HIGH ALERT MEDICATIONS
Education Module
For
Pharmacy Services
Author: Medication Management Safety Team
Date: January 2015
Contents
Purpose .............................................................................................................................................................................................................................. 4
Responsibility, Maintenance and Sustainability ................................................................................................................................................................. 4
Policies and Procedures ..................................................................................................................................................................................................... 4
High Alert Medication Storage Requirements and Key Principles ...................................................................................................................................... 5
Storage Containers ....................................................................................................................................................................................................... 5
Segregated Storage ....................................................................................................................................................................................................... 5
HAM Labeling ..................................................................................................................................................................................................................... 6
High Alert Medication Labels ........................................................................................................................................................................................ 7
Caution and Auxiliary Labels ......................................................................................................................................................................................... 7
High Potency Narcotics: ........................................................................................................................................................................................... 7
Concentrated Electrolytes: ...................................................................................................................................................................................... 7
Unfractionated heparin: .......................................................................................................................................................................................... 7
Obtaining labels ............................................................................................................................................................................................................ 7
Label Placement............................................................................................................................................................................................................ 7
Implementation and Pictures ............................................................................................................................................................................................. 8
High Alert Medication Storage Containers .................................................................................................................................................................... 8
High Alert Medication Label Placement ........................................................................................................................................................................ 8
Cautionary Auxiliary Labels ........................................................................................................................................................................................... 8
Neuromuscular Blocking Agents .............................................................................................................................................................................. 8
Narcotics.................................................................................................................................................................................................................. 8
Epidurals .................................................................................................................................................................................................................. 9
Insulins .................................................................................................................................................................................................................... 9
Sodium chloride hypertonic IV bags ........................................................................................................................................................................ 9
Potassium IV solutions............................................................................................................................................................................................. 9
Code Trays and Miscellaneous Trays ..................................................................................................................................................................... 10
Night Cupboard and Automated Dispensing Cabinets Storage and Labeling Requirements ................................................................................. 10
Restricted High Alert Medications .................................................................................................................................................................................... 11
Concentrated Electrolyte solutions ............................................................................................................................................................................. 11
Heparin Products ........................................................................................................................................................................................................ 11
Opioid products: ......................................................................................................................................................................................................... 11
Exceptions to Restricted products .................................................................................................................................................................................... 11
References ....................................................................................................................................................................................................................... 12
Appendices and Tables ..................................................................................................................................................................................................... 13
Table 1 Clinical Data Category for High Alert Medications with ROP exceptions ........................................................................................................ 13
Appendix A* - Covenant Health HAM List ................................................................................................................................................................... 14
Appendix B - HIGH ALERT MEDICATION LABELS AND CAUTION/AUXILLARY LABELS .................................................................................................. 15
APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING.............................................................................................................................. 19
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High Alert Medications: Storage and Labeling Guidelines
Purpose
The purpose of this document is to provide standardization of labeling formats and storage
requirements for High Alert Medications (HAMs) within Covenant Health facilitates where HAMs are
stored.
HAMs can cause significant patient harm when selected in error and therefore require specific risk
reduction strategies. Covenant Health will meet the requirements set by Accreditation Canada and
will provide a standardized approach to the storage and labeling requirement for HAMs.
Please see Appendix A for the Covenant Health Provincial High Alert Medication List. Also
review the Covenant Health High Alert Medications Policy
Responsibility, Maintenance and Sustainability
Pharmacy is responsible for the proper labeling and storage of HAMs in the Pharmacy department
and on patient care areas where HAMs are available.
Covenant Health managers will demonstrate commitment to safety of all patients by ensuring HAM
storage and labeling is maintained. Managers are responsible to alert the Pharmacy departments of
any HAM labeling and storage maintenance requirements.
The Covenant Health Medication Management Safety Team is responsible for coordinating and
following up on annual audits and ensuring compliance and maintenance of HAM storage and
labeling.
Policies and Procedures
Please review all the related policies and procedures listed below for a comprehensive overview of
the HAMs. Supporting documents are listed in the reference section of this learning module.





