ALWAYS TAKE EXTRA CARE WITH: APINCH
High Risk Medications
High risk medications are those medicines that have a high risk of causing significant patient harm or death when used in error.
Commonly described medicines identified by APINCH:
A - Antimicrobials/anti-infectives
Commonly prescribed aminoglycocides, including gentamicin, and tobramycin, as well as amphotericin, vancomycin, etc
P - Potassium IV and concentration electrolytes
Injections of potassium, magnesium, calcium, hypertonic sodium chloride. Concentrated electrolytes, including: potassium chloride 15% amps, potassium phosphate amps, sodium chloride 30% amps, magnesium sulfate 50% / 20% / 10% amps
I - Insulin*
All insulins. Commonly prescribed insulins include: Novorapid, Actrapid, Lantus, Levemir, Humulin M3, Mixtard 30
* remember, all insulins should be prescribed by brand name
N - Narcotics/Opioids and Sedatives
Commonly prescribed opioids include hydromorphone, oxycodone, morphine, fentanyl, alfentanil, remifentanil tapentadol, and analgesic patches (fentanyl patches, buprenorphine patches).
Commonly prescribed sedatives include benzodiazepines ( eg diazepam, midazolam, lorazapam).
Thiopentone, propofol and other short term anaesthetics
C - Cytotoxic/Chemotherapeutic drugs
Commonly prescribed cytotoxic drugs include methotrexate, azathioprine, mercaptopuring, valganciclovir, capecitabine, vincristine, etoposide
H - Heparin and other anticoagulants
Commonly prescribed anticoagulants include heparin sodium and low molecular weight heparins (enoxaparin and tinzaparin), warfarin and DOACs (dabigatran, rivaroxaban, apixaban, edoxaban)
APINCH is not an exhaustive list and variations of the ‘APINCH’ can also include other high-risk medications or high-risk situations such as epidural, intrathecal and neuromuscular-blocking agents.
