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Background and Importance High-Alert Medications (HAMs) carry a heightened risk of significant patient harm when they are used in error.Aim and Objectives To analyse pharmaceutical interventions (PIs) involving HAMs upon admission.Material and Methods Prospective interventional study of patients admitted to the Emergency Department who received pharmaceutical care (PC) from 20-01-2025 to 07-03-2025.Demographic data, drugs, PIs and acceptance rate were obtained from electronic medical records and healthcare activity. PIs related to HAMs from hospital drug (HAM-H) and chronic pathology (HAM-C) lists of the Institute for Safe Medication Practices were analysed.Results 139 patients received PC: 69% women, median age 73 (interquartile range [IQR]=66-85) years and 14 (IQR=11-17) drugs in e-prescribing. Fifty-three (38.1%) patients had any PIs (n=110, median=2 interventions/patient (IQR=1-2)), 88.2% were accepted. Thirty-seven PIs related to HAMs were found in 32 patients (23%). Of all PIs, 20.0% (n=22/110) were related to HAM-H and 31.8% (n=35/110) to HAM-C.Therapeutic groups linked to PIs on HAM-H list were A (alimentary tract and metabolism) =50.0%, B (blood and haematopoietic organs) =22.7%, N (nervous system) =18.2% and C (cardiovascular system) =9.1%. Drugs mainly involved were insulins (38.1%), oral anticoagulants (OAC=19%), opioids (14.3%) and oral antidiabetics (9.5%). PIs on the HAM-H list were mainly related to reconciliation, 78.9% were reconciliation errors (RE). PIs due to reconciliation (n=19/22) were omission (54.5%), different regimen (18.2%), incomplete regimen (9.1%) and commission (4.5%); other PIs (n=3/22) were interaction (4.5%), contraindication (4.5%) and age/renal adjustment (4.5%).Therapeutic groups linked to PIs on the HAM-C list were N=40.0%, A=37.1%, B=11.4%, M (musculoskeletal system) =5.7%, C=2.9% and L (antineoplastic/immunomodulators) =2.9%. Drugs mainly involved were insulins (22.9%), benzodiazepines (20.0%), OAC (11.4%), opioids (8.6%), long-term corticosteroids (8.6%), antipsychotics (8.6%), non-steroidal anti-inflammatory drugs (8.6%), digoxin (2.9%) and narrow therapeutic index antiepileptics (2.9%). PIs on the HAM-C list were mainly related to reconciliation, 86.7% were RE. PIs due to reconciliation (n=30/35) were classified as omission (60.0%), different regimen (14.3%), incomplete regimen (2.9%) and commission (8.6%); other PIs (n=5/35) were interactions (8.6%) and contraindications (5.7%).Conclusion and Relevance PIs on HAMs in ED are mainly RE, the most frequent is omission. PIs mainly involve insulins, benzodiazepines, OAC, and opioids.These findings highlight the need to reduce HAM-related errors and PC potential optimising pharmacotherapy.Conflict of Interest No conflict of interest