Covenant Health High Alert Medications Policy
Covenant Health Managing of High Alert Medications: High Potency Narcotics Policy
Covenant Health Managing of High Alert Medications: Heparin Policy
Covenant Health Managing of High Alert Medications: Concentrated Electrolyte Policy
Corporate Pharmacy Policy and Procedures Manual: Labelling Standards
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Policy and Procedures (continued)

Covenant Health Standardized Medication Concentrations for Parenteral Administration
Policy
Covenant Health Tall Man Lettering Policy
Covenant Health Prohibited Abbreviations, Symbols and Dose Designations Policy


High Alert Medication Storage Requirements and Key
Principles
Storage Containers
Each HAM should be stored in an individual storage container with one medication per container.
Where space is an issue, more than one HAM may be stored in a single container provided that the
medications are segregated by a labeled divider.
Storage containers can be ordered from any medical supply company. The storage containers
should be plastic to withstand moisture and be easily cleaned to uphold infection control standards.
Segregated Storage
Where possible, HAMs shall be stored according to the following recommendations:
1. Look-alike medications shall be physically separated in separate non-adjacent bins, unless
this separation is likely to introduce a new risk for selection error as a result (one strategy
is to put an empty box or bin to make a separation between bins). When physical
separation is not possible, local safe guards shall be in place to identify HAMs. Storage
and labeling precautions need to be in place for sound-alike and look-alike medications
(e.g., using Sound-alike/Look-alike auxiliary labels to alert staff of potential selection error).
2. Insulins are to be organized by duration of action (i.e., rapid, short, intermediate and long
acting).
3. Oral narcotics with long acting dosage formats are to be segregated from those that are in
short acting dosage formats.
4. Heparin vials/ampoules are to be stored separately from heparin lock solutions/syringes.
5.
Unit Managers, Pharmacy Services and Stores need to collaborate to ensure the proper
storage and labeling of HAMs provided by Stores and those available in patients care
areas (i.e. sterile water for inhalation or injection, radio contrast dyes etc.)
.
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High Alert Medication Storage Requirements and Key Principles
(continued)
Segregated Storage (continued)
6. IV solutions containing sodium chloride (greater than 0.9%) should be segregated from other IV
solutions.
7. HAMs are to be removed from original shipping containers where possible. Due to the large
volume of medications stored in Pharmacy departments, some drug stock may be kept in
original shipping containers (e.g., IV solutions).
8. A larger HAM shelf label can be used to identify the stock on the specific shelf rather than
labeling each box (see Appendix C, Picture 11).
9. Products removed from original shipping containers (e.g., opened cases of IV heparin bags)
should be stored in a container labeled with a HAM icon and appropriate auxiliary
label/cautionary label.
HAM Labeling
HAMs must have a clearly labeled storage container. The storage container must have a HAM label as
well as any other appropriate auxiliary labels. The following format for labeling storage containers is
recommended:
1. Black print on white label
2. Left justification
3. Sans Serif font style
 Tahoma or Verdana fonts are preferred (upper case “I” does not look like lower case “1”);
 Font size needs to be a minimum of 14, where possible;
 A space between the numeric strength and the unit of measure (e.g., 5 mL not 5mL);
 The first line information should contain lower case lettering for full generic name;
 No capital at the beginning of a generic name unless Tall Man lettering is appropriate;
 The second line should contain the strength/concentration formulation and product size;
 Brand name in brackets and in all capital letters except where Tall Man lettering is appropriate
and indicated as per Covenant Health policy Tall Man Lettering.
 Do not use prohibited abbreviations, symbols or dose designations (e.g. do not use ‘U’ for
unit as per Covenant Health policy Prohibited Abbreviations, Symbols and Dose Designations
VII-A-25); and,
 Any additional site specific information (e.g., inventory numbers or barcode labels), can be
affixed below the medication label or added to the bottom of the medication label space
permitting.
