Devising of a risk map on the management of high risk alert medication in a high level university hospital.

Objective: To classify hospital units into three risk levels in order to define and prioritise  improvement and training measures in each of them.

Method: The risk map was developed in two phases: First phase involved the setting up of a  multidisciplinary team, a bibliographic search, the identification of medications and of the criteria to  design the map: (1) Location: number of high-alert medications; (2) Staff turnover: the units were  classified in low turnover units = 1, medium turnover units = 2 and high turnover units = 3 according  to data provided by the human resource department; (3) Frequency: quotient between the number of high alert medicactions in each unit and the total of medications used, and (4) Severity: voluntary  survey of professionals. An accumulated risk of severity of each unit was calculated: Σ (severity of the  drug x number of its units). The Neperian logarithm was applied to this value to reduce the  variability of the values. Thus a risk probability index was established = staff turnover x frecuency x  Neperian logarithm of severity. In a  second phase, the units were classified into three groups and the  risk map of high-alert medication was elaborated in the hospital. In it, the units that had a risk  probability index higher than 2.9 were classified as high risk units, those that had between 1-2.9 as  intermediate risk units and those that had less than 1 as low risk units. According to the risk probability index, improvement measures were defined and priorities were set for each of them.

Results: A total 447 high-risk medications corresponding to 227 active ingredients were identified  during the study period. The units showing a higher risk were: Intensive Care Medicine (10.51),  Reanimation (4.01), and Palliative Care (3.90). Improvement actions (informative poster, visual  identification, alerts, training and double checks) were defined and prioritised in accordance with the  risk probability index.

Conclusions: Knowing the degree of risk of hospitalization units in the management of high-alert  medications allows for the implementation of improvement plans in relation to the degree of  vulnerability detected.