ISMP Unveils 2020-2021 Best Safety Practice Updates at ASHP Midyear

The Institute for Safe Medication Practices (ISMP) announced new additions and several modifications to their best safety practices at the 2019 Annual American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exposition. 

ISMP’s best practices were initiated in 2014 to identify, inspire, and mobilize adoption of consensus-based best practices for specific medication safety issues (ie events that continue to cause harmful and fatal errors in patients despite repeated warnings). Reviewed and updated every other year, the practices provide a focus for medication safety efforts and strategic plans for both hospitals and other health care settings. 

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For 2020-2021, ISMP has updated 5 best practices, added a new classification, and introduced 2 new best practices. 

New Best Practices

Best Practice #15: Verify and document patient’s opioid status and type of pain before prescribing and dispensing extended-release and long-acting opioids. 

Best Practice #16: Restrict medications available using override in automated dispensing cabinets (ADC) to those that would be needed emergently (as defined by the organization). Sub rules include the limitations of the amount of medications that can be removed using the override function; requiring medication order prior to removing medication from ADC, including the override function; monitoring the ADC overrides; and listing the medications available using override functions. 

Changes

Best Practice #4: Ensure that all oral liquid medication that are not commercially available in unit dose packaging are dispensed by the pharmacy in an oral or ENFit syringe. 

The best practice has been updated to include an enteral syringe that meets the International Organization for Standardization (ISO) 80369, such as ENFit.

Best Practice #5: Purchase oral liquid dosing devices (oral syringes/cups/droppers) that only display the metric scale. In addition, if patients are taking an oral liquid medication after discharge, supply them with (or provide a prescription for) oral syringes, to enable them to measure oral liquid volumes in milliliters (mL).

Now includes the suggestion to educate patients to request appropriate oral dosing devices to measure oral liquid volumes in milliliters only. 

Best Practice #8: Administer high-alert intravenous (IV) medication infusions via a

programmable infusion pump utilizing dose error-reduction software.

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This best practice has been generalized to include all “medication infusions” instead of “high-alert IVs”. 

New sub sections include: 

• 8b: Maintain a compliance rate of greater than 95% for infusions administered using dose error-reduction software.

• 8c: Monitor compliance with use of smart pump dose error-reduction software on a monthly basis. 

• 8d:  If your organization allows for the administration of an IV bolus or a loading dose from a continuous medication infusion, use a smart pump that allows programming of the bolus (or loading dose) and continuous infusion rate with separate limits for each.

Best Practice #11: Independent verifications should be performmd and directed at all sterile preparations. 

The previous version of this best practice directed independent verification at high-alert, high-risk medications. 

Best Practice #13: Eliminate injectable promethazine from the formulary. 

The previous version directed this rule toward hospitals

New Classification

Update to Best Practice #6: glacial acetic acid removal from the hospital is now archived due to high levels of compliance.