Error Prone Abbreviations

To Abbreviate or Not to Abbreviate? Abbreviations are often used when writing orders to indicate dosage times, frequencies, routes, and other information about the med. However, the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) recommends not using abbreviations when writing med orders because of the high amount of errors that have occurred related to use of abbreviations.

Can you think of any complications related to misinterpreted abbreviations?

JCAHO steps in… JCAHO developed the official “do not use” list of abbreviations in 2004. These abbreviations should NOT be used when documenting med orders or other medication information.

JCAHO’s “Do Not Use List”

Abbreviation: q.d. or QD Meaning: Every Day Misinterpretation: q.i.d (four times daily) Correction: Daily

Abbreviation: U or u Meaning: Unit Misinterpretation: The number zero causing a tenfold overdose. (For example, 10u could be seen as 100!) Correction: Unit

Abbreviation: q.o.d. or QOD Meaning: Every Other Day Misinterpretation: q.d. or q.i.d. Correction: Every Other Day

Abbreviation: MS, MSO4, MgSO4 Meaning: Morphine Sulfate and Magnesium Sulfate Misinterpretation: Confused for one another. Correction: Write out “morphine sulfate” and “magnesium sulfate”

Abbreviation: IU Meaning: International Unit Misinterpretation: IV or the number 10. Correction: Write out “international unit”

Abbreviation: Trailing Zeros. Example: 4.0 mg Misinterpretation: 40 mg Correction: 4 mg

Abbreviation: Lack of a Leading Zero. Example: .5 mg Misinterpretation: 5 mg Correction: 0.5 mg

Don’t let this be you…

Risky Business… An article entitled “Abbreviations: Speed or Risk?” on the website allbusiness.com, states that According to the Institute of Medicine (IOM) of the National Academies, there are more than 7,000 deaths a year due to medication errors. Mistakes can occur anywhere in the medication-use system, from prescribing to administering a drug in a variety of settings (hospitals, outpatient clinics, nursing homes, home care, etc.) Potentially confusing abbreviations are part of this problem.

A major cause for concern. The use of abbreviations has received much attention as one of the major causes of medication errors. The risk of misinterpreting an abbreviation is even greater with handwritten orders, as the handwriting may be illegible. In addition to JCAHO, several other organizations including the Institute of Medicine, American Society of Health-System Pharmacists, Food and Drug Administration, National Coordinating Council for Medication Error Reporting and Prevention, and American Hospital Association, warn that the use of inappropriate abbreviations may lead to confusion and communication failures.

Use caution when “U” use abbreviations! According to the website http://www.ismp.org/tools/abbreviations/ “One of the most common but preventable causes of medication errors is the use of ambiguous medical notations. Some abbreviations, symbols, and dose designations are frequently misinterpreted and lead to mistakes that result in patient harm. They can also delay the start of therapy and waste time spent in clarification.”

Not just handwriting… Not only should you NOT handwrite dangerous abbreviations, you shouldn’t type them either. Abbreviations in print could still be misinterpreted. They could be copied onto handwritten orders. And they may give them impression that it is okay to use such abbreviations, even when it’s not!

Some examples: The “4u” could be misinterpreted as “44” instead of “4 units”

Examples: Instead of taking one tab of KCl every day, this patient could be getting it four times a day!

A PSA from http://www.ismp.org/tools/abbreviations

Reducing the Use of Unsafe Abbreviations: A Study An article titled “Educational interventions to reduce use of unsafe abbreviations” looked at the strategies used to reduce the usage of unsafe abbreviations at a level 1 trauma center at Detroit Receiving Hospital. Six abbreviations were deemed as unsafe by the patient medical safety committees: 1) U for units, 2) µg for microgram, 3) TIW for three times a week, 4) ° the degree symbol for hour, 5) Trailing zeros after a decimal point, and 6) the lack of leading zeros before a decimal point. Data on abbreviation use was collected by examining copies of patient’s order sheets which are sent from nursing units to the pharmacy for processing.

Reducing the Use of Unsafe Abbreviations: A Study For 8 months data was collected during three 24-hour periods each month, with 7-10 days between each period. A data collection sheet was developed to assist in documenting the number of opportunities for each unsafe abbreviation and the actual incidence of each. Educational strategies were developed and began to be implemented a month after the start of the study. These strategies included: inservice education programs for the medical, pharmacy, and nursing staffs; laminated pocket cards; patient chart dividers; stickers; and interventions by pharmacists and nurses during medication prescribing.

Reducing the Use of Unsafe Abbreviations: A Study During the 8 month evaluation, 20,160 orders were reviewed, representing 27,663 opportunities to use a designated unsafe abbreviation. Educational interventions successfully reduced the overall incidence of unsafe abbreviations from 19.69% to 3.31%

Reducing the Use of Unsafe Abbreviations: A Study Results of the study.

In conclusion… Medication errors related to the use of unsafe abbreviations is dangerous AND preventable. Educating hospital staff on this matter is necessary to ensure that these errors do not occur. JCAHO’s do not use list is just the minimum. There are other risky abbreviations that you should consider not using. Check your agencies policy and procedure manual, they may have their own additional list of abbreviations not to use.

And lastly… When in doubt… WRITE IT OUT!!!

Questions: 1. What is the appropriate way to chart “every day”? A. QD B. q.d. C. daily D. QRST

Questions: 1. What is the appropriate way to chart “morphine sulfate”? A. Morphine Sulfate B. MS C. MSO4 D. The pain pill

Questions: What is the appropriate way to chart four tenths of a milligram? A. 4/10ths mg B. 0.4 mg C. .4 mg D. 4mg

Questions: Who can name 3 abbreviations on the JCHAO do not use list?

Questions: Why is it dangerous to use the “do not use” abbreviations?

Questions: Where should you check to find out additional abbreviations you shouldn’t use at your agency?