How to handle high-alert medications
Other platforms explain it with text and video. In VMS you practice it on the patient.
High-alert drugs are not given wrong more often than others, but when they are, the harm is severe. Extra safeguards around them prevent most serious medication injuries.
Step by step
Know the list
Learn your facility's high-alert drugs. Common ones are insulin, opioids, anticoagulants, concentrated electrolytes such as potassium chloride, chemotherapy and paralytics. [1]
Store them safely
Keep concentrated electrolytes off general unit stock and separate look-alike packages. Paralytics should carry a warning label. [1]
Do an independent double check
A second qualified person checks the order, drug, dose, math and pump settings on their own, not by reading your numbers. [1]
Use standard strengths and smart pumps
Use premixed standard concentrations and the pump drug library. Do not override a hard limit without a verified reason. [1]
Write orders clearly
Write units in full, use a leading zero (0.5 mg) and never a trailing zero (5 mg, not 5.0 mg). [2]
Follow the anticoagulant rules
Use approved protocols, check lab results such as INR and aPTT, and teach the patient about bleeding signs. [2]
Monitor closely
Check glucose after insulin, breathing and sedation after opioids, and bleeding after anticoagulants. Know the antidote and where it is kept. [1]
Common errors
- Skipping the double check when the unit is busy.
- Overriding a smart pump limit without checking the order.
- Writing U for units or a trailing zero after a decimal point.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- Open RN, Nursing Pharmacology 2e (CC BY 4.0)
- The Joint Commission, National Patient Safety Goals
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
Steps adapted from Open RN, Nursing Pharmacology 2e and Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. VMS is not affiliated with these organizations. Updated: 2026-10-11.