Gyanaprava Maharana,PGDHQM 16- REVIEW OF LITERATURE

REVIEW OF LITERATURE
Review of literature is an essential step in research project the beginning to the end. A
literature review helps to lay the foundation for the study and inspire new research ideas. It is
an integral component of any study or research project. It enhances the depth of the
knowledge and inspires a clean insight in to the crux of the problem.
A review of related literature assists on interpreting study findings and on developing
implication and recommendation. Its major rule is to ascertain what is already known in
relation to the prospect of our study.

DEFINITION
“The review of literature is defined as a broad, comprehensive in depth, systematic and
critical review scholarly publications, unpublished scholarly print materials, audio-visual
materials and personal communications.”
(Basvanthappa BT,2007)
“It is a critical summary of research on a topic of interest after prepared to put a research
problem in context or as the basis for an implementation project.”
(Polit and Hunger,2003)
A review of literature for the study are organized under the following headings.

1.Review of literature related to LASA drugs and medication error

2. Review of literature related to nurse’s knowledge of drugs and medication error.

1.Review of literature related to LASA drugs and medication error

A study was conducted in London on incidence, type and causes of dispensing error. The
main objective of the study was to identify, review and evaluate the published literature on
the incidence, type and causes of dispensing errors in hospital. Electronic data base were
searched from 1996 to 2008 for the data collection. This was supplemented by hand
searching the bibliographies of retrieved articles. Analysis of the findings explored the
research methods, operational definitions, incidence, type and causes of dispensing error. The
results indicated that the most common dispensing errors were dispensing the wrong drug,
strength, form or quantity. The factors contributing to dispensing errors were low staffing,
look alike sound alike-drugs (LASA) and computer software.

A study was conducted in Italy on risk assessment of look‒alike, sound‒alike (LASA)

medication errors in hospital. ‘Failure Mode and Effect Analysis’ (FMEA) technique were
used for the data analysis. Analysis led to the identification of the potential failure modes,
together with their causes and effects, using the risk priority number (RPN) scoring system.
The result indicated that a lot of potential failure modes related to LASA drugs distribution
system provided by the hospital pharmacy. Information technology solutions can be effective
 Gyanaprava Maharana,PGDHQM 16- REVIEW OF LITERATURE

to reduce this risk, but the potential for error will remain unless these systems are carefully
implemented.

A study was conducted in England on paediatric vaccination errors by application of 5 rights

frame work to a national error reporting database. The study analysed 607 outpatient
paediatric errors reports from MEDMARX (a national wide voluntary medication error
reporting system) occurred from 2003 to 2006.The results indicated that wrong vaccine errors
were more common among LASA groups than among vaccine with no LASA groups.

A study was conducted in United Kingdom on Patient Safety in Medication Nomenclature:

Orthographic and Semantic Properties of International Non-proprietary Names. The study
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. The result indicated 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.

A study was conducted in South Carolina on using pharmacy data to screen for lookalike
sound alike substitution errors in paediatric prescription. The objective was to test a screening
approach to detect potential look alike sound alike (LASA) errors in paediatric outpatient
prescriptions. The prescriptions were analysed on selected 22 drugs. The results indicated that
among 22 test drugs, there were 1420091 prescriptions to 173005 subjects. The study
identified 43 true LASA errors. The overall LASA error rate is estimated to be approximately
0.00003% or 0.03 LASA errors per 1000 prescriptions. The study concludes that prescription
dispensing patterns can be used to screen for LASA errors appear to be much lower than
other types of paediatric medication errors and may be best addressed by automated
processes.

A study was conducted in Netherlands on A systematic literature review on strategies to

avoid look-alike errors of labels. The objective was to systematically evaluate the current
evidence on strategies to minimize medication errors due to look-alike labels. A literature
search of PubMed and EMBASE for all available years was performed independently by two
reviewers. Original studies assessing strategies to minimize medication errors due to look-
alike labels focusing on readability of labels by health professionals or consumers were
included. Data were analysed descriptively due to the variability of study methods. The study
conclude that Tall Man lettering contributed to a better readability of medication labels. Only
few studies evaluated other strategies such as color-coding. More evidence, especially from
real-life setting is needed to support safe labelling strategies.
 Gyanaprava Maharana,PGDHQM 16- REVIEW OF LITERATURE

A study was conducted in Maharashtra and Gujarat on misbranding of drugs and look alike
sound alike drugs (LASA) responsible for medication error. The objective of the study was to
provide ready reference for LASA and misbranded drugs and to minimize medication errors.
The study period was 2 years, a field survey was done to few hospitals and pharmacies to
take the individual database of brands and compilation of brands of pharmaceutical
formulations to develop a database to detect misbranded drugs and LASA drugs available at
drug stores across the surveyed institutions. The results indicated that there were 2582 brands
of LASA drugs and 201 brands of misbranded drugs in Gujarat and a list of 3847 brands of
LASA drugs and 317 brands of misbranded drugs in Maharashtra, which are responsible for
medication errors and patient harm.

