Medical Staff Portal

High Alert Medications

The Institute for Safe Medication Practices (ISMP) defines HAMs as drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. Covenant Health has developed a HAM list adopted from the ISMP HAM list and a policy suite.

High Alert Medications (HAM) have an increased risk of causing significant patient harm when they are administered in error. 

Errors involving HAM may not be more common than that of regular medications however, the consequences are typically more devastating. 

As a result, Covenant Health has put mitigation strategies and safeguards in place to decrease the opportunity of errors from occurring and to satisfy the Required Organizational Practice (ROP) requirements set out by Accreditation Canada.

The Covenant Health Medication Management Safety Team's (MMST) role is to lead and support medication quality and safety initiatives across Covenant Health. The MMST is responsible to ensure compliance in the labeling, storage and availablity of HAMs in Pharmacy Department and Patient Care Areas.

Required Organizational Practice Exceptions (ROPE)

Covenant Health has restricted the availability of some HAMs as a risk reduction strategy and to meet requirements set by Accreditation Canada. An exception for these restricted products is called a Required Organizational Practice Exception (ROPE). These are made when it is necessary for a restricted product to be available in a selected patient care area. 

If an ROPE is approved for a restricted HAM, specific safeguards must be put in place to minimize errors and risk.   

A ROPE Request Form must be submitted to the Medication Management Safety Team for processing. To obtain this form click here:

Required Organizational Practice Exceptions Request Process

Required Organizational Practice Exceptions Request form  

Covenant Health ROPE

Concentrated Electrolytes




High Alert Medications (HAM) Auditing Information

Why do we audit High Alert Medications (HAM)?

  • Labelling
  • Storage
  • Auxiliary/ Cautionary Labels
  • Required Organizational Practice Exceptions (ROPE)

Additionally,  the audit measures whether the following Accreditation Canada Required Organizational Practice (ROP) Tests for Compliance are being met:

  • Information and ongoing training is provided to team members on the management of HAM (this is done annually)
  • The policy includes a lis of HAM identified by the organization (the list is to be posted in ALL medication storage and preparation areas).

The High Alert Medications (HAM) audit is conducted on an annual basis. The audit is sent out each year for completion inMay and June.

This year the audit will focus on the areas being accredited this year (2017) - Continuing Care, Long Term Care and Palliative Care.

High Alert Medications Auditing FAQ

High Alert Medications Auditing

How to Complete the High Alert Medication Audit Tool


Questions/Contact Information

RLS - Reporting and Learning System

Good Catch Reporting