Microsoft word - sound alike look alike- guideline 2010.doc
Community Mental Health for Central Michigan
PROTOCOL FOR LOOK-ALIKE AND SOUND-ALIKE DRUGS This protocol should be posted in all licensed residential group homes who contract with Community Mental Health for Central Michigan ADMINISTRATIVE GUIDELINE In an effort to improve medication safety and to meet The Joint Commission’s National Patient Safety Goal Number 3, Community Mental Health for Central Michigan (CMHCM) has identified a process to address sound-alike and look-alike drugs. The Performance Improvement Team that developed this guideline will continue to monitor new drugs on the market as they are released, review the list included with this guideline on an annual basis, and provide appropriate updates. Appropriate action to prevent errors involving the interchange of these drugs will be taken. Each CMHCM site (including direct and provider network sites) where medication is distributed or administered will post the attached lists and implement a plan for preventing drug mix-ups. This plan may consist of but not be limited to:
Listing both the brand and generic names on medication records. Storing products with look-alike or sound-alike names in different locations. Employing double checks in the distribution process. Affixing “name alert” stickers to areas where look-alike or sound-alike products are stored. Changing the appearance of look-alike product names on pharmacy labels, computer screens, shelf
labels and bins, and medication records by highlighting, through bold face, color, and/or tall man letters, the parts of the names that are different (e.g. hydrOXYzine, hydrALAzine).
Having physicians write prescriptions using both the brand and generic names. Alerting consumers to the potential for mix-ups. Encouraging patients and direct care staff to question pharmacists and nurses about medications
that are unfamiliar or look or sound different than expected.
Community Mental Health for Central Michigan
PROTOCOL FOR LOOK-ALIKE AND SOUND-ALIKE DRUGS Institute for Safe Medication Practices (ISMP) List of Confused Drug Names
Permission is granted to reproduce material for internal newsletters or communications with proper attribution. Other reproduction is prohibited without written permission. Unless noted, reports were received through the ISMP Medication Errors Reporting Program (MERP). Report actual and potential medication errors to the MERP via the web at www.ismp.org/merp or by calling 1-800-FAIL-SAF(E). ISMP is a federally certified patient safety organization (PSO), providing legal protection and confidentiality for patient safety data and error reports it receives. This list of confused drug names, which includes look-alike and sound-alike name pairs, consists of those name pairs that have been involved in medication errors published in the ISMP Medication Safety Alert! and the ISMP Medication Safety Alert! Community/Ambulatory Care Edition. The errors involving these medications were reported to ISMP through the ISMP Medication Errors Reporting Program (MERP). This list also contains the names that appear on The Joint Commission’s list of look-alike and sound-alike names. The Joint Commission established a National Patient Safety Goal that requires each accredited organization to identify a list of look-alike or sound-alike drugs used in the organization. Those names that appear on The Joint Commission’s list have been noted with an asterisk (*) below. Drug Name Confused Drug Name
acetaZOLAMIDE*
acetoHEXAMIDE*
acetoHEXAMIDE*
acetaZOLAMIDE* ALPRAZolam* LORazepam*
aMILoride
amLODIPine Drug Name Confused Drug Name
amLODIPine
aMILoride
Community Mental Health for Central Michigan amphotericin B*
azaCITIDine
azaTHIOprine
azaTHIOprine
azaCITIDine
buPROPion
busPIRone
busPIRone
buPROPion Drug Name Confused Drug Name
carBAMazepine OXcarbazepine CARBOplatin CISplatin
Community Mental Health for Central Michigan ceFAZolin
cefTRIAXone
cefTRIAXone
ceFAZolin
CeleBREX*
CeleBREX*
CeleBREX*
CeleBREX*
chlordiazePOXIDE
chlorproMAZINE
chlorproMAZINE
chlordiazePOXIDE
chlorproMAZINE
chlorproPAMIDE
chlorproPAMIDE
chlorproMAZINE CISplatin CARBOplatin
clomiPHENE
clomiPRAMINE
clomiPRAMINE
clomiPHENE
clonazePAM
cloNIDine
clonazePAM LORazepam
cloNIDine
clonazePAM
cloNIDine*
KlonoPIN*
cycloSERINE
cycloSPORINE
cycloSPORINE
cycloSERINE DACTINomycin DAPTOmycin DAPTOmycin DACTINomycin Drug Name Confused Drug Name
Darvon Diovan DAUNOrubicin* DAUNOrubicin citrate liposomal* DAUNOrubicin* DOXOrubicin* DAUNOrubicin* IDArubicin* DAUNOrubicin citrate liposomal* DAUNOrubicin*
