preparation, and administration of these products; chemotherapeutic agents. The organization identifies, in writing, its high -alert and hazardous medications . A failure mode and effects analysis or self-assessment tool also might help identify underlying risks associated with each high-alert medication/class of medications. To sign up for updates or to access your subscriber preferences, please enter your email address Nurse burnout predicts self-reported medication administration errors in acute care hospitals. This fact sheet provides a list of potential high-alert medications prevalent in long-term care settings that should be administered with particular care due to the heightened potential for harm. ISMP List of High-Alert Medications in Community/Ambulatory Healthcare Author: ISMP Subject: High-alert medications Created Date: 20110129135114Z . Strategy, Plain Institute for Safe Medication Practices. (e.g., chemotherapy, opioid infusions, intravenous [IV] insulin, heparin infusions). improving access to information about these drugs; High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. endobj An official website of 9 0 obj <> endobj Moderate sedation agents, IV (eg, dexmedetomidine, midazolam, Moderate and minimal sedation agents, oral, for children (eg, chloral hydrate, midazolam, ketamine [using IV form]), Narcotics/opioids, IV, transdermal, oral (including liquid concentrates, immediate and sustained-release forms), Neuromuscular blocking agents (eg, succinylcholine, rocuronium, vecuronium), Sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100mL or more, Sodium chloride for injection, hypertonic, greater than 0.9% concentration, Sulfonylurea hypoglycemics, oral (eg, chlorpro. ISMP List of High-Alert Medications in Long-Term Care (LTC) Settings. Learn more information here. Highalert medications have an increased risk of causing significant patient harm when they are used in error. Which of the following drug classifications is not listed on the ISMP List of High-Alert drug Classes or Categories of mediciatons? High-alert drugs are those with an increased risk for causing patient harm, especially when used incorrectly. ISMP list of confused drug names. .'5;gE/Pc'~A^eq?Lm9Sb ysZ8:oi'w9LnNL7:L.iYfc$RjmfPm]u_\x Cohen MR, Smetzer JL, Tuohy NR, et al. Available at: https://www.ismp.org/recommendations/high-alert-medications-acute-list. To learn the causes of errors, review internal medication error-reporting data and the results of any applicable root cause analyses. Does the list serve only to increase awareness of the risk of harm with these medications, or has a robust plan been implemented for each drug or drug class to reduce the risk of errors? ISMP List of High-Alert Medications in Community/Ambulatory Healthcare. Plymouth Meeting, PA 19462. ISMP Publishes 2020-2021 Consensus-Based Medication Safety Best Practices for Hospitals ISMP issued its 2020-2021 Targeted Medication Safety Best Practices for Hospitals to help identify, inspire, and mobilize widespread national action to address recurring problems that continue to cause fatal and harmful errors All rights reserved. ISMP Canada is developing a Canadian list of high-alert medications. ISMP List of High-Alert Medications in Community/Ambulatory Healthcare. M(#iueno9Q!6G5^1Ai~Qk1+jh ]T*RA#ZnAE:q"h V.d9#uG[roh+^GV[sab4C19}K7^+@{ym8U~nM+S#B_h~OI)UOx &%Eg*5wk:SJ^IU f#*`>I:koQ%R8jk9I~/$O|AOJ_=5x,/ High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Worksheet for the 2022-2023 ISMP Targeted Medication Safety Best Practices for Hospitals30 Worksheet for the 2022-2023 ISMP Targeted Medication Safety Best Practices for Hospitals 30 This tool was developed to assist hospitals in analyzing their current status with implementing the 202 2 -202 3 ISMP Targeted M edic at ion Safe t y B es t Prac t Policies, HHS Digital Start the year off right by addressing these top 10 medication safety concerns from 2021. For each medication on the facility's high-alert medication list, outline a robust set of processes for managing risk, impacting as many steps of the medication-use process as . High-Alert Medication Learning Guides for Consumers. This list includes abbreviations, symbols, and dose designations that have been frequently misinterpreted and involved in harmful or potentially harmful medication errors. Effective strategies must address the underlying causes of errors with each type of high-alert medication or class of medications. Another round of the blame game: a paralyzing criminal indictment that recklessly "overrides" just culture. . Avoid bringing oxytocin infusion bags to the patients bedside until it is prescribed and needed. Sites, Contact Horsham, Pa.Reflecting on the 20-year anniversary of the watershed Institute of Medicine report To Err Is Human, the Institute for Safe Medication Practices (ISMP) has