Effective Administration of LASA Drugs

  

Sivakumar Murugesan.

Chief Consultant: Medpoint Healthcare

LASA drugs are medications that look or sound similar to each other, either by their generic name, or brand name. They might have similar packaging, similar-sounding names, or similar spellings

Effective Administration of LASA medications

a.Annually reviewing the LASA medications.

b. Implementing clinical protocols which:

·        Minimize the use of verbal and telephone orders.

·        Emphasize the need to carefully read the label each time a medication is accessed and again prior to administration, rather than relying on visual recognition, location, or other less specific cues.

·        Emphasize the need to check the purpose of the medication on the prescription/order and, prior to administering the medication, check for an active diagnosis that matches the purpose/indication.

·        Include both the nonproprietary name and the brand name of the medication on medication orders and labels, with the nonproprietary name in proximity to and in larger font size than the brand name.

c. Developing strategies to avoid confusion or misinterpretation caused by illegible prescribing or medication orders, including those that:

·        Require the printing of drug names and dosages.

·        Emphasize drug name differences using methods such as “tall man” lettering.

d. Storing problem medications in separate locations or in non-alphabetical order, such as by bin number, on shelves, or in automated dispensing devices.

e. Using techniques such as boldface and colour differences to reduce the confusion associated with the use of LASA names on labels, storage bins and shelves, computer screens, automated dispensing devices, and medication administration records.

The potential for errors can be reduced by:

·        Legible handwriting

·        Clear oral communications

·        Writing complete drug orders

·        Use generic names; do not abbreviate drug names

·        Specifying the route of administration

·        Specifying the drug strength, e.g. 100mg

·        Never abbreviate unit as "U": Spell out "unit"

·        Never use a trailing zero: 1mg, not 1.0mg

·        Never leave a decimal point "naked": Use 0.25mg or 250microgram, not .25mg

·   Specifying directions for when required medicines, include frequency, total daily dose and indication for use

 

Listed below are some drug names that can look and/or sound alike. Some are dangerously close, whereas others require incomplete prescribing information, poor communication skills, poor listening, and/or a lack of knowledge about the drugs for an error to result.

Aminophylline	Amitriptyline
Amoxicillin	Ampicillin
Amiloride	Amlodipine
Amiloride	Amiodarone
Amitriptyline	Nortriptyline
Anafranil	Enalapril
Atenolol	Timolol
Azithromycin	Erythromycin
Baclofen	Bactroban®
Beclometasone	Betamethasone
Beconase®	Becotide®
Betnovate®	Dermovate®
Bisacodyl	Bisoprolol
Carbamazepine	Carbimazole
Carbimazole	Chlorpromazine
Carboplatin®	Cisplatin®
Cefotaxime	Cefuroxime
Chlorpromazine	Chlorpropamide
Ciclosporin	Cycloserine
Clobazam	Clonazepam
Clomiphene	Clomipramine
Clomiphene	Clonidine
Clotrimazole	Co- trimoxazole
Clonazepam	Lorazepam
Clonidine	Clomiphene
Co-codamol	Co- proxamol
Co-dydramol	Co- proxamol
Cortisone	Cordarone®
Dacarbazine	Procarbazine
Daunorubicin	Doxorubicin
DepoMedrone	DepoProvera
Dermovate	Betnovate
Digoxin	Doxepin
Dipryridamole	Disopyramide
Domperidone	Droperidol
Dopamine	Dobutamine
Dothiepin	Doxepin
Enflurane	Isoflurane
Ergometrine	Ergotamine
Etidronate	Etretinate
Epinephrine(Adrenaline)	Ephedrine
Etidronate	Etomidate
Fenoprofen	Flurbiprofen
Fentanyl	Alfentanyl
Fluoxetine	Fluvoxamine
FolicAcid	FolinicAcid
Gliclazide	Glipizide
Humalog®	Humulin®
Hydroxyurea	Hydroxyzine
Hydroxyzine	Hydralazine
Idarubicin®	Doxorubicin
Imipramine	Trimipramine
IsosorbideDinitrate	IsosorbideMononitrate
Ketoprofen	Ketotifen
Lamivudine	Lamotrigine
Levothyroxine	Liothyronine
Lisinopril	Fosinopril
Lofepramine	Loperamide
Maxidex	Maxitrol
Mebendazole	Metronidazole
Metformin	Methyldopa
Methylprednisolone	Medroxyprogesterone
Metolazone	Metoprolol
Migraleve	Migril
Motilium	Motival
Motipress	Motival
Nicotinamide	NicotinicAcid
Nifedipine	Nicardipine
Nifedipine	Nimodipine
Nortriptyline	Amitriptyline
Olsalazine	Olanzapine
Penicillamine	Penicillin
Prednisolone	Prenisone
Priadel	Parlodel
Prochlorperazine	Penicillamine
Promazine	Promethazine
Quinidine	Quinine
Rifadin	Rifinah
Sandocal	Sando-K
Selegiline	Stelazine
Senokot	Seroxat
Sinemet	Cimetidine
Sinemet	Sinequan
Tamoxifen	Temazepam
Tamoxifen	Tenoxicam
Temazepam	Temgesic
Tramadol	Trazodone
Trimeprazine	Trimipramine
Triptafen	Tryptophan
Vermox	Volmax
Vinblastine	Vincristine

 