For comprehensive medication labeling standards refer to:
Corporate Pharmacy Policy and Procedures Manual: Labelling Standards
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HAM Labeling (continued)
High Alert Medication Labels
The HAM label shall be affixed to all storage containers containing HAMs. The HAM label is intended to
differentiate HAMs from other medications. It is also intended to promote staff awareness and vigilance
when using HAMs. For HAM label see Appendix B.
Caution and Auxiliary Labels
 Additional appropriate caution and auxiliary labels shall be affixed to storage containers and
products as per the HAM labeling guide. See Appendix B.
 PHARMACY USE ONLY auxiliary label to be affixed to storage container in Pharmacy to the
right of the medication label. This is applicable to the following:
High Potency Narcotics
 fentaNYL 50 mcg/mL (50 mL vial size)
 HYDROmorphone 10 mg/mL (50 mL vial size)
 HYDROmorphone 50 mg/mL (50 mL vial size)
 morphine 2 mg/mL (50 mL vial size)
 morphine 50 mg/mL (50 mL vial size)






Concentrated Electrolytes
calcium (all salts) in concentrations greater than or equal to 10%
magnesium sulfate in concentrations greater than 20%
potassium (all salts) in concentrations greater than or equal to 2 mmol/mL
sodium acetate in concentrations greater than or equal to 4 mmol/mL
sodium phosphate in concentrations greater than or equal to 4 mmol/mL
sodium chloride in concentrations greater than 0.9%
Unfractionated heparin
 Unfractionated heparin 50,000 units total per container
Obtaining labels
Please see Appendix B for the ordering of HAM labels as well as applicable auxiliary labels.
Label Placement




Center the medication label on the front of the storage container;
For each HAM, affix a HAM label to the left of the medication label on storage containers;
Affix the auxiliary label to the right of the medication label on the storage container;
If any additional labeling is required (e.g., inventory number or barcode), it should be placed on a
separate label below the medication label, or at the bottom of the medication label if space is an
issue; and,
 Please note it is recognized that situations may exist where adaptations are necessary in order
to fit information on small spaces (Pharmacy to use best judgment).
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Implementation and Pictures
High Alert Medication Storage Containers
See Appendix C, Picture #1
High Alert Medication Label Placement
See Appendix C, Picture #1
Cautionary Auxiliary Labels
Neuromuscular Blocking Agents
 See Appendix C, Picture # 2.
 Affix the “Warning: Paralyzing agent. Causes Respiratory Arrest” auxiliary label to the right of
the medication label as well as a HAM label to the left of the medication label on the storage
bin (refer to “Label Placement” in Section 5).
Narcotics
 See Appendix C, Picture # 3.
 For Narcotics that have both SHORT and LONG acting formulations:
o Physically separate the storage containers for both formulations, in Pharmacy and the
patient care units.
 Affix a LONG ACTING or SHORT ACTING auxiliary label to the right of the medication label
on each of the corresponding storage containers, as well as the product in Pharmacy and on
patient care units.
Narcotics on Patient Care Areas
 HAM icon label should be affixed to the left of the medication label on the storage
container for narcotics stored on patient care units.
Narcotic Storage in Pharmacy
 Place a HAM icon sign on the Narcotic vault door. This will indicate that every
medication in the vault is a HAM, and it is not necessary to label each storage
container with a HAM icon.
Narcotics: High Potency
 High potency Narcotics require a HAM icon label affixed to the left side of the
medication label on the storage container.
 High Potency Narcotics require a “High “Potency Medication Confirm Dose” auxiliary
label to the right of the medication label on the storage container The “High Potency
Confirm Dose” auxiliary label should be applied to the product if feasible.
