Information about high alert medications

Learn about high alert medications training for the Medication Administration Program (MAP).

Frequently asked questions

Who needs to be trained on the two high alert medications (i.e., warfarin sodium, clozapine) policies?

Only those MAP Certified staff (including relief staff), who administer or assist in the administration of a high alert medication are required to receive the training specific to the medication or medications.

What documentation does the MAP registered site need as evidence that a MAP Certified staff has been trained on the two high alert medications?

For any/all of the two high alert medications, the site must have documentation that includes the date of the training, the name(s) of the staff trained, and the name and contact information of the trainer. In addition, for required documentation specific to warfarin sodium and/or clozapine training, the Evaluation Tool must be completed and retained at the site.

Can an LPN provide initial training on the two high alert medications?

No. However, if the LPN receives the training and is able to demonstrate initial and continued competence, then the LPN can provide secondary or re-training.

What is the role of the second MAP Certified staff in the dosage verification procedure for warfarin sodium therapy?

The second MAP Certified staff must verify that the correct dose was prepared by the first MAP Certified staff before the individual receives the warfarin sodium. The second MAP Certified staff should compare the Health Care Provider order to the pharmacy label and to the medication sheet and verify that the correct warfarin dosage was placed in the medication cup. The second staff should verify that the correct dose was prepared. It is not required that the second staff watch the medication being administered.

What if there is no second MAP Certified staff available for the warfarin sodium dosage verification procedure?

If a second MAP Certified staff is not available for the dosage verification procedure, the warfarin sodium should still be administered. The MAP Certified staff who is administering the medication can document NSS in the second check medication box. The NSS indicates that a second MAP Certified staff was not available to verify the dosage. The NSS can be added to the acceptable code listing on the designated warfarin sodium medication administration record. By using this acceptable code, an additional progress note would not be needed.

Do relief staff need training on the two high alert medications?

Only those MAP Certified staff (including relief staff), who administer or assist in the administration of a high alert medication are required to receive the training specific to the medication(s). This would be similar to administration of any other medication that requires training for MAP Certified staff. Examples include: staff needing to be vital sign trained to take blood pressure readings to administer medication in accordance with blood pressure medication order parameters; administration of epinephrine by auto-injectors (EpiPens®) requires specific training; and training to administer medications by G-tube.  

More information

For more information about the Medication Administration Program, please contact:

Department Contact number
Department of Public Health/Bureau of Health Professions Licensure (617) 973-0800
Department of Developmental Services (617) 624-7792
Department of Mental Health (508) 616-2161
Departments of Children and Families  (617) 748-2073
Massachusetts Rehabilitation Commission (978) 697-2072
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