Solu-MEDROL
Community Mental Health for Central Michigan dexmethylphenidate
dimenhyDRINATE
diphenhydrAMINE
diphenhydrAMINE
dimenhyDRINATE DOBUTamine DOPamine DOPamine DOBUTamine DOXOrubicin* DAUNOrubicin* DOXOrubicin* DOXOrubicin liposomal* DOXOrubicin* IDArubicin* DOXOrubicin liposomal* DOXOrubicin* DULoxetine FLUoxetine
ePHEDrine* EPINEPHrine* Drug Name Confused Drug Name EPINEPHrine*
ePHEDrine*
fentaNYL SUFentanil FLUoxetine PARoxetine
Community Mental Health for Central Michigan FLUoxetine DULoxetine
glipiZIDE
glyBURIDE
glyBURIDE
glipiZIDE
guaiFENesin
guanFACINE
guanFACINE
guaiFENesin
HMG-CoA Reductase Inhibitors ("statins")
HumaLOG*
HumuLIN*
HumaLOG*
HumaLOG Mix 75/25
HumuLIN 70/30
Humapen Memoir (for use with HumaLOG)
umapen Memoir (for use with HumaLOG)
HumuLIN*
NovoLIN*
HumuLIN*
HumaLOG*
HumuLIN 70/30
HumaLOG Mix 75/25
hydrALAZINE*
hydrOXYzine* HYDROcodone*
oxyCODONE*
hydrOXYzine HYDROmorphone*
hydrOXYzine Drug Name Confused Drug Name
hydrOXYzine*
hydrALAZINE* IDArubicin* DAUNOrubicin* IDArubicin* DOXOrubicin*
inFLIXimab
riTUXimab
tuberculin purified protein derivative (PPD)
Community Mental Health for Central Michigan Kaopectate (bismuth subsalcylate)
KlonoPIN*
cloNIDine *
LaMICtal
LaMICtal
lamiVUDine*
lamoTRIgine*
lamoTRIgine*
lamiVUDine*
lamoTRIgine Drug Name Confused Drug Name
lamoTRIgine LORazepam* ALPRAZolam* LORazepam
clonazePAM LORazepam LORazepam
Community Mental Health for Central Michigan Lyrica
metFORMIN*
metroNIDAZOLE*
metroNIDAZOLE*
metFORMIN* Drug Name Confused Drug Name HYDROmorphone*
morphine - non-concentrated oral liquid*
morphine - non-concentrated oral liquid*
OxyCONTIN*
Community Mental Health for Central Michigan Neurontin
niCARdipine NIFEdipine NIFEdipine
niCARdipine NIFEdipine
niMODipine
niMODipine NIFEdipine
NovoLIN*
HumuLIN*
NovoLIN*
NovoLOG*
NovoLIN 70/30*
NovoLOG Mix 70/30*
NovoLOG*
HumaLOG*
NovoLOG*
NovoLIN*
NovoLOG FLEXPEN
NovoLOG Mix 70/30 FLEXPEN
NovoLOG Mix 70/30 FLEXPEN
NovoLOG FLEXPEN
NovoLOG Mix 70/30*
NovoLIN 70/30* Drug Name Confused Drug Name
HMG-CoA Reductase Inhibitors ("statins")
OLANZapine QUEtiapine
paregoric (camphorated tincture of opium)*
OXcarbazepine
carBAMazepine
oxyCODONE* HYDROcodone*
oxyCODONE*
OxyCONTIN*
OxyCONTIN*
OxyCONTIN*
oxyCODONE*
paregoric (camphorated tincture of opium)*
PARoxetine FLUoxetine PENTobarbital PHENobarbital PHENobarbital PENTobarbital
Community Mental Health for Central Michigan Platinol
prednisoLONE
predniSONE
predniSONE
prednisoLONE
PriLOSEC* Drug Name Confused Drug Name
PriLOSEC* QUEtiapine OLANZapine
quiNIDine
quiNIDine
Community Mental Health for Central Michigan Ritalin SR
riTUXimab
inFLIXimab Drug Name Confused Drug Name
SandIMMUNE
SandoSTATIN
SandoSTATIN
SandIMMUNE SINEquan SEROquel SEROquel XR SEROquel SEROquel SINEquan SEROquel XR SEROquel SEROquel SINEquan SINEquan SEROquel SINEquan SINEquan SINEquan
sitaGLIPtin SUMAtriptan
Solu-CORTEF
Solu-MEDROL
Solu-MEDROL
Solu-MEDROL
Solu-CORTEF SUFentanil
fentaNYL
sulfADIAZINE
sulfiSOXAZOLE
sulfiSOXAZOLE
sulfADIAZINE SUMAtriptan
sitaGLIPtin SUMAtriptan TEGretol TEGretol XR TEGretol TEGretol
Community Mental Health for Central Michigan TEGretol XR TEGretol TEGretol Drug Name Confused Drug Name
tuberculin purified protein derivative (PPD)
tiaGABine*
tiZANidine*
tiZANidine*
tiaGABine* TOLAZamide TOLBUTamide TOLBUTamide TOLAZamide
traMADol*
traZODone*
traZODone*
traMADol* TEGretol
tuberculin purified protein derivative (PPD)
tuberculin purified protein derivative (PPD)
vinBLAStine*
vinCRIStine*
vinCRIStine*
vinBLAStine*
Community Mental Health for Central Michigan Xanax*
Drug Name Confused Drug Name
ZyPREXA Zydis
ZyPREXA* SUMAtriptan SINEquan
ZyPREXA*
ZyPREXA*
ZyPREXA Zydis
ZyPREXA*
ZyrTEC-D
ZyrTEC (cetirizine)
ZyrTEC Itchey Eye Drops (ketotifen fumarate)
ZyrTEC-D
ZyrTEC Itchey Eye Drops (ketotifen fumarate)
ZyrTEC (cetirizine)
* These drug names are included on The Joint Commission’s list of look-alike or sound-alike drug names from which an accredited organization creates it own list to satisfy the requirements of the National Patient Safety Goals. Visit www.jointcommission.org for more information about this Joint Commission requirement. Approved by ELT:
Title: Can You Can a Can? A discovery/exploration lesson investigating the production of a cylindrical can of a given volume with the least amount of material, thus minimizing the cost of production. Links to Outcomes: • Problem Solving Students will use problem solving to investigate the possibilities for dimensions of a cylindrical can, given its volume. • Communication St
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