Slide 1

[Audio] Hello. We will talk about look alike sound alike medications on this presentation slides. It is commonly known as short form LASA. We need to know what is LASA, what are the risk factors of LASA and what are the strategies to avoid error with LASA..

[Audio] First of all, what is LASA? LASA medications involve medications that look similar in their physical appearance or their packaging and the name of medications which have spelling similarities or similar phonetics. As more medicines and new brands are being marketed, many of these medications names may look or sound alike. Hence, it creates unnecessary confusion and may leads to potentially harmful medication errors..

[Audio] Common risk factors associated with LASA medications includes: illegible handwriting, incomplete knowledge of drug names, newly available products, similar packaging or labeling, similar strengths, dosage forms, frequency of administration and similar clinical use. Prescriber should clearly specify the name of medications, dosage form, dose and frequency of use. By including the diagnosis or medication's indication of use help to differentiate possible choices in illegible orders..

[Audio] These are the example of LASA medications. This two products ( Augmentin Injection and Unasyn Injection) are manufactured by the same company. Hence, they have similar product packaging which makes them looks alike. Same goes to the example of Frusemide Injection and Chlorpheniramine injection. Error happens when the filler or dispenser recognizes the medications based on their packaging without checking on their ingredient names..

[Audio] Other examples of look alike medications are Injection vitamin K 10mg and Injection vitamin k 1mg, Injection hydrocortisone and Injection streptomycin, Human Albumin 20% and Human Normal Immunoglobulin 2.5g..

[Audio] Whereas the example of sound alike medications are alfacalcidol and calcitriol. Both medications have the same available strength of 0.25mcg. The use of verbal or telephone order between the two medications may leads to error as they are sound alike. Hence, the use of verbal or telephone order should be minimized to prevent the error. Verbal order should be limited to emergency situations only. Prescriber should repeat the medication name and its dose during verbal order..

[Audio] Noradrenaline and adrenaline are 2 inotropes that are sound alike. Promethazine injection and prochlorperazine injection are sound alike as well as they similar in their spelling and pronounication of azine..

[Audio] Hence, extra care should be taken to avoid errors involving LASA. All the healthcare professionals involving the doctors, pharmacists and nurses are responsible to prevent LASA error as the precaution steps includes storage, prescribing, dispensing or supplying, administration and monitoring..

[Audio] The storage of LASA medications should be separately from their LASA pair. Wherever possible, avoid storing the products in immediate proximity to one another. Other than that, the use of Tallman lettering is practiced to emphasize the difference in medications of sound alike names. Additional warning labels for look alike medications should be carried out and placed at the storage bin of the look alike medications..

[Audio] For example, the storage of mycophenolate 250mg and 360mg should be separated from each other due to their different strength..

[Audio] Next, is the use of warning labels. The warning labels should be uniform throughout the whole facility to facilitate identification. In Hospital Umum Sarawak, the warning label is yellow and red in color with written the words " caution" and " look alike sound alike" on the label..

[Audio] For sound alike medications where Tallman lettering is not applicable, proprietary names either brand or trademarket names may be added to distinguish between the medications. Confusion between human albumin and IVIG often occurs. Hence, extra care and labeling are done to prevent this error..

[Audio] Tallman lettering uses selective capitalization to help the similar looking or sound alike medicines to be more easily differentiable. Part of the medicine's name is in upper case letters. This purposely disrupts the reading of a medicine name so that erroneous selection of a medicine with similar name can be prevented. For example, metformin and metoprolol. The dissimilar letters ( Formin and Toprol) for this 2 drugs are highlighted and capitalized to distinguish between the 2 drugs..

[Audio] Dopamine and dobutamine injection are also differentiated using Tallman lettering..

[Audio] For your information, the LASA medication list may be different between the facilities. The LASA medication list will also be reviewed periodically to ensure medication error can be prevented. The pharmacy department of Sarawak General Hospital has generated a medication safety booklet which contains the updated list of High Alert Medications, Look Alike Sound Alike medication with their Tallman lettering, approved trade names and medication abbreviations to be used. With this booklet, it is hope that medication error can be prevented to ensure our patient safety..

[Audio] The yellow highlight drugs are the newly identified LASA medications which has been added into the list..

[Audio] For prescriber, it is always advisable to write legibly on the prescription. Try to avoid abbreviations or brand/ trade name whenever prescribing a medication. For example: Losec which is omeprazole and Lasix which is frusemide might cause medication error. All the liquid or syrup should be prescribed in mg instead of ml. This is because there are different strength of liquids available in the market. For example, syrup paracetamol available in SGH currently is 120mg in 5ml whereas in the market, there is 250mg in 5ml available as well. Trailing zero is also need to be prevented when prescribing..

[Audio] When filling or serving the medication to the patient, it is compulsory to read the labels carefully at all stages. Identify the medicines based on its name and strength instead of its appearance or location. Double checking should be conducted during the dispensing and supply process..

[Audio] During the administration process, it is important to perform triangle check. Triangle check is to check the actual medicines against the medication labels and against the prescription. When receiving verbal order during emergency order, the staff who received verbal order must repeat the orders and ensure that they are verified..

[Audio] Monitoring process involve the date collection of all the medication errors and the near misses error. From this, feedback mechanism will be implemented to inform on the LASA medications. The LASA list will need to be reviewed and updated periodically as least once a year. The availability of the guideline is also accessible to all the relevant personnel..

[Audio] By having the available guideline booklet and this topic, it is hope that all the healthcare staff is able to identify the LASA in our SGH. Whenever there is new staff coming in, we should share with them on the knowledge of LASA and Tallman lettering. By doing this, we hoped that errors relating to LASA medications can be minimized and we can provide our patient a safer tomorrow..

[Audio] This are the references for this topic. Kindly contact D.I.S pharmacy at extension 1066 if you have any enquiry. Thank you..