Sample LASA Drug List

HOSPITAL NAME
SOUND ALIKE DRUGS
SL NO	BRAND NAME	CHEMICAL COMPOSITION	ACTION	SOUND ALIKE BRAND NAME	CHEMICAL COMPOSITION	ACTION
1	ADRENOR INJ	NORADRENALIN	CARDIO VASCULAR DRUGS	ADENOCOR INJ	ADENOCINE	ANTI ARRYTHMIC
2	ALPRAX 0.25, 0.5 TAB	ALPRAZOLAM	ANXIOLYTICS, SEDATIVE	ATARAX 10, 25 TAB	HYDROXYZINE	ANTI ALLERGIC
3	ASTHALIN 4MG TAB	SAKBUTAMOL	ANTI ASTHMATIC	ASTHAFEN TAB	KETOTIFEN	ANTI ASTHAMTIC
4	RAZO 20 TAB	RABEPRAZOLE	ANTI LCER	RAZIN 5,10 TAB	FLUNARIZINE	ANTI MIGRAINE
5	REFLIN 250 INJ	CEFAZOLIN	ANTI MICROBIAL	OFLIN INJ	OFLOXACIN	ANTI BACTERIAL
6	OLVANCE 20, 40 TAB	OLMISARTAN MEDOXOMIL	ANTI HYPERTENSIVE	COVANCE 25, 50 TAB	LOSARTAN POTASSIUM	ANTI HYPERTENSIVE
7	EPSOLINTAB	PHENYTOIN	ANTI EPILEPTIC	DEPSONIL 25MG TAB	IMIPRAMINE	ANTI DEPRASSANTS
8	FLUNIL 10MG TAB	FLUOXETINE	ANTI DEPRASSANTS	CLONIL 10MG TAB	CLOMIPRAMINE	ANTI  DEPRASSANTS
9	WOKRIDE CAP	LEVOSULPRIDE + RABEPRAZOLE	NEUROLEPTIC + PROKINEPTIC	OPRIDE 50 TAB	ITOPRIDE	PROKINETIC
10	MISONAC	MISOPROSTOL + DICLOFNAC SODIUM	NSAIDS	MUCINAC 600MG TAB	ACETYLCYSTEINE	COUGH & COLD PREPARATION
PREPARED BY: NAME: MANAGER PAHRMACY		REVIEWED BY; NAME: CHAIRMAN PTC			APPROVED BY; NAME: MANAGING DIRECTOR

               

 

HOSPITAL PVT LTD
LOOK ALIKE DRUGS
SL NO	BRAND NAME	CHEMICAL COMPOSITION	ACTION	LOOK ALIKE BRAND NAME	CHEMICAL COMPOSITION	ACTION
1	ROSCILLIN INJ 500	AMPICILLIN	ANTIBACTERIAL	REFLIN 500 INJ	CEFAZPMIN	ANTIMICROBIAL
2	AVIL TAB	CPM	ANTI ALLERGIC	LASIX TAB	FRUSEMIDE	DIURETICS
3	NITRACURE SYRUP	NITAZOXANIDE	ANTIPROTOZOAL	ALTHROCIN SYRUP	ERYTHROMYCIN	ANTI MICROBIAL
4	TRIKA 0.25 TAB	ALPRAZOLAM	ANXIOLYTIC, SEDATIVE	ALPRAX  0.5 SR TAB	ALPRAZOLAM	ANXIOLYTIC, SEDATIVE
5	CEACT 400 TAB	PIRACETAM	CEREBRAL ACTIVATORS	TRENTAL 400 TAB	PENTOXYFYLLIN	PERIPHERAL VASODIALATORS
6	DIABEND 40 MG TAB	GLICLAZIDE	ANTI DIABETIC	ALDACTONE 25 TAB	SPIRANOLACTONE	DIURETICS
7	BECOSULES CAP	B- COMPLEX	VITAMINS	BECOSULES Z  CAP	B –COMPLEX – ZINC	VITAMINS
8	DOMSATAL TAB	DOMPERIDONE	ANTI EMETIC	ALPRAX 0.25MG TAB	ALPRAZOLAM	ANXIOLYTIC, SEDATIVE
9	PANLIPASE CAP	LIPASE+PROTEASE	DIGESTIVE ENZYMES	PANTOCID DSR CAP	PANTOPRAZOLE+ DOMPERIDONE	ANTI ULCER
10	BENEFICIALE CAP	MULTIVITAMINS	VITAMINS	KEE-  7 CAP	ZINC SULPHATE	MINERALS
11	CIPLAR 10 TAB	PROPRANOLOL	ANTI HYPERTENSIVE	DYTOR 10 TAB	TORSEMIDE	DIURETICS
12	NAPROSYN 250 TAB	NAPROXEN	NSAIDS	ALDACTONE 100 TAB	SPIRANOLACTONE	DIURETICS
13	AZTOR 40 TAB	ATORVASTATIN	DYSLIPIDAEMIC AGENT	LORNIT 500 TAB	L-ORNITHINE, L-ASPARTATE	AMINO ACID
PREPARED BY: NAME: MANAGER PAHRMACY			REVIEWED BY; NAME: CHAIRMAN PTC		APPROVED BY; NAME: MANAGING DIRECTOR

 

Strategies to Prevent Look-Alike/Sound-Alike Errors

 

·        Avoid abbreviations of drug names.

·         Physically separate agents in storage areas and automated dispensing cabinets (Pyxis®).

·         Use novel dosage delivery devices to distinguish products with similar names.

·         Print generic and brand names on unit-dose packaging, when possible.

·        Use TALL MAN lettering to emphasize the spelling of drug names in Pyxis® and medication storage areas.

·        Include prompts for nurses to specify indication for use when medication is removed from Pyxis.

·         Include dosing limits for medications with similar indications.

·         Place “Look Alike, Sound Alike” auxiliary alerts on medication storage bins.

·         Remove drugs with potentially problematic names from formulary, whenever poss