Analysis of APINCH Drugs: Adverse Effects and Nursing Implications

This report provides a comprehensive overview of APINCH drugs, a classification of high-risk medications including anti-microbial, potassium and other electrolytes, insulin, narcotics and sedatives, chemotherapeutic agents, and anticoagulants. It highlights the potential dangers associated with these drugs due to their narrow therapeutic index, leading to severe adverse effects with even small dosage changes. The report discusses specific adverse effects associated with each drug category within the APINCH acronym and emphasizes the regulatory measures implemented by the Australian government to control and mitigate the risks associated with their usage in healthcare facilities. These policies focus on transparency, error prevention, and risk mitigation through risk management strategies, clinical indications, and timely drug administration. The conclusion underscores the importance of correct drug administration and the role of healthcare facilities in developing strategies to manage the risks associated with APINCH drugs, ensuring patient safety.

Running head: NURSING ASSIGNMENT
APINCH DRUGS AND ITS ADVERSE EFFECTS
Name of the Student
Name of the University
Author note

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Introduction
High risk medications are set of medicines having higher risk factors associated with
them such as severe allergic reaction, harm and injury if they are consumed in higher amounts or
due to medication error in the healthcare facilities (Hanlon, Semla & Schmader, 2015, p. 10). As
per Clinical Excellence Commission (2019), the error rate of these medications are not much
higher than any other medications, however the side effects if these medications affect the
patients health drastically. Despite the fact that such high risk medications may vary depending
on the healthcare facility, universalization of such medications has already been achieved. These
group of medication involves anti-microbial, anti-psychotic drugs, potassium, insulin,
narcotics and sedatives, chemotherapy and anticoagulants such as heparin (Clinical
Excellence Commission, 2019). These group of drugs are defined by the acronym ‘APINCH’.
This classification helps the healthcare physicians in Australia as well as throughout the world to
screen and scrutiny the usage of these medications to determine the level of medication related
harm.
Why these are potentially dangerous?
Therapeutic Index or the ‘TI’ is the factor depending on which the effectiveness of any
drug is decided as well as the harmful dose and therapeutic dose are determined. This index is
the ratio in which, comparison between the blood concentration in which a drug surpasses toxic
level and the concentration, at which the drug effectively exerts its action is done (Tamargo, Le
Heuzey & Mabo, 2015, p. 560). Therefore, higher therapeutic index determines higher safety of
any drug within human body. However, the therapeutic index of these APINCH drugs are narrow
due to which, the small increase in their amount leads to adverse effects (Tamargo, Le Heuzey &

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Mabo, 2015, p. 560). As per the report published in the Roughead, Semple and Rosenfeld (2016,
p. 120), within the total number of deaths occurring due to adverse events, 27% of the deaths are
due to adverse drug events associated with high risk medications, specifically APINCH drugs.
Due to this, the Australian government has implemented screening interventions and methods so
that usage of such drugs in healthcare facilities could be controlled and regulated for the safety of
patients and their health (Government of Western Australia, 2014).
Adverse effects of these drugs (APINCH group)
The adverse effects of these drugs, depend on the dose or extent of usage in patient’s
healthcare. The following section will discuss the drugs, and their associated adverse effects on
patient’s health.
A: antimicrobial drugs such as aminoglycosides, amphotericin and vancomycin are the
high risk drugs involved that exerts severe allergenic condition in patients if not regulated
properly. Hence, proper vigilance and awareness regarding the rug should be provided to the
patient (Clinical Excellence Commission, 2019).
P: Potassium and other electrolytes such as magnesium, hypertonic sodium chloride
and calcium and associated injections are included in this classification as uncontrolled
administration of these could lead to severe reaction within the body and lead to hospitalization
(Clinical Excellence Commission, 2019).
I: all kind of Insulin injections are involved in this group as majority of the insulin
associated adverse effects are generated due to the improper dispensing associated errors. It has

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been observed that patients who take their insulin doses on their own, dispenses the injection
incorrectly and leads to adverse events (Clinical Excellence Commission, 2019).
N: narcotics and all kind of sedatives are included in this classification such as
diazepam, midazolam, benzodiazepines, oxycodone and fentanyl. These drugs are used by the
healthcare physicians in controlled amount however, if more than one drug is used or taken in
improper combination, it leads to severe adverse effects in patients (Clinical Excellence
Commission, 2019).
C: Chemotherapeutic agents such as Azathioprine, methotrexate, vincristine and others
chemotherapeutic agents are involved in this classification. Incorrect labelling, incorrect
implementation and administration of these drugs leads to rapid and faster actions on patients.
H: this group includes heparin and other anticoagulants such as Rivaroxaban,
dabigatran and others and the adverse effect of these drugs are severe and rapid as improper dose
adjustment in healthcare facility as well as in patients home could lead to severe complications
(Clinical Excellence Commission, 2019).
Further, evidences collected from the recent literature by Saedder et al. (2014, p. 640)
determine through a systematic review that majority of the adverse events, and 47% of the
serious medicational error associated adverse events are associated with these six group of drugs
and 73% of the drugs identified in these events belonged to the APINCH group of high risk
medications.

