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June 27, 2021


The Australian Commission on Safety and Quality Healthcare works to improve the safety and quality of medication use in Australia. It leads and coordinates national initiatives to reduce medication errors and harm from medicines. Medication safety forms part of the National safety and Quality Health Service Standards. Read more about their work HERE.

One such initiative has been the identification of high risk medications (HRMs). Errors with these medicines are not necessarily more common than with other medicines. As they have a very narrow margin of safety, the consequences of errors with these medicines can be more devastating.

HRMS include:

  • Medicines with a narrow therapeutic index
  • Medicines that present a high risk when;
    • Administered via the wrong route or
    • Other medication management system errors occur.


Alignment to Western Health Best Care Framework

Right Care & Safe Care


What does this look like in practice?

While there is no complete or exhaustive list of HRMs as these vary between health care settings and locations, the Commission launched the APINCH initiative to assist clinicians to focus on groups of medicines that are known to be associated with high potential for medication related harm.

Download this chart from HERE.

The Commission has also recently introduced an ‘S’ at the end of APINCH to form the new acronym APINCHS. The ‘S’ at the end is to highlight SYSTEMS to ensure that medication safety systems such as independent double checks, safe administration of liquid medications, standardised order sets and medication charts are also a consideration when administering HRMs.


Within EMR Potassium and Insulin have built-in warnings for the medical officer when prescribing.  The APINCH medications list is quite extensive therefore not all have these warnings. Potassium-containing infusions has this warning when a medical officer is searching for the desired infusion.  The list is highlighted in ‘red’ to alert them to a high risk medication and to prevent selection error.

When Prescribing insulin there is a HIGH DOSE alert. This alerts when over 50 unit(s) of insulin is prescribed.


Policies, Procedures and Guidelines (PPG’s)

External Links

For further useful resources on High Risk Medicines at the Australian Commission on Safety and Quality in Health Care: CLICK HERE


The ACSQHC online resources for HRMs were used in the creation of this learning tool.