General High-Alert Medications
                             Neuromuscular Blocking Agents
                             Concentrated Electrolytes Injection
                             Magnesium Sulfate Injection 
                             Moderate Sedation in Adults and Children,
    ISMP                     Minimal Sedation in Children
    Medication Safety        Insulin, Subcutaneous and Intravenous
                             Lipid-Based Medications and Conventional
    Self Assessment®         Counterparts
                             Methotrexate for Non-Oncologic Use
    for High-Alert           Chemotherapy, Oral and Parenteral
                             Anticoagulants
                             Neuraxial Opioids and/or Local Anesthetics
    Medications              Opioids
                               ISMP Medication Safety Self Assessment®
                               for High-Alert Medications
               Contents
               Endorsing Organizations ...................................................................................................................................... 3
               Invitation to Participate ........................................................................................................................................ 4
               Acknowledgements  ............................................................................................................................................. 5
               Purpose and Targeted High-Alert Medications ................................................................................................. 6
               Key Definitions and Abbreviations...................................................................................................................... 8
               Instructions for Conducting the Self Assessment ........................................................................................... 10
               Instructions for Entering and Submitting Information to ISMP....................................................................... 13
               General Demographics (19 questions for hospitals/long-term care, 13 questions for outpatient facilities)............................... 17
               General High-Alert Medications (33 self-assessment items) ............................................................................. 26
               Neuromuscular Blocking Agents (1 demographic question, 15 self-assessment items) .............................................. 31
               Concentrated Electrolytes Injection (26 self-assessment items)..........................................................................34         2
               Magnesium Sulfate Injection (2 demographic questions, 22 self-assessment items) .....................................................38
               Moderate Sedation in Adults and Children, Minimal Sedation in Children (40 self-assessment items)...42
               Insulin, Subcutaneous and Intravenous (5 demographic questions, 45 self-assessment items) ................................. 48
               Lipid-Based Medications and Conventional Counterparts (9 self-assessment items) ............................... 58
               Methotrexate for Non-Oncologic Use (7 self-assessment items) ...................................................................... 60
               Chemotherapy, Oral and Parenteral (5 demographic questions, 48 self-assessment items) ........................................ 61
               Anticoagulants (1 demographic question, 43 self-assessment items) ................................................................................ 68
               Neuraxial Opioids and/or Local Anesthetics (32 self-assessment items)........................................................ 74
               Opioids (60 self-assessment items) ............................................................................................................................. 79
               Glossary  .............................................................................................................................................................. 89
               About the Institute for Safe Medication Practices (ISMP).............................................................................. 94
               Logos of Endorsing Organizations ..................................................................................................................... 95
                                                      © 2017 Institute for Safe Medication Practices (ISMP)
               ISMP Medication Safety Self Assessment®
               for High-Alert Medications
        Organizations That Have Endorsed the 
        ISMP Medication Safety Self Assessment® for High-Alert Medications
         • American Association of Colleges of Nursing
         • American Hospital Association
         • American Nurses Association
         • American Society for Healthcare Risk Management
         • American Society for Parenteral and Enteral Nutrition 
         • American Society of Health-System Pharmacists
         • Anesthesia Patient Safety Foundation
         • Association for the Advancement of Medical Instrumentation Foundation
         • Association of periOperative Registered Nurses                     3
         • ECRI Institute
         • Health Care Improvement Foundation
         • Infusion Nurses Society
         • Institute for Healthcare Improvement
         • National Committee for Quality Assurance
         • National Patient Safety Foundation
         • Pediatric Pharmacy Advocacy Group
         • Society of Critical Care Medicine
         • The Joint Commission
         • USP
                                ISMP Medication Safety Self Assessment®
                                for High-Alert Medications
                Invitation to Participate 
                Dear Healthcare Provider:
                The Institute for Safe Medication Practices (ISMP) is pleased to provide our nation’s healthcare providers with the ISMP Medication Safety
                Self Assessment®for High-Alert Medications. This tool, funded by the US Food and Drug Administration (FDA), offers hospitals, long-term
                care facilities, and certain outpatient facilities, such as ambulatory surgery centers, emergency/urgent care facilities, oncology clinics, treat-
                ment centers, dental surgery centers, endoscopy centers, and diagnostic testing centers, a unique opportunity to assess the safety of systems
                and practices associated with up to 11 categories of high-alert medications. ISMP defines high-alert medications as those bearing a height-
                ened risk of causing significant patient harm when used in error. 
                The assessment items were assembled by ISMP working with an expert Advisory Group to ensure that the systems and practices most critical
                to patient safety were included and achievable in many healthcare facilities. As with our past ISMP Medication Safety Self Assessment®
                tools, many key organizations have endorsed or supported the ISMP Medication Safety Self Assessment® for High-Alert Medications
                and offered their ongoing support of this important endeavor. Our endorsers’ names appear on the previous page, and their logos appear on the
                back cover and on our website.
                Healthcare facilities that complete the assessment for any or all of the targeted high-alert medications will be able to identify specific chal-
                lenges and opportunities for improvement as well as track their experiences over time. Use of the self assessment will also help providers meet        4
                or gauge their compliance with managing high-alert medications as required by various state and federal regulatory agencies, such as The Joint
                Commission and the Centers for Medicare & Medicaid Services. Healthcare facilities that submit their assessment findings to ISMP anony-
                mously via a secure internet portal by February 28, 2018, will also be able to obtain weighted scores for each item based on their effective-
                ness in reducing the risk of errors, as well as access aggregate data to compare their individual experiences to the aggregate experiences of
                demographically similar healthcare providers. 
                In addition to the usual high standard of confidentiality associated with any information submitted to ISMP, we are also a federally certified
                patient safety organization (PSO). If self-assessment information is collected within the health system’s patient safety evaluation system and
                submitted to ISMP as patient safety work product, the information is granted protection from discovery in connection with a federal, state, or
                local civil, administrative, or disciplinary proceeding. No contract with ISMP is required for this legal protection. 
                As with the data submitted by thousands of healthcare providers in response to our prior ISMP Medication Safety Self Assessment® tools,
                we will use the aggregate findings to develop tools and plan curricula and other means of support to assist you in enhancing safety when using
                high-alert medications. Additionally, an analysis of the aggregate results will be submitted for publication in a professional journal to detail our
                nation’s baseline efforts to prevent patient harm from errors associated with high-alert medications.
                ISMP, FDA, and the endorsing organizations encourage you to participate in this very important endeavor by completing the self assessment as
                directed in the instructions and by submitting your findings anonymously to ISMP. We welcome the opportunity to work with you as you assess
                the safe use of high-alert medications in your organization! 
                Warm regards, 
                Michael R. Cohen, RPh, MS, ScD (hon), DPS (hon), FASHP