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Implementation and Pictures (continued)
Caution and Auxiliary Labels (continued)
Narcotics (continued)
Patient Specific Narcotics
 See Appendix C, Picture # 4
Epidurals
 See Appendix C Picture # 5
 Ready to administer epidurals should be stored separately and in a secured location in
Pharmacy and on nursing units
 Storage containers will require a HAM icon
 Affix a “For Epidural Use” auxiliary label onto each epidural bag/syringe as well as the storage
container
Insulins
 See Appendix C, Picture #6
 If possible, store Insulins together but away from other medications
 Separate long acting and short acting insulin products
 Label Insulins storage containers with HAM icon to the left of the medication label
 Label short acting Insulins with a SHORT ACTING auxiliary label to the right of the medication
 Label long acting Insulins with a LONG ACTING auxiliary label to the right of the medication
Sodium chloride hypertonic IV bags
 See Appendix C, Picture # 7
 sodium chloride hypertonic IV bags will be stocked in one strength and will be stored away
from other IV solutions
 Label sodium chloride hypertonic IV storage containers with HAM icon to the left of the
medication label and a “Caution Hypertonic Saline” auxiliary to the right of the medication
label
 Label sodium chloride bags hypertonic IV bags with “Caution Hypertonic Saline” auxiliary
label to the right of the medication label
Potassium IV solutions
 See Appendix C, Picture # 8
 potassium containing IV solutions should be segregated from other IV solutions if possible
 For potassium vials with a concentration of 2mmol/mL or greater, label storage containers
with HAM icon and appropriate auxiliary labels to the left of the medication label (See
Appendix B)
 Label potassium containing IV bags with “CAUTION IV contains potassium” auxiliary label.
This is applicable to the following potassium products
o potassium chloride 10 mmol/50 mL
o potassium chloride 10 mmol/100 mL
o potassium chloride 20 mmol/50 mL
o potassium phosphate IV solutions made by Pharmacy
o potassium acetate IV solutions made by Pharmacy

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Implementation and Pictures (continued)
Cautionary Auxiliary Labels (continued)
Code Trays and Miscellaneous Trays
 See Appendix C, Pictures # 9 & 10.
 Affix a HAM label on the outside of the code tray, on all sides, if feasible
 HAM items within the code tray need to be labeled accordingly (i.e., dividers to be clearly
labeled with HAM icon label and auxiliary labels)
 If space is a concern, use best judgment when labeling code trays
 Miscellaneous trays/kits (e.g. Epidural trays) will need to be labeled with appropriate HAM
labels and auxiliary labels by Pharmacy. Kits are to be created for exceptional circumstances
only.
Night Cupboard and Automated Dispensing Cabinets Storage and Labeling Requirements
Night Cupboard Storage and Labeling
o HAM labels apply to the transport bag the medications are sent in, not the product.
(e.g., place the HAM icon on the paper bag that the hypertonic sodium chloride 3% IV
bag is stored in).
o Any applicable caution or auxiliary labels apply to the targeted high alert products. See
Appendix B for details on targeted products and appropriate auxiliary labels required.
Automated Dispensing Cabinets Storage and Labeling
o A HAM label icon should be applied to all and any Automated Dispensing Cabinet
(ADC) cubie, carousel or storage bin that contains a HAM (see Appendix C, Picture
# 12b).
o Caution or auxiliary labels should also be applied to any ADC cubie, carousel or
storage bin that contains a targeted/restricted HAM (see Appendix C, Picture # 12
b).
o Ensure adhesive from HAM/auxiliary labels does not interfere with ADC working parts.
Avoid excessive use of tape as this is difficult to remove when drugs need to be
relocated.
o Avoid storage of HAMs in matrix storage bins when possible.
o Carousel drawers should be labeled with a HAM label icon on the bottom and sides of
each individual slot.
o Cubies have a plastic clip inside the clear plastic lid which can be used to insert and
secure a HAM label on a separate card. This will reduce the amount to adhesive used
(see Appendix C, Picture # 12 a).
o All restricted HAMs stored in an ADC must have a “Clinical Data Category” (CDC)
assigned. A CDC is an onscreen alert that provides safeguard information when
selecting a medication in an ADC. Please see Table 1, page 12 for details on CDC
alerts in ADCs.