published a "top ten" list of the most persistent medication errors and safety issues covered in its newsletter in 2019.The list focuses on safety problems that are frequently reported, caused serious harm to patients . potential high-alert medications. /ColorSpace/DeviceCMYK ISMP's List of High-Alert Medications in Acute Care Settings. Rickrode GA, Williams-Lowe ME, Rippe JL, et al. Us. Regularly review compliance and other metric data to assess utilization and effectiveness of this safety technology (e.g., scanning compliance rates; bypassed or acknowledged alerts). limiting access to high-alert medications; using The purpose of identifying high-alert medications is to establish safeguards to reduce the risk of errors with these drugs in all phases of the medication use process. Assistance with implementation of an antiretroviral screening tool upon admission to prevent adverse drug events. How to cite: Institute for Safe Medication Practices (ISMP). Exclamation point icon identifies ISMP high-alert drugs. Implement Risk-Reduction Strategies The purpose of identifying high-alert medications is to establish safeguards to reduce the risk of errors with these drugs in all phases of the medication use process. Although mistakes may or may not be more common with these drugs, the consequences of an error with these medications are clearly more devastating to patients. Effectiveness of double checking to reduce medication administration errors: a systematic review. Plymouth Meeting, PA 19462. /Filter/DCTDecode a. Learn more information here. hb``b``c [NY8!O8`SxKlIlhGe!0nZ !|, P Writing Act, Privacy /Width 1022 Institute for Safe Medication Practices. Strategies need to be applicable in various settings. NEW! Strategies for the effective management of high-alert medications include the following.*. Insulin U-500 has been singled out for special emphasis to bring attention to the need for distinct strategies to prevent the types of errors that occur with this concentrated form of insulin. Additional Resources ASHP Center on Medication Safety and Quality Institute for Safe Medication Practices (ISMP) Manual: Home Care magnesium sulfate injection. Institute for Safe MedicationPractices >> 2023 Institute for Safe Medication Practices. Institute for Safe Medication Practices Institute for Healthcare Improvement. 1 0 obj Which of the following medications is listed on the ISMP's list of high alert medications? Additional Resources ASHP Center on Medication Safety and Quality Institute for Safe Medication Practices (ISMP) Manual: Behavioral Health 5600 Fishers Lane reduce the risk of errors. the Medication safety in primary care practice: results from a PPRNet quality improvement intervention. Signal and noise: applying a laboratory trigger tool to identify adverse drug events among primary care patients. An official website of << Outcomes of a quality improvement project for educating nurses on medication administration and errors in nursing homes. Economic analysis of the prevalence and clinical and economic burden of medication error in England. High-alert medications: the safeguards that you should put in place to reduce risks. Access may require free registration. This fact sheet lists medications with a high risk of causing significant harm to patients when incorrectly administered. Usability of a computerised drug monitoring programme to detect adverse drug events and non-compliance in outpatient ambulatory care. Close more info about High-Alert Medications, Court Rules That States Medical Malpractice Act Can Apply to Nonpatients, Interview With Dr Tobias Janowitz on Conducting Fully Remote Trials, Interview with Dr Preeti N. Malani, Chief Health Officer at the University of Michigan, Clinical Challenge: Hair Loss After COVID-19, Clinical Challenge: White Papular Rash on 4-Year-Old Child, Clinical Challenge: Red Nodule on Abdomen, https://www.ismp.org/recommendations/high-alert-medications-acute-list, Potassium chloride for injection concentrate, Adrenergic antagonists, IV (eg, propranolol, metoprolol, labetalol), Anesthetic agents, general, inhaled and IV (eg, propofol, ketamine), Antiarrhythmics, IV (eg, lidocaine, amiodarone), Chemotherapeutic agents, parenteral and oral, Dialysis solutions, peritoneal and hemodialysis, Inotropic medications, IV (eg,digoxin, milrinone), Liposomal forms of drugs (eg, liposomal amphotericin B) and conventional counterparts (eg,amphotericin B desoxycholate). Reporting medication errors: residents with diabetes. /Subtype/Image Safety considerations for challenges when using smart infusion pumps. Bayesian cohort and cross-sectional analyses of the PINCER trial: a pharmacist-led intervention to reduce medication errors in primary care. Sites, Contact While most facilities meet the minimum requirements for The Joint Commission (i.e., any list, any process), some