High Risk Medicines Framework

What are high risk medicines?

High risk medicines are defined as medicines that have a high risk of causing injury or harm if they are misused or used in error. Error rates with these medications are not necessarily higher than with any other medicines, but when problems occur, the consequences can be more significant. (American Pharmacists Association, Medication Errors. 2nd ed 2007, Washington DC, American Pharmacists Association.) High risk medicines are also context specific, and may vary according to care setting, patient group and staff. 

High risk medicines framework

Reducing harm due to high risk medicines has been identified as a priority by health boards across Scotland. High risk medicines was a key theme at the 2016 National SPSP Conference, with a facilitated discussion on how teams can improve the prevention, recognition and response to harm due to high risk medicines. Following on from the national conference a discussion framework has been produced to support local teams discuss and prioritise improvement activities related to high risk medicines.

  • Medicine or medicine group
  • Harm (adverse effect or effect of omitted dose(s))
  • Deterioration (changes that are associated with increased likelihood of harm in that patient)
  • Interventions to PREVENT deterioration
  • Interventions to increase RECOGNITION of deterioration
  • Interventions to improve (structured) RESPONSE to deterioration

Using this framework examples of potential interventions to improve the prevention, recognition and response to harms due to high risk medicines have been developed based on feedback from key stakeholders and networks (updated May 2017 - clozapine and lithium added). This is a live resource, and the SPSP Medicines Team would welcome further suggestions to add to the document. A blank discussion framework template is also available to support teams discuss and plan improvements related to local high risk medicines priorities.