A study was conducted in Goa on Confusing brand names: Nightmare of medical profession.
The objective of the study was to analyse and sort out the multitudinous brand names
thronging the Indian market, and identified those that could create a possible confusion. The
study was based on recent issues of drug formularies like Indian Drug Review, Drug Index,
and Monthly Index of Medical Specialities-India were checked and all the brand names given
were included. The result indicated that Several brand names are strikingly identical, similar
looking (orthographic), or similar sounding (phonological). Preventing this possible
confusion is not the work of any one person involved. They describe the role of prescribing
doctors, dispensing pharmacists, consumer patients, and the manufacturing companies to
prevent "wrong prescribing" due to similarities in brand names.

A prospective study was conducted in general hospital in Delhi on medication errors arising
out of lookalike sound alike brand name confusion. For the data collection the errors in drug
ordering method were analysed for 6 months, and a list of commonly involved drugs were
analysed for seriousness on the basis of their potential to cause patient harm. Which was
further classified in to 5 categories a)look alike drugs with same generic name
b) Look alike drugs with different generic name.
c) Sound alike drugs with same generic name.
d) Sound alike drugs with different generic name
e) Identical brand names with same generic names
Findings indicated that there were 4.5% of look-alike sound-alike drugs with same generic
names, 4.92%of look- alike drugs with different generic names and 0% of sound alike drugs
with different generic names, 84.01% of identical brands with same generic name. The study
conclude that name confusion is seen in almost all identical brand names for combination
drugs and such type of errors could be dangerous for the patients.
Studies related to nurse’s knowledge of drugs and medication error
A study was conducted in York university in Toronto on the role of typography in
differentiating look alike sound alike drugs LASA).The objective of the study was to provide
a visual means to help differentiate problematic names to reduce medication error.11 acute
care nurses were participated in the study, the study consist of word recognition tasks and
 Gyanaprava Maharana,PGDHQM 16- REVIEW OF LITERATURE

questions intended to elicit opinions regarding the visual treatment of LASA names in the
context of a label prototype. The FDA’s (food and drug administration) name differentiation
project recommendations and other typographic alternatives were considered to address
attention and cognition. The results indicated that the typographic differentiation may help
nurses to reduce medication error occurring from LASA drug names.
A study was conducted in Jordan on Nurses’ Perceptions of Medication Errors. The objective
of the study was to investigate the differences in causes, rate, and reporting of medication
errors across three types of hospitals as perceived by nurses. Data were collected during fall
2005. Using a sample of Jordanian nurses, the study was a replication of Osborne et al. and
Mayo and Duncan’s. This was the first nursing study about medication errors in Jordan, and
this was one of few international comparative studies about this phenomenon. The study
concluded that “Medication errors” is a serious practice issue which requires the immediate
attentions of all health care professionals and decision-makers.

A study was conducted in England on nurse’s knowledge of pharmacology behind drugs they
commonly administer. The participants were 42 nurses working in surgical wards of
foundation hospital. Data were collected by structured interview and questionnaire methods.
The participants made a blinded selection of 1 out of 4 drugs they commonly administer, and
they answered standard questions on specific pharmacy knowledge. The results indicated that
out of 10, only 11 nurses scored 8 and majority scored below 7 and mean knowledge score
was 6 ranging from 2 to 9, indicating that nurses have inadequate knowledge of drugs they
commonly administer.
A study was conducted on nurses’ perception of causes of medication errors. The objective of
the study was to identify the causes of medication error. A convenient sample of 61 medical
surgical nurses were surveyed. The results indicated that 78% of nurses were admitted
medication errors. The causes of medication error they perceived were poor handwriting,
workload, drug name confusion (LASA) and lack of knowledge of drugs.
A study was conducted in Malta on nurse’s perception of medication error. The objective of
the study was to identify the Maltese nurses’ perception of medication error including factors
that contribute medication error. A survey was conducted on nurses between Dec 2004 to Jan
2005. Data were collected by using questionnaire.38 nurses were participated. The results
indicated that, the factors causing errors were illegible hand writing, nurse’s tiredness, and
lack of knowledge of drugs. The study concludes that the hospital policies and the
development of structured protocol on drug administration will decrease the incidence of
medication error.
A study was conducted in England on nurse’s perception of their pharmacology educational
needs. The objective of the study was to explore nurse’s pharmacology educational needs by
identifying nurses’ role that require pharmacology knowledge, nurse’s preparation for
practice and medication safety. A qualitative approach was used to collect data from a
purposive sample of 10 nurses from an emergency unit. Semi structured interviews were
conducted. The results revealed a limited knowledge of nurses regarding drugs. The study
conclude that although nurses have a limited understanding of pharmacology, they recognize
the need for pharmacology knowledge in practice.
 Gyanaprava Maharana,PGDHQM 16- REVIEW OF LITERATURE

Summary:
This chapter deals with literature review related to LASA drugs and medication error,
literature related to nurse’s knowledge of drugs and medication error.