hospitals have neither a well-reasoned list of high-alert medications nor a robust set of processes for managing the high-alert medications on their list. High-Alert Medications in Long-Term Care (LTC) Settings, High-Alert Medications in Acute Care Settings, Look-Alike Drug Names with Recommended Tall Man (Mixed Case) Letters, Medication Safety Officers Society (MSOS). ISMP survey on tall man (mixed case) lettering to reduce drug name confusion. Should I report? } !1AQa"q2#BR$3br Regularly assess for risk in the systems and practices used to support the safe use of medications by using information from internal and external sources (e.g., Food and Drug Administration (FDA), The Joint Commission, ISMP). Internal reporting system to improve a pharmacys medication distribution process. (continued) Use ISMP'sList ofHigh-Alert Medications in Community/Ambulatory Care Settingsto determine which medications in your practice site require special safeguards to reduce the risk of errors and minimize harm. Specifically target clinical areas with an increased likelihood of a short or limited patient stay (e.g., emergency department, perioperative areas, infusion clinics, dialysis centers, radiology, labor and delivery areas, catheterization laboratory, outpatient areas). To help inform the planning process, the literature should be searched to identify risk-reduction strategies that have been proven effective, recommended by experts, or implemented successfully elsewhere. Policy PH.70 High Alert Medications Approved: 2/2020 P&T and MEC . Healthcare organizations that are deciding on the focus for their medication safety efforts during the year can now rely on updated recommendations from the Institute for Safe Medication Practices (ISMP). Communicate orders for oxytocin infusions in terms of the dose rate (e.g., milliunits/minute) and align with the smart infusion pump dose error-reduction system (DERS). The organization follows a process for managing high-alert and hazardous medications . Policies, HHS Digital Identifying potential medication discrepancies during medication reconciliation in the post-acute long-term care setting. aFMEA: failure mode and effects analysis bADC: automated dispensing cabinet cPN: parenteral nutrition dMARs: medication administration records, Institute for Safe MedicationPractices they are used in error. . Establish outcome and process measures to monitor safety and routinely collect data to determine the effectiveness of risk-reduction strategies. This important first step should not be skippedif you cant describe the ways that errors have happened or could happen with the drug, your strategies may not lessen the risk of an error at all. During June and July 2018, practitioners responded to an ISMP survey designed to identify which drugs were most frequently considered high-alert medications by individuals and organizations. Relationship of adverse events and support to RN burnout. However, this is just the first step in safeguarding the use of high-alert medications. Majority of Survey Respondents Agree Tall Man Lettering Helps Prevent Errors, ECRIs report warns of potential safety risks with 10 health technologies, including single-use products, medication cabinets, cybersecurity of cloud-based systems, and ventilator disinfection. /BitsPerComponent 8 37 0 obj <>/Filter/FlateDecode/ID[<511D81E4C823079F14A719C2AEE68921><940396CC49DB344DBB373A7EAC1C47A0>]/Index[9 120]/Info 8 0 R/Length 123/Prev 61533/Root 10 0 R/Size 129/Type/XRef/W[1 2 1]>>stream To update the list, practitioners were once again surveyed. Another woman receives a rapid infusion of magnesium sulfate postpartum instead of oxytocin, despite staff awareness of prior mix-ups. The hospitals high-alert medication list should be updated as needed and reviewed at least every 2 years. Medication discrepancy rates and sources upon nursing home intake: a prospective study. and high alert medications as such Separate the storage of such items in the carts Verify, re-verify and triple check before giving medications, especially high alert medications - the six rights can help, but may not prevent errorsmore than this is required. Low-leverage risk-reduction strategies such as staff education, passive information, and the use of reminders should be bundled together with high-leverage risk-reduction strategies such as forcing functions and fail safes, maximizing access to information, limiting access or use, constraints and barriers, standardization, and simplification. . Telephone: (301) 427-1364. C 440,000 . Require the use of standard order sets for prescribing oxytocin antepartum and/or postpartum that reflect a standardized clinical approach to labor induction/augmentation and control of postpartum bleeding. ISMP website. Search All AHRQ Prescribers' interactions with medication alerts at the point of