Identifying High-Alert and LASA Medications — Practice Checklist

Step-by-Step Procedure (5 steps)

1. 1.

   Know the categories of high-alert medications: these carry a heightened risk of significant patient harm when used in error, even though the error itself may be no more likely than with any other drug — examples include insulin, anticoagulants (e.g., warfarin, heparin), opioids, and concentrated electrolytes.

2. 2.

   Recognize common look-alike/sound-alike (LASA) pairs by sight and by name before pulling stock — e.g., hydroxyzine vs. hydralazine, clonidine vs. klonopin (clonazepam), Celebrex vs. Celexa.

3. 3.

   Use Tall Man lettering cues where your pharmacy system displays them (e.g., hydrOXYzine vs. hydrALAzine) as a deliberate visual check, not just a formatting detail to skim past.

4. 4.

   Physically separate high-alert and LASA-paired products on the shelf where your pharmacy's layout allows it, and double-check the product in hand against the order before counting.

5. 5.

   Involve the pharmacist for an independent check on any high-alert medication fill, per your pharmacy's SOP — these typically require verification beyond the technician's initial check.

Quality Checkpoints (3)

Confirm each of these before considering the task complete.

• High-alert medications are identified as such and routed through any extra verification step your pharmacy requires.

• LASA pairs are checked by reading the full name, not a glance at the first few letters.

• Tall Man lettering, when present, is read and used as an active cross-check, not ignored.

Avoid These Mistakes

• ⚠

  Grabbing a bottle based on a quick glance at the first syllable of the drug name — this is exactly how LASA errors happen.

• ⚠

  Treating "high-alert" as a label rather than a trigger for an actual extra verification step.

• ⚠

  Not recognizing that a drug can be ordinary-risk in one form/strength and high-alert in a concentrated or injectable form (e.g., concentrated electrolyte solutions).