A systematic literature review of LASA error interventions

Abstract

The aim of this systematic review was to explore and evaluate the efficacy of interventions to reduce the prevalence of look-alike, sound-alike (LASA) medication name errors. Methods: We conducted a systematic review of the literature, searching PubMed, EMBASE, Scopus and Web of Science up to December 2016, and reran the search in February 2020 for later results. We included studies of interventions to reduce LASA errors and included randomized controlled trials, controlled before-and-after studies, and interrupted time series. Details were registered in Prospero (ID: CRD42016048198). Results: We identified six studies that fulfilled our inclusion criteria. All were conducted in laboratories. Given the diversity in the included studies, we did not conduct a meta-analysis and instead report the findings narratively. The only intervention explored in RCTs was capitalization of selected letters ("Tall Man"), for which we found limited efficacy and no consensus. Conclusions: Tall Man lettering is a marginally effective intervention to reduce LASA errors, with a number of caveats. We suggest that Tall Man gives rise to a "quasi-placebo effect", whereby a user derives more benefit from Tall Man lettering if they are aware of its purpose.

Analogous comparison of registered brand name drugs of tablets and capsules commercially available in Thailand: A retrospective study

“…The registration process should be designed to encourage both pharmaceutical manufacturers and regulatory authorities to determine whether the similarity in brand names are acceptable on the market. However, if pharmaceutical manufacturers decide to pursue more than one registration number for one formulation, brand name and physical character distinction of the product should be apparent [ 4 , 5 , 8 , 18 ]. Theoretically, if one API (single strength) from one manufacturer has one registration number, redundancy in registration numbers can be reduced to 1,498.…”

“…If Thailand seeks to achieve a 2P safety goal, the awareness of LASA drug names should be intensively established from pre-marketing to post-marketing phase. Reducing problematic name pairs decreases the potential for confusion by healthcare professionals [ 4 , 5 , 28 ]. Collaboration and safety culture between the regulatory affair bodies and pharmaceutical manufacturers should be organized to build a common ground [ 12 ].…”

“…Medication safety is a strategic objective to promote global patient safety campaigns and strengthen patient safety in all healthcare systems [1]. Medication safety strategies focus on minimizing medication errors, especially on "look-alike, sound-alike" (LASA) drugs, which cause unintentional mistakes in drug prescribing, dispensing, and administration [2][3][4][5][6].…”

Análise da Conformidade da Prescrição de Medicamentos de Alta Vigilância de Pacientes Onco-hematológicos em um Hospital de Ensino

“…No entanto essa não é a realidade da maioria das instituições de saúde pública do país. Outras estratégias podem ser utilizadas como, por exemplo, a redução da variabilidade do comportamento humano, que envolve a limitação das distrações e interrupções de trabalho, além da adoção do armazenamento estratégico 41 .…”

Análise das prescrições de antimicrobianos para pacientes hematológicos em relação ao protocolo de medicação segura em um hospital de ensino

“…As estratégias para reduzir esse tipo de erros envolvem ajustes tipográficos, como letras maiúsculas seletivas (letras Tall Man) ou negrito e código de barras 23 . Além disso, existe um software (LASA v2) que tem potencial para identificar pares de medicamentos confundíveis 24 .…”