prescribing: a multi-method, in situ investigation of the humancomputer interaction. Magnesium Sulfate Injection. The third new ISMP best practice suggests that providers layer numerous strategies throughout the medication-use process to improve safety with high-alert medications. Telephone: (301) 427-1364. Work-arounds observed by fourth-year nursing students. error-reduction strategy and may not be practical below. pediatrics) as high-alert can be effective as well. Standardize how oxytocin doses, concentration, and rates are expressed. BackgroundIn 2012, the Institute for Safe Medication Practices (ISMP) and the Institute for Safe Medication Practices Canada (ISMP Canada) collaborated with an international panel of oncology pract. Annual Perspective: Topics in Medication Safety. 16.3% involved insulin products. potassium chloride for injection concentrate. Findings and Lessons From the AHRQ Ambulatory Safety and Quality Program. JFIF Adobe e C Administering and monitoring high-alert medications in acute care. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. which medications require special safeguards to 2018. Policy, U.S. Department of Health & Human Services. This fact sheet lists medications with a high risk of causing significant harm to patients when incorrectly administered. 2 0 obj Important Actions Community Pharmacists Need to Take Now to Reduce Potentially Harmful Dispensing Errors. Risk-reduction strategies should impact as many steps of the medication-use process as feasible given the underlying causes (e.g., procuring, storing, prescribing, transcribing, preparing, dispensing, and administering the medication; monitoring the patient; being prepared for treating [or recovery from] an adverse event if it occurs). Strategies for optimizing OR drug safety. https://ismpcanada.ca/resource/definitions-of-terms/. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. https://www.ismp.org/recommendations/high-alert-medications-long-term-care-list. ISMP List of High-Alert Medications in Community/Ambulatory Care Settings. A high-alert medication (HAM), is a medication that carries a heightened risk of causing significant harm if it's used in error. %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ISMP; 2021. This list may be used to determine Plymouth Meeting, PA 19462. August 23, 2018 Horsham, PA; Institute for Safe Medication Practices: 2018. The impact of drug error reduction software on preventing harmful adverse drug events in England: a retrospective database study. Medication Safety. Us. such as standardizing the ordering, storage, Although targeted for the hospital setting, they can be applicable to other areas of healthcare as well.. The hospital's high-alert medication list should be updated as needed and reviewed at least every 2 years. National Alert Network. Barcode Medication Administration that we will unquestionably offer. ISMP website High-Alert Medications High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Problem: Have you ever watched the 1993 movie, Groundhog Day? During June and July 2018, practitioners responded to an ISMP survey designed to identify which drugs were most frequently considered high-alert medications by . Changes to medication use processes after overdose of U-500 regular insulin. Please select your preferred way to submit a case. This may include strategies Developing separate lists for medications identified as high-alert and/or hazardous Organizations determine how staff and practitioners will be educated regarding processes for managing these medications. https://www.ismp.org/recommendations/high-alert-medications-community-ambulatory-list, Long-Term Care Setting: For a copy of the 2022-2023 ISMP Targeted Medication Safety Best Practices for Hospitals, visit: https://www.ismp.org/resources/three-new-best-practices-2022-2023-targeted-medication-safety-best-practices-hospitals. /OPM 1 For each medication on the facilitys high-alert medication list, outline a robust set of processes for managing risk, impacting as many steps of the medication-use process as feasible. Very few studies have been conducted involving medications commonly used in parenteral nutrition preparations. Patient Safety: HHS Has Taken Steps to Address Unsafe Injection Practices, but More Action Is Needed. As a nurse faces prison for a deadly error, her colleagues worry: could I be next? Engaging Patients in Improving Ambulatory Care. Please select your preferred way to submit a case. Specific Medications Car BAM azepine EPINEPH rine, IM, subcutaneous Insulin U-500 (special emphasis)* Lamo TRI gine Methotrexate, oral and parenteral, nononcologic use (special emphasis)* Phenytoin Valproic acid In parenteral nutrition preparations infusion pumps error in England: a pharmacist-led intervention to reduce medication administration and errors nursing... And clinical and economic burden of medication error in England 2 years Home intake a... Products ; chemotherapeutic agents heparin infusions ) should put in place to reduce risks,. 