Enhancing patient safety : a review on the effectiveness of initiatives to reduce errors from look-alike and sound-alike medication

Abstract

Introduction: Look-alike and sound-alike (LASA) medication errors, arising from orthographic and phonetic similarities between drug names, increase the risk of errors in prescribing, dispensing, or administration of medicines and remain a persistent threat to patient safety. As healthcare systems continue to expand formularies, adopt generic preparations, and diversify supply chains, the risk of LASA-related incidents grows. A structured literature search was conducted to examine whether labelling interventions effectively reduce LASA medication errors in hospital and in simulation-based settings, and thus inform practice. Method: A Critically Appraised Topic was conducted across PubMed, Scopus, and the Cochrane Database of Systematic Reviews from inception up to May 2025. Quantitative studies were included if they evaluated labelling interventions for LASA medications in inpatient or simulation environments and reported measurable outcomes. Following title and abstract screening, full text review, and backwards and forward citation tracking. Included studies were appraised and categorised using guiding principles from the Centre for Evidence-Based Management. Results: Eight studies met the inclusion criteria. The interventions identified included tall man lettering, boldface, colour coding, red lettering, contrast, larger lowercase, and symbol use. Most studies were conducted in simulation or laboratory settings, with limited representation from real world clinical environments. Labelling interventions, particularly tall man lettering and boldface, consistently improved drug name recognition accuracy and reduced selection errors under controlled conditions. Some studies reported notable reductions in error rates when these enhancements were applied in high-risk settings such as intensive care units. However, evidence from large-scale clinical implementation was mixed, with some studies reporting no statistically significant improvement in actual prescribing error rates. Many studies assessed proxy indicators such as throughput time or patient satisfaction rather than direct measures of safety or clinical effectiveness. Variability in study design, intervention types, and outcome metrics limited the comparability of findings. Discussion: The discrepancies from the studies highlight a gap between experimental success and clinical applicability. While labelling strategies show promise, they are not standalone solutions and should be embedded within broader medication safety frameworks. Their impact is likely to be maximised when supported by staff training, clinical decision support systems, pharmacist involvement, and systems-level policies. While current evidence is primarily drawn from simulated settings, the reviewed interventions appear to enhance the visual differentiation of LASA drug names and reduce the likelihood of selection errors, contributing to the reduction of preventable medication-related harm. Conclusions and Recommendations: These findings provide cautious support for incorporating labelling interventions into wider clinical risk management strategies in practice. Further research in hospital environments is warranted to confirm effectiveness and guide standardised, real-world implementation aimed at strengthening patient safety.