Dangerous Prescriptions and Abbreviations

State Standard 16) Outline in a written or digital presentation industry standards surrounding medication safety. Cite information obtained from textbooks, online and print pharmacy journals, and related websites. Include at minimum the following: a. Error prevention strategies for data entry (e.g., prescription or medication order to correct patient) b. Patient package insert and medication guide requirements (e.g., special directions and precautions) c. Issues that require pharmacist intervention (e.g., DUR, ADE, OTC recommendation, therapeutic substitution, misuse, missed dose) d. Common safety strategies (e.g., tall man lettering, separating inventory, leading and trailing zeroes, limited use of error-prone abbreviations) 17) Identify strategies for preventing medication errors by distinguishing medications that either look alike or sound alike, such as Ceftin, Cefotan, Cefzil, Rocephin and Cipro. Include strategies related to recognizing high-alert/high-risk medications such as Sporanox for patients who have ventricular dysfunction.

Objectives Students will be able to… Identify dangerous prescription errors Identify dangerous abbreviations that should not be used in prescriptions

Contents of the Prescription Name of the drug - CAUTION: Look Alike/Sound Alike drug names Massive number of new drug releases Massive number of reformulations Drug marketing strategy Build on established names New combination drugs – Use converged names

Contents of the Prescription Name of the drug AVOID THE USE OF: Abbreviations Many drugs identified with abbreviations EX: HCT for hydrochlorothiazide, MSO4 for morphine sulfate Attempts to standardize abbreviations have been unsuccessful

Contents of the Prescription Strength of the drug Decimal points Avoid trailing zeros. EX. 5 mg vs. 5.0 mg; can be mistaken for 50 mg Always use leading zeros. EX. 0.8 ml vs. .8 ml; can be mistaken for 8 ml

Rules for writing quantity of drug: Quantities of 1 gram or more should be written in grams. Ex - write 2 g. Quantities less than 1 gram but more than 1 milligram should be written in Milligrams For eg, write 100 mg, not 0.1 g

Drug Quantities Quantities less than 1 milligram should be written in micro / nano gram as appropriate. DO NOT abbreviate micro/ nanograms; since that can lead to Prescribing errors. For ex. write 100 micrograms, not 0.1 mg, nor 100 mcg, nor 100 μg Use ml or mL for milliliters

For some drugs, a maximum dose may need to be stated ( for eg For some drugs, a maximum dose may need to be stated ( for eg. ergotamine in migraine & colchicine in gout). Eg: Ergotamine 1 mg at onset of attack & repeat every 30 min if necessary . Do not take more than 6 mg in one day or more than 12mg in one week

CASE #1 Poor handwriting contributed to a medication dispensing error that resulted in a patient with depression receiving the antianxiety agent Buspar 10 mg instead of Prozac 10 mg

CASE #2 A hypertensive patient accidentally received Vantin 200 mg instead of Vasotec 20 mg when a pharmacist misread this prescription

MAXIMIZE PATIENT SAFETY ALWAYS write legibly. ALWAYS space out words and numbers to avoid confusion. ALWAYS complete medication orders. AVOID abbreviations. When in doubt, ask to verify. ***It is your responsibility to always check if it can not be read or does not make sense

Dangerous Abbreviations The Joint Commission has listed dangerous abbreviations, acronyms, and symbols on its “Do Not Use” list. Some abbreviations could have more than one meaning. Poorly written abbreviations are open to misinterpretation.

Dangerous Abbreviations Items affected by the Joint Commission “Do Not Use” list include: Medication orders Clinical documentation Progress notes Consultation reports

Dangerous Abbreviations Items affected by the Joint Commission “Do Not Use” list include: Operative reports Educational materials Protocols Other related material

Dangerous Abbreviations January 1, 2004 Joint Commission issues minimum list of dangerous abbreviations, acronyms, and symbols (see Table 5.9)

Table 5-9 The Joint Commission’s “Minimum” Do Not Use List.

Dangerous Abbreviations As of April 1, 2004 Each organization required to identify at least three more “do not use” abbreviations, acronyms, or symbols to go on its “do not use” list. Suggestions are given in Table 5.10

Table 5-10 The Joint Commission’s “Recommended” Do Not Use List.

Dangerous Abbreviations The Institute for Safe Medical Practices (ISMP) suggested other abbreviations, acronyms, and symbols to be considered suspect. The ISMP “Recommended” Do Not Use list is found on Table 5.11.

Table 5-11 ISMP’s “Recommended” Do Not Use List.

Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

Table 5-11 (continued) ISMP’s “Recommended” Do Not Use List.

Commonly Used Symbols Table 5.12 provides a list of symbols that are commonly used in pharmacy and medical practice.

Table 5-12 Common Symbols.

Common Terminology Terminology means the set of technical or special terms used in a business, art, science, or specific profession. Pharmacy and medical professionals use a unique language and terminology. This adds to prescribing safety The following slides contain a list of some of the terms found in Pharmaceutical Terminology.

Activity Complete a drug card for the following… Prednisone (Deltasone) Doxycycline (Vibramycin) Alendronate (Fosamax) Complete the Pharmacology Vocabulary activity and add to your “drug book” Once complete, work with a partner to create a incorrect prescription order. Switch with another group and make corrections.