High alert medications off the radar: A systematic review

To identify new drugs that present an increased risk of causing significant damage to critically ill patients due to failure in the administration process. The systematic literature review was conducted in the PubMed, Lilacs, Scopus, Web of Science and gray literature. The year in which the study was conducted was not restricted. The initial search in the databases identified 1477 studies. Fifty manuscripts were selected for evaluation of the full text, at the end of which seven articles were included in this systematic review. As for the characteristic of medication errors, the highest frequency occurred in the administration and prescription phases. In all included studies, incidents with drugs that led to damage were observed. The drugs that are not included in the official lists as High Alert Medications (HAM) that presented an increased risk of causing damage due to medication errors found were: risperidone and piperacycline + tazobactan, in addition to the Infectious Agent class. The results revealed that in fact there are drugs not listed as HAM that, when used in errors, promote greater risks of generating damage in critically ill patients. These described drugs should be considered for inclusion in future official lists of HAM. •All studies demonstrated damage that is considered life- threatening.•One of the articles recorded the death of a patient.•It is possible to state that the drugs involved in these studies are potentially HAM.