Advances in Pharmacology and Pharmacy Vol. 14(2), pp. 223 - 231
DOI: 10.13189/app.2026.140209
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High-Alert Medications: Identification and Assessment of Prescribing Trends in a Hospital Setting - A Prospective Study

Ameena Kadar K A ^1,*, Sreeja P A ², Soumya P V ³, Purushothama Reddy K ³, Deepak K P ^4
1 Department of Pharmacy Practice, Grace College of Pharmacy, India
² Department of Pharmacy Practice, Faculty of Pharmacy, Dr. M.G.R. Educational and Research Institute, Velappanchavadi, Chennai, 600077, Tamil Nadu, India
³ Department of Pharmacy Practice, Sanjo College of Pharmaceutical Studies, India
⁴ MBBS, DNB (Internal Medicine), Consultant Physician, Paalana Institute of Medical Sciences, India

ABSTRACT

High-alert medications (HAMs) are associated with a heightened risk of significant harm when misused, yet data on their prescribing trends in Indian hospital settings remain limited. This study aimed to analyze HAM prescribing patterns to identify areas for improving patient safety and rational drug use. This prospective observational study was conducted over nine months at Paalana Institute of Medical Sciences, Kerala, involving patients aged 18 years and older from the Cardiology, Neurology, General Medicine, and Psychiatry departments. Data on demographics, prescriptions, and HAMs were analyzed using WHO core prescribing indicators, with HAMs classified pharmacologically and assigned ATC codes. Among the 193 patients, predominantly older adults (62.7%) and females (52.8%), 75.1% were inpatients. General Medicine (44.6%) and Neurology (40.9%) had the highest HAM prescriptions, and oral administration (65.52%) was more common than parenteral administration (34.48%). Metformin, Insulin, and Ceftriaxone were the most frequently prescribed drugs. Prescribing patterns showed significant deviations from WHO standards, including polypharmacy (an average of 3.45 drugs per encounter), low generic prescribing (14.54%), and high antibiotic (70.98%) and injectable (55.44%) use. These findings highlight critical gaps, such as over-reliance on brand-name drugs and insufficient adherence to essential drug lists, posing risks of adverse drug events and increased costs. Targeted interventions, such as promoting generics, antibiotic stewardship, and adherence to WHO guidelines, are necessary to enhance medication safety and cost-effectiveness.

KEYWORDS
High-Alert Medications (HAMs), Prescribing Patterns, Polypharmacy, ISMP, WHO Prescribing Indicators, ATC Code, Patient Safety

Cite This Paper in IEEE or APA Citation Styles
(a). IEEE Format:
[1] Ameena Kadar K A , Sreeja P A , Soumya P V , Purushothama Reddy K , Deepak K P , "High-Alert Medications: Identification and Assessment of Prescribing Trends in a Hospital Setting - A Prospective Study," Advances in Pharmacology and Pharmacy, Vol. 14, No. 2, pp. 223 - 231, 2026. DOI: 10.13189/app.2026.140209.

(b). APA Format:
Ameena Kadar K A , Sreeja P A , Soumya P V , Purushothama Reddy K , Deepak K P (2026). High-Alert Medications: Identification and Assessment of Prescribing Trends in a Hospital Setting - A Prospective Study. Advances in Pharmacology and Pharmacy, 14(2), 223 - 231. DOI: 10.13189/app.2026.140209.