Similar Sounding (Phonological) or Similar Looking (Orthographic) Medicines Lead to Medication Errors: A Survey on Residents And Nurses in A Tertiary Care Teaching Hospital, Kolkata, India

  • Subrata Ray Assistant Chief Medical Officer, Department of Health, Govt. of West Bengal, M. R. Bangur Hospital, 241, Deshapran Sasmal Road, Tollygunge, Kolkata, West Bengal.
  • Kaushick Mishra MO Supy, Swasthya Bhaban, Kolkata, WB, India.
  • Suparnna Chatterjee Professor, Department of Pharmacology, IPGMER, Kolkata, WB, India.
  • Avijit Hazra Professor, Department of Pharmacology and Dean IPGMER, Kolkata, WB, India.
Keywords: Medication errors; SALA medication; Awareness and training; Tertiary healthcare system; Drug-pairs confusion


Background: Objectives:  The present observational study was carried out to know the awareness among resident doctors and nursing staff in a tertiary care hospital regarding sound alike look alike (SALA) medications.


Methods: The present questionnaire-based survey work was carried out among 320 nos. of participants in which resident doctors (181 nos.) and nurses (139 nos.) were randomly selected through purposive sampling. A structured questionnaire that has been pretested for data collection. The questionnaire is being administered to respondents individually through face-to-face interview, by two raters, while they were on duty but not during rush hours. All the data were statistically analysed by using Statistical version 8 [Tulsa, Oklahoma: StatSoft Inc., 2007].

Results: In the present findings, highly significant values (p<0.001) in case of doctors in comparison with nurses related to age and working experiences. In case of medication error (ME) reporting, higher percentage (46.96%) was observed for doctors compared to nurses (25.90%) while uncertain condition was identified higher in nurses (50.36%) compared to doctors (37.02%). In case of gender, ME, and SALA itself, highly significant (p<0.001) differences were observed. The problem of SALA and anticipated problems due to SALA were observed significant (p<0.05 and p<0.000) changes. Among several SALA problems factors, significant changes were found only in case of fatigue and deliberate look-alike packaging (p<0.01) and storing multiple medicines in same container (p<0.05), respectively. Among several awareness factors on SALA problems and medication error, significant changes were obtained in two factors like very distinctive packaging and colour coding during storage (p<0.01) among participants.

Conclusion: The present study emphasizes an improved feature of awareness among hospital staffs viz. resident doctors and nurses regarding SALA medication for the sake of patient safety. The pharmacology department has a role to play in this regard with support from the hospital administration.


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How to Cite
Ray S, Mishra K, Chatterjee S, Hazra A. Similar Sounding (Phonological) or Similar Looking (Orthographic) Medicines Lead to Medication Errors: A Survey on Residents And Nurses in A Tertiary Care Teaching Hospital, Kolkata, India. Int Arch BioMed Clin Res [Internet]. 2020Dec.30 [cited 2021Jan.26];6(4):GM1-GM7. Available from:
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