Analysis of current version of implementation expectations



Updates to JCAHO’s Look Alike/Sound Alike Medication Tables

August 25, 2006

JCAHO released revisions Look Alike, Sound Alike (LASA) Medication Tables in August of 2006. National Patient Safety Goal #3 requires hospitals to identify at a minimum a list of ten (10) combinations of LASA medications. The organization’s list at a minimum must contain at least five (5) drug combinations from the JCAHO’s LASA Medication Tables I and/or II and the remaining five (5) are to be selected from any of the JCAHO Tables I, II and/or III. Annually, the organization is required to review the list and reassess the selections giving consideration to new information available regarding LASA interchange error. Revisions in the list should be made accordingly.

Changes to Table I: Applies to Hospitals, Critical Access Hospital, and Office-Based Surgery

ADDITIONS to Table I:

Hydroxyzine (Vistaril) and Hydralazine (Apresoline)

(Similarities in name spelling, dosage strengths and tablet dosage forms)

Metformin (Glucophage) and Metronidazole (Flagyl)

(Look alike packaging and wrong product selection when first three letters “MET” entered into computerized system as mnemonic. )

OxyContin (Oxycontin - Oxycodone controlled release) and Oxycodone (Oxycodone immediate release)

(Confusion over brand name OxyContin with oxycodone or order does not specify controlled release)

DELETIONS from Table I:

Cisplatin (Platinol) and Carboplatin (Paraplatin)

Fentanyl (Sublimaze) and Sufentanil (Sufenta)

Taxol (Paclitaxel) and Taxotere (docetaxel)

Ampnotec (Amphotericin B cholesteryl sulfate complex for injection) removed from Lipid-based amphotericin products

Note: Lipid-based products amphotericin products vs. conventional forms of amphotericin remains on list – only Ampnotec was removed

Changes to Table II: Ambulatory Care, Behavioral Healthcare, Home Care, Long Term Care, Assisted Living, and Disease Specific Care,

ADDITIONS to Table II:

Lorazepam (Ativan) and Alaprazolam (Xanax)

(Same class of drug (benzodiazepines) with different potencies)

Metformin (Glucophage) and Metronidazole (Flagyl)

(Look alike packaging and wrong product selection when first three letters “MET” entered into computerized system as mnemonic.)

Topamax (Topriamate) and Toprol-XL) (Metoprolol)

(Identical dosage strengths, “X” in end of Topamax and Toprol “XL” confusion)

DELETIONS from Table II:

Amaryl (Glimepiride) and Reminyl (Galantamine Hydrobromide)

Lamisil (Terbinifine Hydrochloride) and Lamictal (Lamotrigine)

Serzone (Nefazodone) and Seroquel (Quietapine)

Changes to Table III: Supplemental List

ADDITIONS to Table III:

Amicar and Omacor

Cardura and Coumadin

Darvocet and Percocet

Effexor NR and Effexor

Hydrocodone and Oxycodone

MS Contin and Oxycontin

Mucines and Mucomyst

Tramadol and Trazadone

Zestril and Zyprexa

Zestril and Zetia

Zocor and Zyrtec

DELETIONS from Table III:

Bretyllium and Brevibloc

Chlorpropamide and Chlorpromazine

Opium Tincture and Paregoric (Camphorated Opium Tincture)

Primacor and Primaxin

Actions:

1. Review you LASA Lists: The medication pairs you select (5 from Table I or II, depending on provider type, and 5 from any of the Tables) must be reviewed annually. Make sure this year’s review includes the updated list.

2. Replace Removed Pairs: If any of the pairs you wish to select (or continue) for this year have been removed for the list, you must choose a replacement.

3. Select and Implement Controls for Newly Selected Pairs.

4. Continue Effective Controls for Removed Pairs.

Remember: 10 pairs from the current JCAHO list is the minimum. You can choose to implement controls for more than 10 pairs if you like. For example, if you wish to continue controls for a pair that has been removed from the JCAHO lists, then you must add a new (11th) pair and so on. However, beware of Greeley’s rule 1c … do what you say[1]. If you say a control has been implemented, surveyors will check to make sure.

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[1] Greeley’s three-part rule for compliance with ALL standards is: 1.a “Do the right thing.” (make sure it makes clinical and operational sense);1.b “Say what you do.” (keep it simple); and 1.c “Do what you say.” (If you can’t do it, don’t say it!)

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200 Hoods Lane | P.O. Box 1168 | Marblehead, MA 01945 |

Consulting tel 888/749-3054 fax 781/639-0085 | Seminars tel 800/801-6661 fax 800/738-1553

200 Hoods Lane | P.O. Box 1168 | Marblehead, MA 01945 |

Consulting tel 888/749-3054 fax 781/639-0085 | Seminars tel 800/801-6661 fax 800/738-1553

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