Key Takeaways
- High-alert medications have increased risk of causing significant patient harm when used in error.
- ISMP maintains a list of high-alert medications that require extra safeguards in pharmacy practice.
- Look-alike/sound-alike (LASA) medications can be confused due to similar names or packaging.
- Tall Man lettering (e.g., hydrOXYzine vs. hydrALAzine) helps distinguish LASA drug names.
- Physical separation of LASA drugs on shelves and use of alert labels are key prevention strategies.
High-Alert and Look-Alike/Sound-Alike Medications
Quick Answer: High-alert medications can cause severe harm if given incorrectly. LASA drugs have similar names or appearance and are easily confused. Prevention strategies include Tall Man lettering, physical separation on shelves, independent double-checks, and auxiliary warning labels.
High-Alert Medications
High-alert medications are drugs that bear a heightened risk of causing significant patient harm when used in error. While mistakes may not be more frequent with these drugs, the consequences of an error are much more serious.
Common High-Alert Medication Classes
| Category | Examples | Risk |
|---|---|---|
| Anticoagulants | Warfarin, heparin, enoxaparin | Bleeding complications |
| Insulins | Regular, NPH, glargine, lispro | Hypoglycemia |
| Opioids | Morphine, fentanyl, hydromorphone | Respiratory depression |
| Chemotherapy | Methotrexate, vincristine | Organ toxicity |
| Concentrated Electrolytes | Potassium chloride (IV), sodium chloride 23.4% | Cardiac arrest |
| Neuromuscular Blocking Agents | Succinylcholine, vecuronium | Respiratory paralysis |
| Oral Hypoglycemics | Metformin, glipizide, glyburide | Severe hypoglycemia |
| IV Contrast Agents | Iodinated contrast | Allergic reactions, renal injury |
Safeguards for High-Alert Medications
| Safeguard | Description |
|---|---|
| Independent Double-Check | Second person verifies calculation and drug |
| Dose Limits | System alerts for unusual doses |
| Standardized Concentrations | Use consistent preparations |
| Restricted Access | Store in secure locations |
| Auxiliary Labels | Warning stickers on containers |
| Patient Education | Counsel on risks and monitoring |
Look-Alike/Sound-Alike (LASA) Medications
LASA medications are drug pairs that look or sound similar and can be confused with each other.
Common LASA Drug Pairs
| Drug 1 | Drug 2 | Tall Man Lettering |
|---|---|---|
| Hydroxyzine | Hydralazine | hydrOXYzine / hydrALAzine |
| Metformin | Metronidazole | metFORMIN / metroNIDAZOLE |
| Clonidine | Clonazepam | cloNIDine / clonaZEPAM |
| Prednisolone | Prednisone | prednisoLONE / predniSONE |
| Dopamine | Dobutamine | DOPamine / DOBUTamine |
| Celebrex | Celexa | CeleBREX / CeleXA |
| Humalog | Humulin | HumaLOG / HumuLIN |
| Tramadol | Trazodone | traMADol / traZODone |
| Novolin | Novolog | NovoLIN / NovoLOG |
| Bupropion | Buspirone | buPROPion / busPIRone |
| Vincristine | Vinblastine | vinCRIStine / vinBLAStine |
| Lamictal | Lamisil | LamiCTAL / LamiSIL |
Preventing LASA Errors
- Tall Man Lettering - Capitalize distinguishing letters (e.g., hydrOXYzine)
- Physical Separation - Store LASA drugs in different locations
- Alert Labels - Use warning stickers on shelves and bottles
- Both Brand and Generic Names - Use both names when possible
- Read Back Orders - Verbally confirm medication names
- Barcode Scanning - Verify correct drug at point of dispensing
ISMP and Joint Commission Resources
| Organization | Role |
|---|---|
| ISMP (Institute for Safe Medication Practices) | Publishes high-alert medication lists; LASA list |
| The Joint Commission | Requires LASA management strategies for accreditation |
| FDA | Reviews drug names before approval to minimize confusion |
Exam Tip: Know common LASA drug pairs and how Tall Man lettering is used. Also memorize high-alert medication categories.
Which of the following medications would be classified as a high-alert medication?
The use of "hydrOXYzine" and "hydrALAzine" with capital letters is an example of which safety strategy?
Which organization publishes the widely-used list of high-alert medications and LASA drug pairs?