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Restricted High Alert Medications
The following products are restricted and shall not be stored on patient care units or service areas:
Concentrated Electrolyte solutions






calcium (all salts) in concentrations greater than or equal to 10%
magnesium sulfate in concentrations greater than 20%
potassium (all salts) in concentrations greater than or equal to 2 mmol/mL
sodium acetate in concentrations greater than or equal to 4 mmol/mL
sodium phosphate in concentrations greater than or equal to 4 mmol/mL
sodium chloride in concentrations greater than 0.9%
Heparin Products




Unfractionated heparin greater than or equal to 10,000 units total per container
Unfractionated heparin for intravenous use (e.g. heparin 25,000 units/250 mL)
Low molecular weight heparin in multi-dose vials
Exception critical care areas
Opioid products:
 HYDROmorphone ampoules or vials with a total dose greater than 2 mg per container
 fentaNYL ampoules or vials with a total dose greater than 100 mcg per container
 morphine ampoules or vials with a total dose greater than 15 mg per container in adult care
areas
 morphine ampoules or vials with a total dose greater than 2 mg per container in pediatric care
areas
Exceptions to Restricted products
 When necessary for a restricted product to be available in a selected patient care area, a Required
Organizational Practice (ROP) Exceptions Request form must be submitted to the Medication
Management Safety Team for processing. To obtain a form go to CompassionNet.
 If an ROP exception is applied to one of the above restricted HAM products, the storage and labeling
requirements outlined in this document shall apply. The unit is required to have a copy of the
approved ROP exception form available to staff.
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References
1. Covenant Health High Alert Medications Policy
2. Covenant Health Managing of High Alert Medications: High Potency Narcotics Policy
3. Covenant Health Managing of High Alert Medications: Heparin Policy
4. Covenant Health Managing of High Alert Medications: Concentrated Electrolyte Policy
5. Covenant Health Standardized Medication Concentrations for Parenteral Administration Policy
6. Corporate Pharmacy Policy & Procedures Manual: Labeling Standards
7. Accreditation Canada Medication Management Quantum Program, January 2013. Standard 17
8. Required Organizational Practices Handbook. 2014
9. Covenant Health Tall Man Lettering Policy
10. Covenant Health Prohibited Abbreviations, Symbols and Dose Designations Policy
11. Alberta Health Services High Alert Storage and Labelling Recommendations:
http://insite.albertahealthservices.ca/PharmacyServices/tms-phm-mqst-ham-mslr.pdf
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Appendices and Tables
Table 1 Clinical Data Category for High Alert Medications with ROP exceptions
PRODUCT
Pyxis
PYXIS CDC #
magnesium 5 g vials
Pyxis
#4
calcium chloride 10% syringes
(100 mg/mL)
Pyxis
#1
calcium chloride 5 g/50mL
vials
Pyxis
#6
calcium gluconate vials
Pyxis
#3
Pyxis
#3,
fentaNYL 250 mcg/5 mL ( in
Pyxis OR only, and A-Kits)
Pyxis in ORs ONLY, and AKits
#2, #5
HP HYDROmorphone
10mg/mL (in Palliative Care)
Pyxis in Palliative Care
#5
HP morphine 50 mg/mL ( In
Palliative Care)
Pyxis in Palliative Care
#5
sodium chloride 3% IV bags
Pyxis
#3
low molecular weight heparin
LMWH multi-dose vials
Heparin 250,000 units/250 mL
IV bags
#1 HAM
#2 For Anesthesia Use Only (fentaNYL 250 mcg/5 mL vials)
#3 To be labeled immediately with patient specific label (for Multi-dose vials (MDVs - e.g. LMWH)
and IV bags that are removed from Pyxis)
#4 FOR URGENT USE ONLY WHEN DIRECT IV PUSH REQUIRED. For all other uses, please use
premixed bags.
#5 High Potency Medications Confirm dose
#6 For CRRT USE ONLY.
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Appendix A* - Covenant Health HAM List
To view an alphabetized list of Covenant Health HAMs go to the Covenant Health
High Alert Medication Alphabetized list.
