Look-alike or sound-alike (LASA) medication names may be mistaken for each other, e.g. mercaptamine and mercaptopurine. If an error of this sort is not intercepted, it can reach the patient and may result in harm. LASA errors occur because of shared linguistic properties between names (phonetic or orthographic), and potential for error is compounded by similar packaging, tablet appearance, tablet strength, route of administration or therapeutic indication. Estimates of prevalence range from 0.00003 to 0.0022% of all prescriptions, 7% of near misses, and between 6.2 and 14.7% of all medication error events. Solutions to LASA errors can target people or systems, and include reducing interruptions or distractions during medication administration, typographic tweaks, such as selective capitalization (Tall Man letters) or boldface, barcoding, and computerized physician order entry. K E Y W O R D Slook-alike, medication error, nomenclature, similarity, sound-alike | INTRODUCTIONIn this review we introduce the problem of look-alike, sound-alike (LASA) name errors; give an overview of the landscape of medication nomenclature; outline the scope, importance and prevalence of LASA name errors; and explore solutions. This paper is to be complemented by a systematic review in a forthcoming issue. We adopted a stepwise approach to exploring the literature. After identifying papers that are central to the problem of LASA name errors, we handsearched forward citations (paper that cited it after publication) and backward citations (key papers they cited), and identified further relevant literature. | MEDICATION ERRORS INVOLVING LASA NAMESOf all events that are reported to cause patient harm in the UK, medication errors are the most common. Between January and March 2018 they accounted for 10.7% of incidents (206 485 medication incidents out of a total of 1 936 812 incidents), and 63 deaths. 1 Medication errors can occur when medications have similar-looking or similar-sounding names, and/or shared features of product packaging.These wrong drug errors are so-called LASA errors. 2 LASA errors make up a high proportion of all medication errors; estimates range from 6.2 3 to 14.7%, 4 representing a significant threat to patient safety. 5,6 They can occur during prescribing, dispensing or administration of medicines, and can lead to administration of the wrong medication.LASA errors can result in overdosing, under-dosing, or inappropriate dosing. 7 Confusion can occur between: generic-generic names (e.g. penicillin-penicillamine); brand-brand names (e.g. Prozac-Provera); brand-generic names (e.g. Soriatane-sertraline); or genericbrand names (e.g. methadone-Metadate); these examples are taken from error reports. 8 Most LASA pairs are reciprocal, i.e. each has been mistaken for its counterpart, revealing the influence of inherent pairwise similarity, rather than external environmental factors.This review is primarily concerned with errors that are caused by look-alike names and sound-alike names, and interventions to reduce their preval...

BackgroundConfusion between look-alike and sound-alike (LASA) medication names (such as mercaptamine and mercaptopurine) accounts for up to one in four medication errors, threatening patient safety. Error reduction strategies include computerized physician order entry interventions, and ‘Tall Man’ lettering. The purpose of this study is to explore the medication name designation process, to elucidate properties that may prime the risk of confusion.Methods and FindingsWe analysed the formal and semantic properties of 7,987 International Non-proprietary Names (INNs), in relation to naming guidelines of the World Health Organization (WHO) INN programme, and have identified potential for errors. We explored: their linguistic properties, the underlying taxonomy of stems to indicate pharmacological interrelationships, and similarities between INNs. We used Microsoft Excel for analysis, including calculation of Levenshtein edit distance (LED). Compliance with WHO naming guidelines was inconsistent. Since the 1970s there has been a trend towards compliance in formal properties, such as word length, but longer names published in the 1950s and 1960s are still in use. The stems used to show pharmacological interrelationships are not spelled consistently and the guidelines do not impose an unequivocal order on them, making the meanings of INNs difficult to understand. Pairs of INNs sharing a stem (appropriately or not) often have high levels of similarity (<5 LED), and thus have greater potential for confusion.ConclusionsWe have revealed a tension between WHO guidelines stipulating use of stems to denote meaning, and the aim of reducing similarities in nomenclature. To mitigate this tension and reduce the risk of confusion, the stem system should be made clear and well ordered, so as to avoid compounding the risk of confusion at the clinical level. The interplay between the different WHO INN naming principles should be further examined, to better understand their implications for the problem of LASA errors.

The aim of this systematic review was to explore and evaluate the efficacy of interventions to reduce the prevalence of look-alike, sound-alike (LASA) medication name errors. Methods: We conducted a systematic review of the literature, searching PubMed, EMBASE, Scopus and Web of Science up to December 2016, and reran the search in February 2020 for later results. We included studies of interventions to reduce LASA errors and included randomized controlled trials, controlled before-and-after studies, and interrupted time series. Details were registered in Prospero (ID: CRD42016048198). Results: We identified six studies that fulfilled our inclusion criteria. All were conducted in laboratories. Given the diversity in the included studies, we did not conduct a meta-analysis and instead report the findings narratively. The only intervention explored in RCTs was capitalization of selected letters ("Tall Man"), for which we found limited efficacy and no consensus. Conclusions: Tall Man lettering is a marginally effective intervention to reduce LASA errors, with a number of caveats. We suggest that Tall Man gives rise to a "quasi-placebo effect", whereby a user derives more benefit from Tall Man lettering if they are aware of its purpose.

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Despite years of targeted interventions, young people experiencing socio-economic deprivation are still under-represented in those studying STEM (science, technology, engineering, and mathematics) subjects post-16 and in higher education STEM pathways. We surveyed 61 young people who had participated in the S4 programme in South Wales, UK, and interviewed three of their teachers. Using the theoretical lens of science capital, we asked them about the S4 programme, and their views of science and education in terms of aspirations, attainment, and social obstacles. Whilst widely outdated, a ‘deficit model’ of aspiration raising still guides STEM outreach policy in Wales and we consider the answers to our survey in light of this. Broadly, our participants are enthusiastic and ambitious, and confident in their abilities in both science and wider skill areas. However, we found certain aspects of ambition were linked to socio-economic status. For example, whilst most young people we surveyed aspire to go university, those who do not cite different reasons depending on their socio-economic status. Despite high aspirations around science and education, teachers cited low literacy and numeracy, household poverty, entrenched generational unemployment, rural isolation, disabilities, caring responsibilities, and teenage pregnancy as barriers to higher education for their pupils. Importantly, S4's intervention had the greatest impact with those in the extremes of socio-economic deprivation, particularly in terms of bolstering existing science and education aspirations and increasing the ‘thinkability’ of attending university. Our findings contradict accepted thinking on science and education aspirations in that rather than participation in higher education being motivated by a lack of science and education aspiration or the discourse of family habitus ("people like us"), young people seem to be starkly aware of the very real socio-economic obstacles. We found no poverty of science and education aspiration in the participants we surveyed, and encourage a policy move away from the deficit model of raising science and education aspirations that will take a more nuanced view of widening access to STEM education and higher education in general in Wales.