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Regulation of these drugs by Australian government
With three prime purpose of the high risk medication control such as transparency,
preventing error and mitigating the risk associated with it, the Australian government has
developed regulations to control the usage of these drugs (Government of Western Australia,
2014). These policies contain risk management strategies for high risk medications, associated
clinical indications, guiding principles to develop high risk medication for the healthcare facility
and the guiding principle to timely administer the drug to the patients (Government of Western
Australia, 2014). Further Clinical Excellence Commission (2019) mentions that it is not possible
to mitigate the risk associated to APINCH with one strategy applied throughout the Australian
healthcare facility. Hence, the healthcare facilities need to develop multiple risk management
strategies so that the application of these drugs could be reduced or the adverse effects could be
managed without any fail. Further, the National Safety and Quality Health Service of Australia
(2019) developed the standard of medication administration depending on which, it is the duty of
the healthcare facilities to determine the storage, prescription, dispensing and administration
associated risk of each drug their use and depending on the obtained results prepare the list of
high risk medications.
Conclusion
Administering correct drug through correct route is the required drug administration
process followed by the healthcare facilities all over the world. However few drugs, depending
on their reactions with different food items, doses, improper route or administration method
exerts negative and harmful effect on the patient. Such drugs have been classified in six levels
with acronym of APINCH, which are known to be harmful for human body in specific
conditions. Further, due to their narrow therapeutic index, small changes in the applied dose

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could lead to severe adverse conditions. to mitigate such risk, the Australian government has
implemented regulatory policies throughout the country so that healthcare facilities could
develop strategies and policies to register and mitigate the risk factors associated with this group
of drugs.

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References
Clinical Excellence Commission. (2019). Clinical Excellence Commission - A PINCH.
Retrieved from http://www.cec.health.nsw.gov.au/patient-safety-programs/medication-
safety/high-risk-medicines/A-PINCH
Clinical Excellence Commission. (2019). HIGH-RISK MEDICINES. Retrieved from
http://www.cec.health.nsw.gov.au/patient-safety-programs/medication-safety/high-risk-
medicines
Government of Western Australia. (2014). WA High Risk Medication Policy- Office of Patient
Safety and Clinical Quality. Retrieved from
https://ww2.health.wa.gov.au/~/media/Files/Corporate/Policy%20Frameworks/
Unallocated/Policy/WA%20High%20Risk%20Medication%20Policy/Supporting/WA-
High-Risk-Medication-Policy.pdf
Hanlon, J. T., Semla, T. P., & Schmader, K. E. (2015). Alternative medications for medications
in the use of high‐risk medications in the elderly and potentially harmful drug–disease
interactions in the elderly quality measures. Journal of the American Geriatrics
Society, 63(12), e8-e18. DOI: https://doi.org/10.1111/jgs.13807
National Safety and Quality Health Service of Australia. (2019). Assessment to the NSQHS
Standards | Safety and Quality. Retrieved from https://www.safetyandquality.gov.au/our-
work/assessment-to-the-nsqhs-standards/

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Roughead, E. E., Semple, S. J., & Rosenfeld, E. (2016). The extent of medication errors and
adverse drug reactions throughout the patient journey in acute care in
Australia. International journal of evidence-based healthcare, 14(3-4), 113-122. DOI:
https://doi.org/10.1097/XEB.0000000000000075
Saedder, E. A., Brock, B., Nielsen, L. P., Bonnerup, D. K., & Lisby, M. (2014). Identifying high-
risk medication: a systematic literature review. European journal of clinical
pharmacology, 70(6), 637-645. DOI: 10.1007/s00228-014-1668-z
Tamargo, J., Le Heuzey, J. Y., & Mabo, P. (2015). Narrow therapeutic index drugs: a clinical
pharmacological consideration to flecainide. European journal of clinical
pharmacology, 71(5), 549-567. DOI: https://doi.org/10.1007/s00228-015-1832-0