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Appendix B - HIGH ALERT MEDICATION LABELS AND CAUTION/AUXILLARY LABELS
HIGH ALERT MEDICATION LABELS AND CAUTION/AUXILLARY LABELS
Label Description
Drug Class
All HAM
For complete list of
all high alert
medications please
refer to Appendix A
of this document
Use
 To be affixed to the
storage containers only
(do not label product).
 To be affixed to
automated dispensing
cabinets (ADC) cubies,
carousels and storage
containers/bins
containing HAMs.
Exception: Narcotics - It
is not necessary to label
each storage container
within the narcotic area. A
single large icon can be
affixed to the locked
storage area in Pharmacy
is sufficient.
CAUTION LABELS TO BE USED IN ADDITION TO HIGH ALERT MEDICATION
LABEL
To be affixed to the storage
Neuromuscular
Blocking Agents containers only (no need to
Order Number
Make your own or
Pharmasystems #s:
Small size
(16mmX16mm)
AHSPTO39
Regular size
(44mm X 25mm)
AHSPT04
Large size
(64mmX38mm)
AHSPT05
Pharmasystems #
#2722
label product)
All Pharmasystems labels can be ordered by calling Pharmasystems Customer Service Toll Free at 1-888-475-2500. The website can be accessed
at www.pharmasystems.com.
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Appendix B - HIGH ALERT MEDICATION LABELS AND CAUTION/AUXILLARY LABELS
Label Description
Drug Class
Epidurals
Use
To be affixed to each ready to
administer epidural products AND
storage bins
Order Number*
AHSPT040
Narcotics
To be affixed to the storage
containers and to each product if
the narcotic is available in both
long and short acting formula’s
(Products supplies by Pharmacy
will already be labeled
AHSPT01
High Potency Narcotics:
 HYDROmorphone with total dose
greater than 2 mg per container
 morphine with total dose greater than
15 mg in adult care areas and 2 mg in
pediatric care areas per container
 fentaNYL with total
dose greater than 100 mcg per
container
Electrolyte Products
 potassium Chloride Mini-bags (50 mL and
100 mL)
 potassium phosphate IV Solutions
To be affixed to the storage
containers of short acting and
long acting insulin.
To be affixed to the storage
containers. Should also be affixed
to each product if feasible
AHSPT03
AHSPT010
To be affixed to the storage
containers and to each product.
AHSPT07
Apply auxiliary label directly to
outer wrap if product has outer
wrap (Products supplied by
Pharmacy will already be labeled
appropriately)
*All Pharmasystems labels can be ordered by calling Pharmasystems Customer Service Toll Free at 1-888-475-2500. The website can be accessed at
www.pharmasystems.com.
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Appendix B - HIGH ALERT MEDICATION LABELS AND CAUTION/AUXILLARY LABELS
Label Description
Drug Class
Electrolyte Products
 sodium chloride 3% and 5%(hypertonic) IV
solutions









Unfractionated heparin 50,000 units total
per container
fentaNYL 50 mcg/mL (50 mL)
HYDROmorphone 10 mg/mL (50 mL)
HYDROmorphone 50 mg/mL (50 mL)
morphine 50 mg/mL (50 mL)
potassium phosphate vials
potassium chloride vials
potassium acetate vials
sodium chloride 23.4% vials

Miscellaneous
Use
To be affixed to the storage
containers and to each product.
(Products supplied by Pharmacy
will already be labeled
appropriately).
To be affixed to the storage
container and products which are
stored only in Pharmacy and are
not to be provided to care units.
Order Number*
AHSPT09
To be affixed to the storage
containers and products as a
safeguard for look-alike, soundalike drugs
#2308
Make your own label
Label to insert!
*All Pharmasystems labels can be ordered by calling Pharmasystems Customer Service Toll Free at 1-888-475-2500. The website can be accessed at
www.pharmasystems.com.
