Watch new biotech and high-alert meds

Unintentional overdose is one of the most common adverse drug events, and it often occurs simply because patients are not monitored closely enough when using new medications, says Bruce Lambert, PhD, professor of pharmacy administration at the University of Illinois at Chicago College of Pharmacy, and an expert on adverse drug events and patient safety.

New biotechnology drugs are the culprit in many adverse drug events, he says, and that means risk managers may want to implement stricter controls and require more pharmacist oversight for them, as well as encouraging more education about how to use these often powerful medications. Many of them can be very dangerous, in that they affect the immune system and cause other systemic damage if not used carefully.

"Doctors, patients, and pharmacists all lack experience with these new drugs," Lambert says. "They may have been approved for relatively narrow applications but used in much larger populations. Until experience accumulates with these drugs, we may not know the best way to monitor them and manage risk, but they should be used very carefully."

Lambert advises risk managers to focus drug error risk management on high-hazard drugs. (For guidance on what drugs represent the highest hazards, see the ISMP web site at Under "Medication Safety Tools & Resources," choose "High-Alert Medication List.")

"Most of the actual harm comes from a relatively small number of classes of drugs," he says. "These may be opiate analgesics, anticoagulants, paralytic drugs, for instance. Risk managers should look to that list as a guide for where you can focus your prevention efforts. Start where the most problems occur."