Evaluation of HAM and LASA Medication Management: Alignment Between Standards, Procedures, and Practice

Abstract

Medication errors are an important patient safety concern that can occur at various stages of the medication-use process and result in preventable harm. This study aimed to evaluate High-Alert Medication (HAM) and Look-Alike Sound-Alike (LASA) medication management at RSUD dr. T.C. Hillers Maumere by assessing medication-list concordance, compliance with applicable STARKES 2024 and hospital SOP requirements, and item-level and process-level gaps. A descriptive observational study with an evaluative approach was conducted through document review and direct observation at the Pharmacy Department, emergency trolley, Operating Room, and Intensive Care Unit (ICU) in July 2026. Of the 10 medication-safety indicators assessed according to STARKES 2024, 7 (70.0%) were compliant. The main gaps included the absence of periodic HAM list updating, inconsistent HAM and LASA management across hospital service area, particularly in the emergency trolley, and non-compliance with concentrated electrolyte storage requirements in the Operating Room and ICU. Among 39 observed HAM items, labeling on outer packaging and medication containers achieved 100% compliance, while storage compliance was 32/39 (82.1%). Among 104 LASA items, LASA labeling and physical separation achieved 100% compliance, whereas Tall Man Lettering was applied to 29/94 sound-alike items (30.9%). Neostigmine was included in the hospital HAM list but not in the ISMP reference list. Overall, HAM and LASA management practices assessed at the study sites were generally well implemented, but periodic, risk based evaluation and updating of the HAM and LASA lists are needed to ensure that medication safety practices remain aligned with actual risks.