Look-Alike, Sound-Alike medicines are those that can commonly be miss-selected during the dispensing process due to their similar names or similar looking packaging. LASA dispensing errors are one of the most common causes of medication errors. Pharmacy has a key role to play in patient safety and there are various ways in which the pharmacy team can help to reduce LASA errors.

The top ten highest risk LASA combinations accounted for over 70 million prescriptions on 2017, they are:

LASA errors happen for a variety of reasons related to how our brains work when reading prescriptions and packaging. In the English language, reading from left to right can prompt confusion when the start of a medicine name is similar. As we read by chunking groups of letters in a word similar endings can also cause the same problem:

The Community Pharmacy Patient Safety Group has developed resources to support pharmacy professionals in reducing LASA errors in their practice. One of their resources looks at LASA drugs that begin with the letter A and tries to encourage a different approach to seeing the names using a method that is called ‘tall man’ lettering where mixed case lettering is used on the shelf/medicine to help identify a specific medicine.

 

These resources can be accessed from the Community Pharmacy Patient Safety Group (pharmacysafety.org) website.

What other ways can LASA errors be reduced?

NHS Improvement has provided a list of actions that can be taken to guard against LASA error when selecting packaging. Each one has limitations.

• Making staff aware of the potential for error/consequences of past errors : This can have a temporary effect but does not appear to prevent it recurring
• Physical separation of LASA combinations to different locations : Can be problematic because there are many similar sounding drug combinations
• Annotate the Patient Medication Record (PMR) : This can remind staff to be extra vigilant if the patient has experienced a LASA error in the past but often staff become ‘alert blind’ after a while
• Review of Standard Operating Procedures following a LASA incident : This can reinforce any changes that have been made to mitigate future errors but is not a barrier to errors happening again
• Using stickers on shelves below LASA medicines to highlight the need for vigilance : There may be a need for many such stickers which can then lead to staff not acknowledging them
• Reducing distractions such as background noise and interruptions : Can be challenging to achieve in a busy pharmacy
• Double or triple checking by other members of staff : This may not be feasible due to staff working patterns in the pharmacy but has been shown to improve safety
• Avoiding fatigue : It is important to set a maximum for working continuously without a break as it has been shown that errors are more likely when people are tired, thirsty or hungry
• Barcoding : This is probably the most effective physical barrier to incorrect drug selection, but may be costly to implement and will have an impact on time and efficiency of the dispensing process

 

LASA incident reporting and learning have been incorporated into the PQS Risk Management and Safety domain in previous years. Demonstrable learnings from the CPPE LASA e-learning should continue to be incorporated into annual patient safety reports. It should include a review of, and subsequent actions, where mitigation has failed to prevent either a LASA incident or near miss from occurring. The pharmacy should be able to show that they have actively identified and managed the risks associated with the top ten highest risk LASA combinations (as listed above).

Any reports sent to the National Reporting and Learning System (NRLS) that include a LASA incident should include ‘LASA’ within the description of what happened in the incident to enable NHS Improvement to search for LASA-related reports to maximise shared learning and information from such reports.