Managing High-Alert/Hazardous and Look- Alike/Sound-Alike

Managing High-Alert/Hazardous and Look-

Alike/Sound-Alike (LASA) Medications in your

Bureau of Primary Care Health Center (BPHC)

Overview of Standards and Tips to Help

Maintain Compliance

Bobby J. Hurt, MSN, RN, MA

December 3, 2019

2

− Accredits/certifies over 21,000 health care organizations

and programs.

− Vision Statement: All people always experience the safest,

highest quality, best-value health care across all settings.

The Joint Commission

3

Our Organizing Principle

Leading the Way to Zero

4

Imagine a Day of Zero

− Zero complications of care

− Zero missed opportunities

− Zero overuse

− Zero harm

− Zero lost revenue

− Zero harm events of any kind

5

A Day of Zero 2018

6

A Day of Zero 2019

10 People Hospitalized After Mistakenly

Injected with Insulin Instead of the Flu Shot in

a Group Care Health Care Facility

7

ZERO HARM

High-alert and

Hazardous

Medications

8

− High-alert medications are those medications that bear a

heightened risk of causing significant patient harm and

or/sentinel events when they are used in error and, as a

result require special safeguards to reduce the risk of errors

− Hazardous drugs and medications are those in which studies

in animals or humans indicate that exposure to them has a

potential for causing cancer, developmental or

reproductive toxicity, genotoxicity, or harm to

organs

High-alert and Hazardous medications

9

High-alert and Hazardous Medications

− For safe management, the organization needs to develop its

own lists of both high-alert medications and hazardous drugs

− The list should be based on the organization's unique

utilization patterns, its own internal data about medication

errors and sentinel events or near misses

− In addition, the organization may separately choose to include

other drugs that require special precautions i.e.

investigational drugs, controlled substances, or

psychotherapeutic medications

10

High-alert and Hazardous Medications

−Standard MM.01.01.03 The

organization safely manages

high-alert and hazardous

medications

11

High-alert and Hazardous Medications

− MM 01.01.03 (2 Elements of Performance) (EP’s)

− 1. The organization identifies, in writing, its high-alert and hazardous

medications

− 2. The organization follows a process for managing high-alert and hazardous

medications

− * Note: This element of performance is also applicable to sample

medications

− * Indicates, list must be documented

12

High-alert and Hazardous Medications:

Compliance Tips

− EP 1. The organization identifies, in writing, its high-

alert and hazardous medications

− *Develop a list and document it

− *Collaborate with your pharmacy consultant to help

develop your list

− *Review National Institute for Occupational Safety and

Health (NIOSH) resources to help develop a unique list of

high-alert and hazardous medications

13

High-alert and Hazardous Medications:

Compliance Tips

− EP 2. The organization follows a process for managing

high-alert and hazardous medications

− * Segregate medications in different bins or locations

− * Distinguish medications by using “tall man lettering”

i.e. upper case letters

− * Sticker identification to identify the high-alert or

hazardous medications in your organization

14

High-alert and Hazardous medications

− Examples of High-alert medications

− opioids

− insulin

− anticoagulants

− neuromuscular blocking agents

− Example of a Hazardous medication

− chemotherapy agent

15

ZERO HARM

Look-Alike/Sound-

Alike Medications

16

Look-Alike/Sound-Alike-(LASA)

Medications

− Look-Alike/Sound-Alike medications are those either

written or spoken, which may lead to potentially

harmful errors when confused with each other

17

Look-Alike/Sound-Alike-(LASA)

Medications

− For safe management, the organization needs to develop its

own list of look-alike/sound-alike (LASA) medications

− The list should be based on the organization's unique

utilization patterns, its own internal data about medication

errors and sentinel events or near misses

− In addition, the organization may separately choose to include

other drugs that require special precautions i.e.

investigational drugs, controlled substances, or

psychotherapeutic medications

18

Look-Alike/Sound-Alike-(LASA)

Medications

−Standard MM.01.02.01 The

organization addresses the

safe use of look-alike/sound-

alike medications

19

Look-Alike/Sound-Alike-(LASA)

Medications

− MM 01.02.01 (3 Elements of Performance) (EP’s)

− 1. The organization develops a list of look-alike/sound-alike medications it

stores, dispenses, or administers

− 2. The organization takes action to prevent errors involving the interchange

of the medications on its list of look-alike/sound-alike medications

− 3. The organization annually reviews and, as necessary, revises its list of look-

alike/sound-alike medications

− * Note: This element of performance is also applicable to sample

medications

− * Indicates, list must be documented

20

Look-Alike/Sound-Alike-(LASA)

Medications

− EP 1. The organization develops a list of look-

alike/sound-alike medications it stores, dispenses, or

administers

− *Develop list and document it

− *Collaborate with your pharmacy consultant to help

develop your list

− *One source of look-alike/sound-alike medications is The

Institute for Safe Medication Practices (ISMP)

21

Look-Alike/Sound-Alike-(LASA)

