Selection of LASA drug pairs
Q. How should we select our LASA drug pairs?
A. The current list of look-alike, sound-alike medications that create the greatest risk for medication errors can be found online. Organizations must choose 10 pairs of look-alike, sound-alike medications currently in use from this list and take action to prevent errors involving the interchange of these drugs, being mindful of the differences between tables I, II and III. An organization may choose to include more look-alike, sound-alike medications on its organization specific list, but those medications must be in addition to the 10 pairs of medications chosen from The Joint Commission’s list.
No medications in use
Q. If our organization does not store or dispense medications does NPSG.0.3.03.01 apply?
A. If your organization “uses” medications, the NPSG applies. The term “use” refers to any component of the medication management process: selection and procurement, storage, ordering and transcribing, preparing and dispensing, administration or monitoring.
Less than ten pairsIf our organization does not use medications from 10 of the pairs on the lists of look-alike/sound-alike (LASA) medications, do we still need to select 10 pairs?
Your organization should start with the lists provided by Joint Commission to identify 10 pairs of look-alike and sound-alike medications that your organization uses. If you are unable to identify 10 pairs from those lists, you should select other pairs of dangerous or easily confused medications pertinent to your organization to bring the total number of drug pairs up to 10. Comprehensive lists of LASA drugs are available on the web sites of the Institute for Safe Medication Practices (http://www.ismp.org/) and the U.S. Pharmacopoeia (http://www.usp.org/).
If, after searching all available resources concerning LASA drugs, you are still unable to identify 10 relevant pairs, you must submit a Request for Review of an Alternative Approach to a National Patient Safety Goal, describing the services you provide, the medications you use, and the resources you have used in your effort to identify relevant pairs of LASA drugs.
Actions to prevent errors
Q. Are there specific actions that we must take to avoid confusion of LASA drugs?
A. The requirement is to “take action to prevent errors due to the interchange of these drugs.” The specific actions you take are up to you. Your choices should be based on an analysis of your medication systems, recognized best practices, and specific strategies and general recommendations provided in the literature. Several suggestions are provided with the lists of LASA drugs posted on The Joint Commission web site.
Specific actions should be considered for each phase of the medication management process: procurement, storage, transcribing/ordering, dispensing and administration. Further, in /addition to protecting against interchange of different drugs that look alike or sound alike, the actions must also address different strengths of the same medication. In addition, consideration should be given to the following actions: Staff involved in handling LASA drugs should be periodically educated on potential LASA medications and packaging, as well as the hospital’s strategies to reduce LASA errors; the organization should evaluate technologies such as bar coding and computerized prescriber order entry (CPOE) systems that might be used to minimize LASA errors. It should be noted that separate from NPSG.03.03.01, standard MM.04.01.01 EP 4 requires special precautions for ordering LASA drugs.
Differing concentrations
Q. Do we need to treat different concentrations of the same medication as LASA drugs?
A. Yes. It is a safe practice to store different concentrations or dosages of a drug in a manner that will minimize the risk of accessing the wrong strength of the drug. This does fall under the requirements of this “LASA” safety goal. The intent of this NPSG requirement is to avoid confusing different drug preparations, including different strengths of the same drug. Note that Medication Management standard MM.02.01.01 EP 6 requires that: the number of concentrations (or dosages) of any given drug should be limited.