This document discusses look alike and sound alike medications that can cause errors. It defines look alike and sound alike medications as those that are visually or verbally similar which can cause confusion. Several factors are described that can contribute to errors including individual, environmental, and unique drug factors. The document outlines categories of look alike drugs and lists from the FDA and ISMP. Finally, it proposes strategies to prevent errors related to procurement, storage, prescribing, dispensing, administration, monitoring, and patient education.

1. Look Alike And Sound Alike
Medications
Look Alike And Sound Alike
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Pharmacist/ Yasir A. Alowayyidh
Pharmaceutical Care Administration, Medina

2. DEFINITION OF LASA
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FACTORS OF ERROR WITH LASA
CATEGORIES IN LASA
FDA AND ISMP LISTS OF LASA
Strategies to avoid errors with LASA

3. involve medications that are visually similar in physical appearance or
packaging and names of medications that have spelling similarities and/or
similar phonetics
These confusing drug names are one of the main causes of medication error,
There are many sound and look alike drugs that would result in medication error.
These errors may cause harm or even death to patients.
DEFINITION
Look Alike Sound Alike (LASA)
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4. Individual factors take into capabilities, limitations, and
characteristics, such as, illegible handwriting, knowledge deficit, etc.
Environmental factors work environment or within the workflow
process, such as drug storage, environmental distractions, drug
shortage, etc.
Unique factors are special characteristics to look-alike/sound-alike
drug themselves, such as similar dose, similar indication, same
ingredients available in multiple formulations, etc.
FACTORS OF ERROR IN ALSL
The main reasons for improper dispensing of confusing drug names ,
may due to lack of knowledge of registered pharmacist or due to less number of
pharmacist during rush hours.
INDIVIDUAL FACTORS
ENVIRONMENTAL FACTORS
UNIQUE FACTORS
https://www.ismp-canada.org/download/PharmacyConnection/PC2014-02
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5. LASA drugs-Similar brand names, different generic drugs
Losec® (OMEPRAZOLE) &Lasix® (furosemide)
LASA drugs- Similar brand names , same generic drug
CETRALON ® and CETRO ®, (CETIRIZINE HYDROCHLORIDE )
LASA drugs- Similar brand names with additional letter
Fevadol , Fevadol Plus, FEVADOL EXTRA FEVADOL COLD & FLU
LASA drugs- Similar brand names of the Antibiotics group
CIFLOX ® (CIPROFLOXACIN) , MOXIFLOX ® (MOXIFLOXACIN)
Categories OF LASA
that can easily cause confusion while prescribing, dispensing and
administration ,

6. LASA drugs- Same drug, different Dosage forms
VOLTAREN® Tablet ,SUPP , Gel , eye Drops , ampules ……
LASA drugs- Same drug, different release characteristics
( NIFEDIPINE ) ADALAT RETARD ® , ADALAT LA
LASA drugs- Same brand or Generic name, different composition
Amphotericin B (Abelcet®)
Liposomal Amphotericin B (AmBisome®)
LASA drugs- Generic Drug pairs
VINCRISTINE VINBLASTINE
EPHEDRINE EPINEPHRINE
LORAZEPAM CLONAZEPAM
Categories OF LASA ( CONT.)

7. FDA and ISMP Lists of
Look-Alike Drug Names with Recommended Tall Man Letters
FDA
The US Food and Drug Administration
(FDA) list of drug names with
recommended tall man letters was
initiated in 2001 with the agency’s Name
Differentiation Project
ISMP institute for Safe Medication Practices
Since 2008, ISMP has maintained a list of drug
name pairs and trios with recommended, bolded
tall man (uppercase) letters to help draw attention
to the dissimilarities in look-alike drug names.
The list includes mostly generic-generic drug name
pairs, although a few brand-brand or brand-generic
name pairs are included.
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8. The ISMP list is not an official
list approved by FDA.
It is intended for voluntary
use by healthcare
practitioners and drug
information and technology
vendors.
ISMP
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9. Any manufacturers’ product
label changes require FDA
approval.
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10. ISMP Confused
Drug name List
https://www.ismp.org/Tools/confus
eddrugnames.pdf
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11. Strategies to avoid errors
with LASA
Monitoring
Information
Patient Education
Procurement
Storage
Dispensing
Prescribing
Administration

12. Procurement
Minimise the availability of multiple medicines
strengths , avoid similar packaging and appearance
compare them with existing packaging.
Dispensing/Supply
Storage
Use Tall Man lettering to emphasise differences in medications with
sound-alike
Use additional warning labels for look-alike medicines. Warning labels
should be uniform throughout the respective facility to facilitate
identification.
Prescribing
Administration
Monitoring
Information
Patient
Education
Strategies to avoid errors
with LASA
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13. Minimise the availability
of multiple medicines
strengths , avoid similar
packaging and
appearance compare
them with existing
packaging.
Strategies to avoid errors
with LASA
Procurement
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14.  Use Tall Man lettering to emphasise
 labels for look-alike medication.
 locations separate from each other
Strategies to avoid errors
with LASA
Storage
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15.  using both the brand , generic names ,
dosage form, dose and indication for use.
 computerized prescriber order entry (CPOE) should
used Tall Man lettering.
 Minimize the use of Verbal and Telephone orders.
Strategies to avoid errors
with LASA
Prescribing
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16.  Identify medicines based on its name and strength and not by its
appearance or location.
 Double checking should be conducted during the dispensing and
supply process.
 Highlight changes in medication appearances to patients upon dispensing
Dispensing
Strategies to avoid errors
with LASA
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17. (a) Read carefully the label each time a medication is
prior to administration.
(b) Check the purpose of the medication and the dose
prior to administration
Strategies to avoid errors
with LASA
Administration
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18.  Monitor new drugs added to the hospital formulary as they are
released and provide guidelines to These new drugs.
 Monitor patients who may have received wrong medications
as result of LASA medication error..
Strategies to avoid errors
with LASA
Monitoring
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19.  Update healthcare professionals of changes on the list of LASA and
confusing drug names.
 Provide education on LASA medications to healthcare professionals
at orientation and as part of continuing education
Strategies to avoid errors
with LASA
Information
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20.  Inform patients on changes in medication appearances.
 Encourage patients to learn the names of their medications.
Strategies to avoid errors
with LASA
Patient Education
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21. Example of the Strategies to avoid errors
with LASA in KFHM
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26. DAPSONE 100 MG
SODIUM BICARBONATE
375MG
FLUDROCORTISONE 0.1MG
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28. Risperidone
2 mg
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29. Ampoule
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34. Real incident
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35. Reminders, Checklists, Double Checks” and “Rules &
Policies” are used to remind or control people
not necessarily to fix systems.
“Education & Information” is an important strategy
when it is combined with other that strengthen the
system.
Take Home Message
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