Gastroenterologically relevant high alert medications prescribed to children with chronic diseases-a consensus-driven single-center pilot study.

Introduction: Children with chronic diseases, including complex gastroenterological patients, often manage complex home medication regimens, where errors pose significant patient- and medication-related risks. High Alert Medications (HAMs) are those with a particularly high potential for adverse consequences if administered incorrectly. Aim: This study used a consensus approach to identify HAMs in the pediatric gastroenterological population, using a new scale to measure medication risk and potential patient harms. Methods: This secondary analysis included 106 children with chronic diseases discharged from the Medical University of Vienna. Interdisciplinary teams identified relevant medications through a consensus approach and separately evaluated the inherent risk of each medication and the potential harm of its use at the individual patient level using five-level scales. Substances were coded via the Anatomical Therapeutic Chemical classification system (ATC system), ranked, and compared with existing HAM lists. Results: Thirty-two medications were categorized into the highest medication risk categories, and 16 into the highest potential patient harm group. The intersection of these categories identified 12 medications defined as HAMs, with immunosuppressants forming the largest therapeutic class. Notably, 50% of the identified HAMs appeared in only one other published list, and one-third were not previously classified as High Alert. Discussion: Immunosuppressants carry elevated risk due to narrow therapeutic windows, complex drug interactions, and potential for severe organ dysfunction. Discrepancies between HAM lists stem from varied methodologies and local clinical characteristics. This study distinguishes itself by focusing specifically on home care and by including off-label medications. The findings underscore the need for localized HAM lists to address specific risks within the target population. Validation studies and consideration of empirical data are needed to further generalize our findings.