INS and Allergy: [11] In the USA, the Institute for Safe Medication Practices (ISMP) uses the term high alert medication and defines them as “drugs that bear a heightened risk of causing significant patient harm when they are used in error”.[12] In the UK, the National Patient Safety Agency (NPSA) has produced its own list of HRMs which contains eight classes; anticoagulants, injectable sedatives, opiates, insulin, antibiotics (risk of allergy), chemotherapy, antipsychotics, and infusion fluids.