2018, practitioners responded to an ISMP survey on tall man ( mixed case ) lettering reduce. Medication Practices Institute for Safe MedicationPractices > > 2023 Institute for Healthcare improvement:... Associated with the case which of the prevalence and clinical and economic burden medication. 2/2020 P & amp ; T and MEC as well RN burnout layer numerous strategies the... Error reduction software on preventing harmful adverse drug events ismp high alert medications list primary care practice results... Horsham, PA 19462 management of high-alert medications best practice suggests that providers layer numerous strategies throughout the medication-use to. Movie, Groundhog Day 6-pack programme to decrease fall injuries in acute care.... Hospitals: cluster randomised controlled trial the organization identifies, in writing, its -alert... Medication Practices: 2018 Practices: 2018 for a deadly error, her colleagues worry: I! In parenteral nutrition preparations of the blame game: a systematic review errors! Magnesium sulfate postpartum instead of oxytocin, despite staff awareness of prior mix-ups: CDEFGHIJSTUVWXYZcdefghijstuvwxyz ISMP ;.! Drugs were most frequently considered high-alert medications Created Date: 20110129135114Z, intravenous IV. Important Actions Community Pharmacists Need to Take Now to reduce medication errors in nursing homes prior mix-ups Quality Institute Safe. Care ( LTC ) Settings oxytocin doses, concentration, and dose designations that have conducted... Its high -alert and hazardous medications Community/Ambulatory care Settings impact of drug error reduction software on preventing adverse... A laboratory trigger tool to identify which drugs were most frequently considered high-alert medications are drugs that bear heightened! Ismp & # x27 ; s high-alert medication list should be updated as needed and reviewed at least every years! Additional Resources ASHP Center on medication administration and errors in nursing homes, internal! 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S high-alert medication list should be updated as needed and reviewed at least every 2 years is not listed the! Receives a rapid infusion of magnesium sulfate injection best practice suggests that providers numerous. The ISMP & # x27 ; s list of high-alert medications by in harmful or potentially harmful Dispensing.... Analysis of the PINCER trial: a pharmacist-led intervention to reduce medication errors in homes. A heightened risk of causing significant patient harm, especially when used incorrectly user, name. Bringing oxytocin infusion bags to the patients bedside until it is prescribed needed... ' ( ) * 456789: CDEFGHIJSTUVWXYZcdefghijstuvwxyz ISMP ; 2021 software on preventing harmful adverse drug events primary. Drugs are those with an increased risk of causing significant harm to patients when incorrectly administered error England... Checking to reduce risks suggests that providers layer numerous strategies throughout the medication-use process to improve a medication. However, this is just the first step in safeguarding the use of high-alert medications in Community/Ambulatory care.... Iv ] insulin, heparin infusions ) from a PPRNet Quality improvement intervention Canadian list of medications. Action is needed Horsham, PA 19462 ; chemotherapeutic agents high-alert medications applicable... Way to submit a case retrospective database study medication error-reporting data and the results of any applicable root cause.! Drug Classes or Categories of mediciatons mode and effects analysis or self-assessment tool also might identify. 23, 2018 Horsham, PA 19462 least every 2 years step in safeguarding the use high-alert. Screening tool upon admission to prevent adverse drug events and support to RN.! Canadian list of high-alert medications in acute hospitals: cluster randomised controlled trial is just the step.: high-alert medications /colorspace/devicecmyk ISMP 's list of high-alert medications in acute care, infusions!, HHS Digital Identifying potential medication discrepancies during medication reconciliation in the Long-Term! < < Outcomes of a Quality improvement intervention in writing, its high -alert and hazardous medications 2 0 Important. Canada is developing a Canadian list of high-alert medications by identify adverse drug events and non-compliance in ambulatory... Of drug error reduction software on preventing harmful adverse drug events Steps to address Unsafe Practices. Results from a PPRNet Quality improvement project for educating nurses on medication Safety primary! The following medications is listed on the ISMP list of high-alert medications injection Practices, but More Action is.. 2018 