The original classification used in Australia was APINCH. An ‘S’ for ‘systems’ has been added to include other evidence-based practices known to improve safety such as independent double-checks and safe administration of liquid medicines by using oral dispensing syringes.
|A||Antimicrobials||Aminoglycosides: gentamicin, tobramycin and amikacin
amphotericin – liposomal formulation
|P||Potassium and other electrolytes||Injections of concentrated electrolytes: potassium, magnesium, calcium, hypertonic sodium chloride|
|N||Narcotics (opioids) and other sedatives||hydromorphone, oxycodone, morphine, fentanyl, alfentanil, remifentanil and analgesic patches
Benzodiazepines: diazepam, midazolam
thiopentone, propofol and other short term anaesthetics
|C||Chemotherapeutic agents||vincristine, methotrexate, etoposide, azathioprine
|H||Heparin and other anticoagulants||warfarin, enoxaparin, heparin
Direct oral anticoagulants (DOACs): dabigatran, rivaroxaban, apixaban
|Medication safety systems such as independent double checks, safe administration of liquid medications, standardised order sets and medication charts etc|
Useful resources for high risk medicines including safety alerts, notices and other guidance can be accessed here.
The National Safety and Quality Health Service (NSQHS) Standard on Medication Safety requires health services to identify HRMs used within the organisation and take appropriate action to ensure that they are stored, prescribed, dispensed and administered safely.
It is important to note that a single risk-reduction strategy for each HRM is rarely capable of preventing patient harm. When seeking to reduce the likelihood of harm from HRMs in healthcare settings, a range of strategies need to be considered to promote safer use or decrease the opportunity for misuse or error. The institute for Safe Medication Practices (ISMP) recommends4:
As a minimum, health service organisations can use the ‘APINCHS’ list of medicines to:
Risk-reduction strategies should be prioritised, and based on an assessment of how HRMs are managed within the organisation using audits, incident analysis, risk assessment tools and benchmarking activities. This should be done in consultation with the healthcare organisation’s governance group responsible for medication management, for instance the Drug and Therapeutics Committee.
A recommended approach in prioritising work, as well as determining whether medication safety risks are recorded on the organisation’s risk register, is to use a risk matrix to assess potential risk level and likelihood of occurrence. You can access the one available from the Commission’s website here.
4 Institute for Safe Medication Practices (ISMP) (US). Medication Safety Alert! 4 April 2013. Your high-alert medication list – relatively useless without associated risk-reduction strategies. https://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=45 (accessed September 2017).