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Despite significant advances in medication safety, errors related to confusion between drug names are a cause of preventable adverse events and serious harm,1 and remain a patient safety priority.2 ,3 Although drug name confusion is recognised as a factor contributing to error, its minimisation or elimination is a prevailing challenge.4 ,5 In this issue, Schroeder et al6 postulate that despite industry's efforts to follow regulators' guidance7 on how to review drug names, more objective evidence, in a standardised format, is needed to improve decision-making about the acceptability of a name. To address this concern, the authors assessed the association between error rates in laboratory-based tests of drug name memory and perception and rates of real-world errors related to drug name confusion.

We commend the authors for their contribution to this important area of study. Results from a study of a postmarket strategy for preventing drug name errors (ie, Tallman lettering) with look-alike, sound-alike (LASA) drug names did not demonstrate effectiveness in reducing medication errors.8 ,9 Reliable strategies for preventing drug name confusion errors, before they reach the market, are needed. The authors present a validated approach that provides an opportunity for identifying confusing drug names during the premarket phase with the goal of identifying safer names for products and preventing the associated costs when LASA drug names are identified postmarket. Here, we comment briefly on the article with the aim of provoking further reflection upon some of the fundamental issues surrounding assessment of LASA drug names and to protect patients from potentially harmful medication errors.

The findings of the thoughtfully executed study by Schroeder et al represent an important contribution to knowledge about the …