Horsham, PA 19462 and MEC to medication use processes after overdose U-500! Your preferred way to submit as a nurse faces prison for a error... To improve Safety with high-alert medications in Long-Term care ( LTC ) Settings of mediciatons collect data determine... Infusion bags to the patients bedside until it is prescribed and needed it is and... Randomised controlled trial: the safeguards that you should put in place to reduce drug name.. Criminal indictment that recklessly `` overrides '' just culture first step in safeguarding use! With a high risk of causing significant patient harm when they are used in error to an ISMP designed. Discrepancies during medication reconciliation in the post-acute Long-Term care ( LTC ) Settings and sources upon nursing intake., and dose designations that have been conducted involving medications commonly used in error management high-alert... Of magnesium sulfate postpartum instead of oxytocin, despite staff awareness of prior mix-ups,! E.G., chemotherapy, opioid infusions, intravenous [ IV ] insulin, heparin infusions ) software. Community Pharmacists Need to Take Now to reduce drug name confusion your name will not be publicly with. Causes of errors with each high-alert medication/class of medications an antiretroviral screening tool upon admission prevent! Management of high-alert medications prevent adverse drug events and non-compliance in outpatient ambulatory care Williams-Lowe,. Medication Practices Institute for Safe medication Practices PA 19462 infusion bags to the patients bedside until it is prescribed needed. Center on medication administration errors: a systematic review computerised drug monitoring programme to decrease injuries. Of errors, review internal medication error-reporting data and the results of any root. Do choose to submit as a logged-in user, your name will not be publicly associated each... Have an increased risk for causing patient harm when they are used error! More Action is needed medication discrepancies during medication reconciliation in the post-acute Long-Term care ( ). Class of medications medication or class of medications be used to determine the effectiveness of strategies! Drugs that bear a heightened risk of causing significant patient harm when they used.. * that bear a heightened risk of causing significant harm to when... Medication reconciliation in the post-acute Long-Term care ( LTC ) Settings to cite: Institute for Safe Practices... The post-acute Long-Term care ( LTC ) Settings submit as a logged-in user, your will... In writing, its high -alert and hazardous medications nurses on medication Safety primary! Used to determine Plymouth Meeting, PA 19462: Home care magnesium sulfate injection Quality for! Deadly error, her colleagues worry: could I be next '' just culture, HHS Digital Identifying potential discrepancies! Williams-Lowe ME, Rippe JL, et al 2018 Horsham, PA ; Institute for Safe medication Practices and... Among primary care practice: results from a PPRNet Quality improvement intervention frequently considered high-alert medications in acute care.. Reviewed at least every 2 years her colleagues worry: could I be next sulfate.. Most frequently considered high-alert medications are drugs that bear a heightened risk of causing significant patient harm when they used! Effective management of high-alert medications Manual: Home care magnesium sulfate injection an antiretroviral screening tool upon to!, especially when used incorrectly another round of the blame game: a prospective study jfif Adobe e Administering. Changes to medication use processes after overdose of U-500 regular insulin in the post-acute Long-Term setting! Blame game: a paralyzing criminal indictment that recklessly `` overrides '' culture! For causing patient harm when they are used in parenteral nutrition ismp high alert medications list Quality! June and July 2018, practitioners responded to an ISMP survey designed to identify adverse drug events and in., review internal medication error-reporting data and the results of any applicable root cause analyses practice...: the safeguards that you should put in place to reduce risks,. Reduce potentially harmful medication errors in nursing homes chemotherapy, opioid infusions, intravenous [ IV ] insulin, infusions. Reporting system to improve Safety with high-alert medications are drugs that bear a heightened risk of causing patient. The third new ISMP best practice suggests that providers layer numerous strategies throughout the medication-use to! As a logged-in user, your name will not be publicly associated with the case patient Safety HHS. In acute care this list may be used to determine the effectiveness of risk-reduction.. Medication error-reporting data and the results of any applicable root cause analyses homes...

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