CLINICAL SERIES - Close Call, Clear Insight: Strengthening Safety Through Near Misses & LASA Awarene

Clinical Edge: The Missed That Matters: Building a Culture of Learning from Near Misses (July 14)

This session explores the concept of near misses in home infusion, highlighting how close calls can reveal hidden risks and opportunities for improvement. Participants will learn why reporting near misses is essential to strengthening safety culture, enhancing care quality, and preventing future harm.

1. Describe how near-miss events provide insight into various vulnerabilities and opportunities for improvement.
2. Analyze key contributors to near misses in clinical settings, with emphasis on workflow inefficiencies, human factors, and breakdowns in communication.
3. Explain the importance of early recognition and reporting of near miss events to strengthen a culture of safety and prevent patient harm.

Clinical Connect: Double Take: Managing Look-Alike Sound-Alike Drugs for Safer Infusion Care (July 15)

This session dives into the risks posed by look-alike sound-alike (LASA) medications in home infusion, where visual and verbal similarities can lead to serious errors. Participants will learn how to identify LASA drugs, implement safeguards, and strengthen safety protocols to protect patients and uphold clinical quality.

1. Explain how LASA drug errors can occur and the impact they can have on patient care.
2. Describe examples of LASA drugs and resources available to identify them.
3. Discuss different strategies to prevent LASA errors in the home infusion setting.

Clinical Edge: Behind the Mix-Up: A Root Cause Deep Dive into a LASA Near Miss (July 16)

This session walks through a real-world case study of a near miss involving a look-alike sound-alike (LASA) drug, using root cause analysis to uncover contributing factors and system vulnerabilities. Participants will learn how to apply structured investigation tools to strengthen safety practices, prevent recurrence, and foster a culture of learning from close calls.

1. Describe the sequence of events and contributing factors within a LASA near-miss case.
2. Discuss system and human elements that can lead to LASA errors in the home infusion setting.
3. Explain process improvements and preventative strategies to reduce recurrence and reinforce safety culture.

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