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Appendix B - HIGH ALERT MEDICATION LABELS AND CAUTION/AUXILLARY LABELS (continued)
Label Description
Drug Class
Applicable to these concentrated electrolyte
products
 calcium (all salts) intravenous solution in
concentrations greater than or equal to 10
per cent (100 mg/mL)
 magnesium sulfate IV in concentrations
greater than 20 per cent (200 mg/mL)
Applicable to sodium chloride 23.4% for
injection when transferred to an oral container
for pediatric feeds



Use
To be affixed to the storage
containers, not product
Order number*
AHSPT024
To be affixed to the product
#1-51G
To be affixed to the storage
sodium acetate 4 mmoL/mL
containers
sodium phosphate intravenous solution;
To be affixed to each
4 mmoL/mL sodium and 3 mmoL/mL
individual vial
phosphate
 sodium chloride 23.4% 4 mmoL/mL vial for
injection (Pharmacy use only)
To be affixed to the storage
 potassium chloride intravenous solution
concentrations greater than or equal to two containers
To be affixed to each
(2) mmoL/mL (Pharmacy use only)
 potassium phosphate intravenous solution; individual vial
monobasic greater than or equal to 1.29
mmoL/mL or dibasic greater than or equal
to 4.4 mmoL/mL; potassium and three (3)
mmoL/mL phosphate (Pharmacy use
only)
 potassium acetate intravenous solutions in
concentrations greater than or equal to 2
mmol/mL
All Pharmasystems labels can be ordered by calling Pharmasystems Customer Service Toll Free at 1-888-475-2500
The website can be accessed at www.pharmasystems.com.
AHSPT08
AHSPT06
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture # 1 High Alert Medication Storage Container and Label Placements
a) HAM icon
b) HAM icon and auxiliary label “CAUTION Concentrated Electrolyte”
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture #2: Storage container for Neuromuscular Blocking Agents – Ham icon and auxiliary label
“WARNING: Paralyzing Agent Causes Respiratory Arrest”
Picture # 3 Narcotics
a) Narcotic Vault Door with HAM icon
b) Automated Dispensing Cabinet with fentaNYL
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture # 3 Narcotics (continued)
c) HYDROmorphone controlled release 3 mg cap- auxiliary label –“LONG ACTING”
d) morphine 50 mg/mL, 50 mL inj auxiliary labels – “Caution High Potency Medication Confirm Dose”
“Pharmacy Use Only” & “SHORT ACTING”
e) Temporary narcotic bin for nursing unit storage
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
f) Codeine 30 mg tab – auxiliary label “SHORT ACTING”
g) Temporary narcotic bins for nursing units storage with oral short acting and long acting auxiliary labels
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture # 4 Patient Specific Narcotics for nursing units- HAM Icon and auxiliary label- “Caution High Potency
Medication Confirm Dose”
Picture # 5 Epidurals – HAM ICON, auxiliary labels “For Epidural Use Only” and “Contains EpiNEPHrine
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture #6 a – d : Insulins are to be organized by duration of action (i.e., rapid, short, intermediate and
long acting).
 All insulins labeled with HAM icon
 Label short acting insulin with short acting auxiliary label.
 Label long acting insulin with long acting auxiliary label.
a) Rapid Acting Insulin
b) Short Acting Insulin- auxiliary label “SHORT ACTING”
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
c) Intermediate acting insulin
d) Long acting insulin- auxiliary label “LONG ACTING”
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture # 7 sodium chloride3% Hypertonic IV bags HAM icon and auxiliary label “CAUTION Concentrated
Electrolyte”
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture # 8 Potassium IV solutions – auxiliary label “CAUTION IV contains potassium” on storage container
and product.
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture #9 Code Trays – HAMs labeled with HAM icon and appropriate auxiliary labels
Picture #10 miscellaneous trays – HAM icon
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture #11 Segregated Bulk Storage - If original IV bag storage containers are opened, IV bags shall be
placed in a designed bin with HAM icon and auxiliary label “Heparin”. Use a large HAM icon for bulk storage
boxes that are unopened.
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APPENDIX C - PICTURES OF STORAGE CONTAINERS & LABELLING
Picture # 12 a & b
a. Automated Dispensing Cabinets (Pyxis machines) – HAM icon
b. Ham icon and auxiliary label "CAUTION Concentrated Electrolyte"
.
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