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Peningkatan Keamanan High-Alert Medication

High-Alert Medication atau obat dengan kewaspadaan tinggi adalah obat-obat


yang secara signifikan berisiko membahayakan pasien bila digunakan dengan salah
atau pengelolaan yang kurang tepat. Di Indonesia, pada Peraturan Menteri
Kesehatan RI Nomor 58 Tahun 2014 Tentang Standar Pelayanan Kefarmasian di
Rumah Sakit mengharuskan rumah sakit untuk mengembangakan kebijakan
pengelolan obat untuk meningkatkan keamanan khususnya obat yang perlu
diwaspadai (high-alert medications). Obat ini sering menyababkan kesalahan
serius (sentinel event) dan dapat menyababkan reaksi obat yang tidak diinginkan
(ROTD). Berdasarkan study yang dilakukan oleh Institute for Safe Medication
Practices (ISMP) di US, obat yang paling sering menyebabkan ROTD dan sentinel
event adalah insulin, opium dan narkotik, injeksi potassium
chloride (phospate)concentrate, intravenous anticoagulants (hepari) dan sodium
chloride solution lebih besar dari 0,9%.

Berikut adalah ketagori dan spesifikasi obat yang termasuk ke dalam high alert
medication .

List of High Alert Medication in Acute Care Setting

-Kategori/ kelas obat-obatan Spesifikasi Obat

adrenergic agonists, IV EPINEPHrine, subcutaneous


(e.g., EPINEPHrine, phenylephrine,
norepinephrine)

adrenergic antagonists, IV (e.g., epoprostenol (Flolan), IV


propranolol, metoprolol, labetalol)

anesthetic agents, general, inhaled insulin U-500 (special emphasis) :


and IV (e.g., propofol, ketamine) *All forms of insulin, subcutaneous
and IV, are considered a class of
high-alert medications.

Insulin U-500 has been singled out


for special emphasis to bring
attention to the

need for distinct strategies to prevent


the types of errors that occur with
this concentrated

form of insulin
antiarrhythmics, IV (e.g., lidocaine, magnesium sulfate injection
amiodarone)

antithrombotic agents, including: methotrexate, oral, non-oncologic


use
anticoagulants (e.g., warfarin, low
molecular weight heparin, IV
unfractionated heparin)
Factor Xa inhibitors (e.g.,
fondaparinux, apixaban, rivaroxaban)
direct thrombin inhibitors (e.g.,
argatroban, bivalirudin, dabigatran
etexilate)
thrombolytics (e.g., alteplase,
reteplase, tenecteplase)
glycoprotein IIb/IIIa inhibitors (e.g.,
eptifibatide)

cardioplegic solutions opium tincture

chemotherapeutic agents, parenteral oxytocin, IV


and oral

dextrose, hypertonic, 20% or greater nitroprusside sodium for injection

dialysis solutions, peritoneal and potassium chloride for injection


hemodialysis concentrate

epidural or intrathecal medications potassium phosphates injection

hypoglycemics, oral promethazine, IV

inotropic medications, IV (e.g., vasopressin, IV or intraosseous


digoxin, milrinone)

insulin, subcutaneous and IV

liposomal forms of drugs (e.g.,


liposomal amphotericin B) and
conventional counterparts

(e.g., amphotericin B desoxycholate)

moderate sedation agents, IV (e.g.,


dexmedetomidine, midazolam)
moderate sedation agents, oral, for
children (e.g., chloral hydrate)

narcotics/opioids

IV
Transdermal
oral (including liquid concentrates,
immediate and sustained-release
formulations)

neuromuscular blocking agents (e.g.,


succinylcholine, rocuronium,
vecuronium)

parenteral nutrition preparations

radiocontrast agents, IV

sterile water for injection, inhalation,


and irrigation

(excluding pour bottles) in containers


of 100 mL or more

sodium chloride for injection,


hypertonic, greater than 0.9%
concentration

List of High Alert Medications in Ambulatory Healtcare

-Kategori/ kelas obat-obatan Spesifikasi Obat

antiretroviral agents (e.g., efavirenz, carBAMazepine


lamiVUDine, raltegravir, ritonavir,

combination antiretroviral products)

chemotherapeutic agents, oral chloral hydrate liquid, for sedation of


(excluding hormonal agents) children

(e.g., cyclophosphamide,
mercaptopurine, temozolomide)

hypoglycemic agents, oral heparin, including unfractionated and


low molecular weight heparin
immunosuppressant agents (e.g., metFORMIN
azaTHIOprine, cycloSPORINE,

tacrolimus)

insulin, all formulations methotrexate, non-oncologic use

opioids, all formulations midazolam liquid, for sedation of


children

pediatric liquid medications that require propylthiouracil


measurement

pregnancy category X drugs (e.g., warfarin


bosentan, ISOtretinoin)

Dengan adanya daftar obat di atas, diharapkan bisa mengurangi kesalahan dalam
pemberian high alert medications. Pemberian high-alert medications harus teliti.
Hal-hal yang dilakukan untuk meningkatkan keamanan high alert
medications adalah perawat harus melakukan pengecekan ganda (double check)
terhadap semua high alert medications sebelum diberikan kepada pasien. Selain
itu, persiapan dan penyimpanannya pun harus jelas. High alert medications harus
disimpan di pos perawat di dalam troli atau kabinet yang terkunci dan diberi label
yang jelas.

Oleh: Eva Tirtabayu Hasri S.Kep.,MPH


Sumber:
_____(2011). List of High-Alert Medications in Community/Ambulatory Healthcare.
ISMP
_____(2014). L is t o f High-Alert Medicationsin Acute Care Settings. ISMP