 11 HAM identified in the literature could have serious events. The most frequently cited were warfarin (22.2%) which progressed from deep vein thrombosis to gangrene, suggesting lower initial doses, followed by cyclophosphamide (22.2%) and cyclosporine (22.2%) which presented invasive fungal infection and death. In addition to these, morphine was compared with its active metabolite (M6G), with M6G causing fewer serious clinical events related to nausea and vomiting, reducing the need for concomitant use of antiemetics.

Conclusions: The most reported drug classes in the articles included that were related to incidence of drug-related adverse events in use of high-alert medications: morphine, M6G-glucuronide, haloperidol, promethazine, ivabradine, digoxin, warfarin, ximelagatran, cyclophosphamide, cyclosporine, and ATG. The formulate protocols for the use of these medications, with importance placed on evaluating, among the classes, the medication that causes the least harm.

Keywords: High-alert medication or dangerous drugs; Hospital; Medication errors; Patient safety.

Publication types

Review