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In a high-alert medication pinch? Create a double-check system

Pharmacy Regulation Resource, March 24, 2004

Get nurses to understand the importance of having a colleague double-check high-alert medications before giving them to patients. Creating a PINCH high-alert medication list to tell nurses which orders they need to double-check before they administer drugs is one way to get the point across.


Many hospitals have created versions of a PINCH list to help nurses remember high-alert medications. Robin Keyack, RPh, assistant vice president of pharmacy services for Virtua Health, a four-hospital system in New Jersey, says her organization's list stands for the following:

  • Patient-controlled analgesia
  • Potassium challenges
  • Insulin drips
  • Narcotic drips
  • Chemotherapy
  • Heparin drips


When nurses administer a drug from this list, another nurse must double-check the order, Keyack says. Nurses must double-check the medication and the order at four different stages, including

  • when they hang the intravenous (IV) bag
  • when they change the IV bag
  • when the medication administration rate changes
  • when the patient is transferred to another unit