1. National Patient Safety Goal #2 Eliminate the Use of Unacceptable Abbreviations in the Medical Record by All Healthcare Providers

2. Opportunity Statement The use of ambiguous abbreviations in the medical record may lead to serious medication errors. The JCAHO has compiled commonly used abbreviations which have a high potential for error. The elimination of these “unacceptable abbreviations” should reduce medication errors and promote patient safety.

3. Goals Improve patient safety by the elimination of the use of unacceptable abbreviations in the electronic and handwritten medical record Achievement of 100% compliance with the use of acceptable abbreviations in the electronic and handwritten medical records

4. Solutions Implemented Resident education with monthly discussion on the use of unacceptable abbreviations at staff meetings QD warning signs placed in key spots on every patient unit Chart reviews which focus on the use of unacceptable abbreviations by specialty in order to identify patterns of individual physicians Results shared with department chairs Laminated pocket cards with the unacceptable abbreviations distributed to attending physicians and resident staff Larger laminated cards will be placed in each medical record on unit Poster presentations at the Safety Fair (March 8-9) and Quality Fair (April 11-12)

5. Analysis of Results Inpatient providers achieved target (90%) October 2005. Outpatient providers achieved and maintained the target 7 out of 8 months. Data collection processes revised to enable department specific analyses and improvement efforts

9. Unacceptable Abbreviations and Dose Designations Unacceptable Abbreviation or Dose Designation ReasonAcceptable Practice U (for units) U can be confused with 0 or 4 Must write out “units” IU (for International Units) IU can be mistaken for IV or 10 Must write out “International Units”

10. Unacceptable Abbreviation or Dose Designation ReasonAcceptable Practice Q.D (for daily) Q.O.D (for every other day) Q.D. and Q.O.D can be mistaken for each other, the period after the Q can be mistaken for a I, and the O can be mistaken for an I. Must write out “daily” “every other day”  g (for microgram)  g can be mistaken for mg, which is 1,000 times larger “mcg” must be written for microgram Zeroes after a decimal point (1.0) Can be misread as 10 Use a decimal point only when necessary; write 1 mg rather than 1.0 mg

11. Unacceptable Abbreviations and Dose Designations Reason Acceptable Practice A leading decimal point (.1) Can be misread as 1 Use a zero in front of a decimal point when necessary; write 0.1 mg rather than.1 mg MSO4 or MS (for morphine) Can be misinterpreted as magnesium sulfate Must write out “morphine” MgSO4 (for magnesium sulfate) Can be misinterpreted as morphine sulfate Must write out “magnesium sulfate”