APINCHS classification of high risk medicines

In Australia, the APINCHS acronym and classification provides a framework to assist clinicians to focus on a group of medicines known to be associated with high potential for medication-related harm. APINCHS does not encompass all high risk medicines, but it is a valuable tool to raise clinician awareness and to educate them about medication safety systems. 

Categorisation of and policy relating to high risk medicines may vary between states, territories and health service organisations. This means that health service organisations should have systems and process in place for the safe use of high risk medicines.

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APINCHS

APINCHS is explained below:

A Antimicrobials
  • Aminoglycosides: gentamicin, tobramycin and amikacin
  • vancomycin
  • amphotericin – liposomal formulation
P Potassium and other electrolytes
  • Injections of concentrated electrolytes: potassium, magnesium, calcium, hypertonic sodium chloride
I Insulin
  • All insulins  
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
  • Oral chemotherapy
H Heparin and other anticoagulants
  • Heparin and low molecular weight heparins (LMWH): dalteparin, enoxaparin
  • Warfarin
  • Direct oral anticoagulants (DOACs): dabigatran, rivaroxaban, apixaban
S   Systems  
  • Medication safety systems such as independent double checks, safe administration of liquid medications, standardised order sets and medication charts etc

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.

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Medication safety
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