Objective  To investigate the current status of high-alert medication management and the cognition of pharmacists in medical institutions at various levels in Hubei Province, analyzing the influencing factors, and to provide evidence for optimizing the safety management of high-alert medications.

Methods Snowball sampling method was used to conduct a questionnaire survey among pharmacists from different medical institutions in Hubei Province from August to November 2025. The questionnaire covered pharmacists' demographic characteristics, current status of high-alert medication management, pharmacists' cognitive level and risk factors. SPSS 26.0 was used for descriptive analysis, Chi-square test and Logistic regression analysis.

Results A total of 405 valid questionnaires were collected. The implementation of high-alert medication management systems in Hubei Province was generally well-established, with implementation rates of "establishing a high-alert medication list", "uniform warning labels", "designated storage areas", and "four-check and ten-confirm and double-check procedures" all exceeding 95.00%. However, specific management processes such as rectification tracking (50.62%), shift handover records (49.88%) and regular analysis and feedback (59.26%) showed relatively low implementation rates. The average score of pharmacists' cognitive level was (14.0±2.8), with only 42.47% of pharmacists achieving a high cognitive level on high-alert medications. Univariate analysis showed that gender, educational background, years of work experience, training, and implementation of "four-check and ten-confirm and double-check procedures" were significantly associated with pharmacists' cognitive level of high-alert medications (P<0.05). Further multivariate Logistic regression analysis revealed that gender, educational background, years of work experience, training, and implementation of "four-check and ten-confirm and double-check procedures" were the main influencing factors of pharmacists' cognitive level (P<0.05).

Conclusion  The basic management systems of high-alert medications in medical institutions in Hubei Province are well implemented, but the closed-loop management process remains weak. It is recommended to strengthen whole-process closed-loop management, enhance information system support, and provide targeted training for pharmacists to improve the risk prevention and management of high-alert medications.

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