Generic Drug Names Cause Confusion
Valacyclovir (Valtrex) and valganciclovir (Valcyte) are easily confused. Both have uses associated with cytomegalovirus. Anakinra (kineret), an interleukin-1 blocker, was prescribed; however, Amikacin (amikin) was dispensed. Clinicians should use both brand names and generic names when prescribing these medications.
Unsafe Labeling
Some respiratory therapy medications and certain injectables are packaged in low-density polyethylene (LDPE) vials that look alike, with embossed labels that are difficult to read.
The FDA no longer permits paper labels or colored inks applied directly to LDPE containers because the adverse effects of label glue volitiles are not clearly defined.
When alternatives exist, avoid LDPE ampuls with embossed labels. Store respiratory medications separately and affix auxiliary labels before dispensing.
Problems with Look-Alike Drugs
Lantus (insulin glargine) and Lente (insulin zinc suspension) may cause confusion with both verbal and written orders. Prescribers should be alert to potential mix-ups. Clinicians should not use the abbreviation "L ", and all orders received in this manner should be clarified. Lantus insulin should be given daily at bedtime, not in the morning as other insulins. Place auxiliary warning labels on Lantus vials.
Nomenclature similarities with Serzone (nefazodone), an antidepressant, and Seroquel (quetiapine), an antipsychotic, have led to reported mix-ups. Poorly written orders, storing medications in close proximity, and listing names sequentially have been contributing factors; similar instructions, dose ranges, and availability heighten error risk. Advise staff and patients about potential confusion. Separate product storage areas and drug names on computer screens or printed forms, build computer alerts, and affix warning labels as appropriate.
Although Aggrastat (tirofiban) is an antiplatelet drug and Argatroban is a synthetic direct thrombin inhibiter, each may be thought of as an anticoagulant. Confusion has resulted from the packaging and name similarity-the argatroban label states "100 mg/ml," but the vial size (2.5 ml) is not listed near the concentration. The 250 mg total amount is not specified; errors are possible if it's concluded that only 100 mg is in the vial.
Before adding either drug to the formulary, evaluate the potential for confusion and clarify the required drug's purpose prior to dispensing or administering. Provide comparisons for reference, build computer alerts, place reminders on drug containers and shelving, and highlight the volume on argatroban cartons.
Oral Medication Safety
A child died when a cap flew off the hypodermic syringe given to the child's parents to measure medication and lodged in his throat. Although oral syringe caps do not pop off easily, alert parents and staff to remove the cap before administration. Instruct parents to only use a proper measuring device, such as a measuring cup or ORAL syringe. Never use a hypodermic syringe to administer oral medications.