look alike and sound a like medications

Pharmacist/ Yasir A. Alowayyidh

Pharmaceutical Care Administration, Medina

1. Look Alike And Sound Alike Medications Look Alike And Sound Alike 8/7/2017 1 Pharmacist/ Yasir A. Alowayyidh Pharmaceutical Care Administration, Medina

2. DEFINITION OF LASA 8/7/2017 2 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) 8/7/2017 3

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 4

5. Category I Category II Category III Category IV 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. Category V Category VI Category VII Category VIII 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 VINCRI STINE VINBLA STINE EPHED RINE EPINEPH RINE LOR AZEPAM CLON AZEPAM 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. 8/7/2017 7

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 Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. 8/7/2017 8

9. Any manufacturers’ product label changes require FDA approval . 8/7/2017 9

10. ISMP Confused Drug name List https://www.ismp.org/Tools/confuseddrugnames.pdf 8/7/2017 10

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 8/7/2017 12

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 8/7/2017 13

14. Use Tall Man lettering to emphasise labels for look-alike medication. locations separate from each other Strategies to avoid errors with LASA Storage 8/7/2017 14

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 8/7/2017 15

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 8/7/2017 16

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 8/7/2017 17

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 8/7/2017 18

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 8/7/2017 19

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 8/7/2017 20

21. Example of the Strategies to avoid errors with LASA in KFHM 8/7/2017 21

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26. DAPSONE 100 MG SODIUM BICARBONATE 375MG FLUDROCORTISONE 0.1MG 8/7/2017 26

27. CHLORPHENIRAMINE 4MG CAPTOPRIL 25MG 8/7/2017 27

28. Risperidone 2 mg Risperidone 4 mg 8/7/2017 28

29. Xefo ® Ampoule Xefo ® tablet Lornoxicam Xefo ® 8/7/2017 29

30. Levothyroxine 25 mcg 50 mcg 100 mcg 8/7/2017 30

31. Adalat ® LA ( nifedipine ) 30mg 60mg 8/7/2017 31

32. CARBAMAZEPINE 200MG METOPROLOL 50MG Clomipramine 10mg Clomipramine 25mg 8/7/2017 32

33. DEXAMETHASONE 0.5MG AMITRIPTYLINE 10mg AMITRIPTYLINE 25MG METHYLDOPA 250MG 8/7/2017 33

34. Real incident 8/7/2017 34

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 8/7/2017 35