Medications

− EP 2. The organization takes action to prevent errors

involving the interchange of the medications on its list of

look-alike/sound-alike medications

− * Segregate medications in different bins or locations

− * Distinguish medications by using “tall man lettering”

i.e. upper case letters

− * Sticker identification to identify the look-alike/sound-

alike medications in your organization

22

Look-Alike-Sound-Alike-(LASA)

Medications

− EP 3. The organization annually reviews and, as necessary,

revises its list of look-alike/sound-alike medications

− * Review your processes to ensure your list of LASA

medications is reviewed on an annual basis

− * Ensure you have a process in place to document the review,

and (if applicable), changes, to your LASA medication list

− * Date stamp the list and/or ensure the information is

captured in annual medication management minutes, which

are then reviewed and approved by your governing body

23

Look-Alike/Sound-Alike-(LASA)

Medications

− Examples of Look-Alike/Sound-Alike (LASA) medications

− Allegra Viagra

− Benadryl Benazepril

− Cerebyx Celebrex

− Lidocaine Novocaine

− Epinephrine Ephedrine

24

Other Tips for Compliance

− *Keep your lists available in all areas of your organization where

medications on your high-alert/hazardous and look-alike/sound-

alike(LASA) medications are administered and available such as:

− Medication rooms

− Crash carts

− Dental carts

− Automatic Dispensers

− Narcotic Lockers

− Procedure Rooms

− Immunization Rooms

− Refrigerators that store medications (i.e. insulin or other medications)

− etc….

25

Other Tips for Compliance

− * Make sure all staff who administer medications within

your organization are aware of your organization's lists,

polices, and processes (strategies to prevent errors when

administering medications that are on your high-

alert/hazardous and look-alike/sound-alike (LASA)

medication lists

− * Add the discussion of your high-alert/hazardous and

look-alike/sound-alike (LASA) medication to a discussion

point in staff meetings i.e. lists, strategies, and purpose

26

Resources to help develop your lists

− National Institute for Occupational Safety and Health

(NIOSH)

https://www.cdc.gov/niosh/topics/hazdrug/

− Institute for Safe Medication Practices (ISMP)

http://www.ismp.org/Tools/confuseddrugnames.pdf

27

Tracer Activity (Medication Management)

− Medication Management Tracer - In tracer activities,

surveyors will:

* Look to see if you have high-alert and hazardous Look-

alike/sound-alike medication lists and where the lists are located

* Talk with staff to see if they understand the meaning of the lists

and the strategies used within the organization to identify

medications on your high-alert and hazardous look-alike/sound-

alike medication lists

* Look to see if you have implemented your strategy

* Look to see if you have completed an annual review of your look-

alike/sound alike (LASA) medication list

28

(Frequent Observations) (RFI’s)

− Organization has not implemented or partially implemented

its strategy from preventing errors from medications on its

high-alert and hazardous or look-alike/sound-alike (LASA)

medication lists

− Organization’s staff are unaware of the strategy used within

the organization to prevent errors on its high-alert and

hazardous or look-alike/sound-alike (LASA) medication lists

− Organization has not completed and or documented an

annual review of its look-alike/sound-alike (LASA)

medication list

29

(Frequent Observations) (RFI’s)

− Organization has downloaded a copy of a high-alert and

hazardous or look-alike/sound-alike (LASA) medication

list from the internet and have not made it unique to the

medications used within the organization (i.e.

medications on the downloaded copy are not

administered within the organization)

30

(Frequent Observations) (RFI’s)

− Organization has no high-alert and hazardous or look-

alike/sound-alike medication lists available

− Organization’s lists are not available in areas where

medications on your high-alert and hazardous or look-

alike/sound-alike (LASA) are administered or stored (i.e.

staff are unaware of lists)

31

Develop your high-alert and look-alike/sound-alike lists

Utilize resources and a pharmacy consultant to help develop your list

Make sure the lists are unique to the medications used within your BPHC

Document the lists

Keep your lists available in all areas of your organization where medications on your high-

alert/hazardous and look-alike/sound-alike (LASA) medications are administered and stored

Make sure all staff who administer medications within your organization are aware

of your organization's lists, polices, and processes (strategies to prevent errors

when administering medications that are on your high-alert/hazardous and Look-alike-

/sound-alike (LASA) medication lists

Document an annual review of your look-alike/sound-alike medications list (LASA)

Summary

32

− Imagine a day of zero.

− Zero patient falls.

− Zero complications of

care.

− Zero infections.

− Zero lost revenue.

− Zero patient safety

events of any kind.

− All gone.

− Replaced by improved

efficiency and care.

33

“Aiming for zero harm

is the first step toward

achieving it.”

--- Chassin and Loeb 2013

34

Questions??????

35

− These slides are current as of December 3 ,2019. The Joint Commission

reserves the right to change the content of the information, as appropriate.

− These slides are only meant to be cue points, which were expounded upon

verbally by the original presenter and are not meant to be comprehensive

statements of standards interpretation or represent all the content of the

presentation. Thus, care should be exercised in interpreting Joint

Commission requirements based solely on the content of these slides.

− These slides are copyrighted and may not be further used, shared or

distributed without permission of The Joint Commission. Distribution of

the speaker’s presentation other than in PDF format is expressly prohibited.

Disclaimer