High-Alert Medication List & Guidelines

High-Alert Medication List & Guidelines

PSYCHOTROPIC Medications:

▪ LITHIUM – can be fatal in accidental or intentional overdose. Toxicity can easily result when persons develop 

dehydration from nausea, vomiting, diarrhea, or poor intake of fluids. Think about this when you hear someone 

“has a stomach bug” and during the hottest months if the client has inadequate or no shelter. Another situation to 

be on alert for Lithium toxicity is when clients take NSAIDS (such as Ibuprofen) or they get new prescriptions from 

the primary care doctor (such as blood pressure meds).

Classic signs of Lithium toxicity include marked tremors, confusion, slurred 

speech, poor balance, vomiting/diarrhea. Note that vomiting and diarrhea are both a cause and symptom 

of Lithium toxicity. Confusion is serious business. If your client no longer recognizes her caretaker or doesn’t 

know where she is and cannot understand what is going on, this is an immediate trip to the ER for delirium. 

(This goes for all clients whether they are on lithium or not.)

▪ DEPAKOTE OR VALPROIC ACID – Rarely toxic. Patients may be unsteady on their feet. You should make the 

prescribing MD aware if someone is unsteady or having falls. Persons can develop yellow skin or bleeding and 

bruising problems and need to see their prescribing MD. 

▪ BENZODIAZEPINES – Such as Xanax (alprazolam), Valium(diazepam), Klonopin (clonazepam) are at risk of 

causing injury/ death with accidental or intentional overdose or when taken in combination with alcohol/other meds 

that affect the central nervous system. There is also a significant risk of abuse/dependence.

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▪ SEDATIVES – Such as Ambien, Lunesta, Sonata are at risk of causing injury/death with overdose, in combination 

with alcohol/other meds and also have significant abuse/dependence potential.

▪ STIMULANTS – Such as Adderall, Concerta, Vyvanse, Ritalin can cause irregular heart rhythms when used as 

prescribed and injury/ death with overdose or in combination with alcohol/ other meds. There is also a significant risk 

of abuse and as such these drugs are highly regulated by the DEA (Drug Enforcement Agency).

▪ Older Antipsychotics – Such as Haldol, Prolixin, Stelazine, Thorazine –Watch for unrelenting muscle spasms. 

This is acute dystonia and most often affects the face, head, neck, and shoulders. If you see it, it is unmistakable. 

Patients are scared and in pain, and contorted. They need to be taken to the ER to be given Cogentin or Benadryl

▪ NMS (Neuroleptic Malignant Syndrome) can develop with these medications. If someone becomes confused with 

fever, they need to be seen by a MD urgently. That goes for all patients.

▪ Newer ANTIPSYCHOTICS – Such as Risperdol, Invega, Zyprexa, Geodon, Abilify –Watch for rapid weight gain 

and refer to primary care MD to be evaluated for metabolic syndrome. Patients may also complain of increased thirst 

or urination if they are developing diabetes. The prescriber will be monitoring for these complications. 

NON-Psychotropic Medications:

▪ Opiates – Such as Percocet, Oxycontin, Codeine, Methadone are at risk of causing injury/death with overdose, 

in combination with alcohol/other meds and have significant abuse/dependence potential.

Risk Management Guidelines:

Arrange Transportation to ER or call 911 if…. Contact Prescribing MD if…..

Confusion in any situation – Person does not recognize familiar people and/or does 

not understand where she is or what is going on, but usually person knows these 

things.

Person reports increased thirst or urination

Person taking Lithium has nausea/vomiting/diarrhea or slurred speech and 

unsteady on feet. 

Rapid weight gain

Person taking Antipsychotic has unrelenting muscle spasm or fever greater than 

102. 

Near falls, woozy

Person taking Depakote has unrelenting bleeding (usually nosebleeds) Yellow skin, marked bruising

ANY person is falling down/passing out. Person is suspected of misusing or abusing any medicine.

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Do-Not-Use List

In addition to the "minimum required list"

The following items is also considered when expanding the "Do not use" list to include the 

Abbreviation Potential Problem Preferred Term

µg

(for microgram) 

Mistaken for mg (milligrams) resulting in 

one thousand-fold dosing overdose

Write "mcg"

H.S.

(for half-strength or Latin abbreviation 

for bedtime)

Mistaken for either half-strength or hour of 

sleep (at bedtime) q.H.S. mistaken for 

every hour. All can result in a dosing error.

Write out "half-strength" or "at 

bedtime"

T.I.W.

(for three times a week)

Mistaken for three times a day or twice 

weekly resulting in an overdose

Write "3 times weekly" or "three 

times weekly"

S.C. or S.Q.

(for subcutaneous)

Mistaken as SL for sublingual, or "5 every" Write "Sub-Q", "subQ", or 

"subcutaneously"

D/C

(for discharge)

Interpreted as discontinue whatever 

medications follow (typically discharge 

meds). 

Write "discharge"

c.c.

(for cubic centimeter)

Mistaken for U (units) when poorly written. Write "ml" for milliliters

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APPENDIX D:

APPENDIX D:

Infectious Disease Management Steps

Identify – Control – Report – Investigate

Identify

Know the NC Reportable Disease/Condition. Collect clinical information and review any 

applicable laboratory information/report specific to the disease.

Control

Implement control measures to prevent disease and additional exposures. If a staff person, 

volunteer, or program participant has a serious communicable disease that may be spread 

through casual contact, written authorization from a licensed physician, certified nurse practitioner 

or licensed physician’s assistant is required for the person to be present at the facility. Written 

authorization shall include a statement that the person will not pose a threat to the health others 

and specific instructions and precautions to be taken for the protection of others.

Report

Report the disease/condition to your immediate supervisor and/or the local health department if 

applicable.

Investigate

Attempt to identify the source of exposure. 

A.S., A.D., A.U.

(Latin abbreviation for left, right, or both 

ears) O.S., O.D., O.U.(Latin abbreviation for 

left, right, or both eyes)

Mistaken for each other

(e.g., AS for OS, AD for OD, AU for OU, 

etc.)

Write: "left ear," "right ear" or "both 

ears;" "left eye," "right eye," or "both 

eyes