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Health Care Industry

Best practices for abbreviation use - Patient Safety First

AORN Journal, March, 2004 by Suzanne C. Beyea

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established a safety goal for 2004 related to the use of dangerous abbreviations, acronyms, and symbols. Abbreviations contribute to medical errors when clinicians misinterpret a letter or symbol and, because of this misinterpretation, administer a wrong medication or dose or give medication at the wrong time or with the wrong frequency. The Joint Commission recommends that facilities limit their use of certain abbreviations and has required facilities to stop using five specific sets of abbreviations as of Jan 1, 2004. They also require that facilities expand their "do-not-use" lists to include three or more additional abbreviations of the facilities' choosing by April 1, 2004. (1)

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Currently, these requirements relate to all handwritten, patient-specific documents, including orders, progress notes, surgical consents and reports, and consultation reports. Beginning Jan 1, 2005, compliance with these guidelines will be expected for all types of documentation media, including printed and electronic clinical and laboratory records. (1)

THE FIVE DO-NOT-USE ABBREVIATIONS

The five abbreviations that must not be used are abbreviations that can be ambiguous or confusing to clinicians, as well as some that have led to serious medication errors. The first abbreviation on the do-not-use list is the abbreviation "U" (ie, units). This abbreviation has been mistaken for a zero, a four, or even cc (ie, cubic centimeter). Consider a situation in which an order for insulin is written or transcribed as, "give 80 regular insulin." Such an order easily could be interpreted as "give 80 regular insulin," and the patient could be given a dose that is 10 times the dose intended. The Joint Commission recommends that "U" be written out as units to minimize the risk of misinterpretation errors. (1)

The second do-not-use abbreviation is "IU" (ie, international traits). This abbreviation can be misread as IV or 10. Such a misinterpretation could result in a patient inadvertently receiving a medication intravenously instead of by the intended route or receiving the wrong dose. (1) To avoid confusion, the abbreviation should be written out as international units.

The third set of abbreviations on the JCAHO do-not-use list includes "QD" (ie, every day) and "QOD" (ie, every other day). These abbreviations are commonly confused with each other and, in the case of QOD the "O" can be mistaken for an "I," indicating four times daily. If periods are used (ie, Q.D.) the period may be mistaken for an i. Such errors can result in administration of an overdose or inadequate dose of a medication; therefore, JCAHO recommends writing out the words daily or every other day. (1)

A common medication error relates to the use of a trailing zero (eg, 1.0) or lack of leading zero (eg, .1) when a decimal point is used, because the decimal point may not be seen. To prevent an error when using decimal points, JCAHO recommends never writing a zero by itself after a decimal point (eg, 1 mg) and always using a zero before a decimal point (eg, 0.1 mg).

The final set of do-not-use abbreviations are "MS," "MS[O.sub.4]," and "MgS[O.sub.4]." The Joint Commission recommends writing out morphine sulfate or magnesium sulfate to minimize the confusion related to abbreviations for these two medications.

THREE MORE OF THE FACILITY'S CHOOSING

In addition to these abbreviations, JCAHO requires each facility to include three additional abbreviations on their do-not-use list. In perioperative settings, a number of abbreviations may contribute to the potential for error. For example, use of the abbreviations "AS," "AD," and "AU"--left ear, right ear, both ears, respectively--and "OS," "OD," and "OU"--left eye, right eye, both eyes, respectively--in perioperative settings may lead to confusion about the laterality of eye or ear surgery or where to administer eye or ear drops. The Joint Commission recommends that clinicians write left ear, right ear, or both ears when referring to ears and left eye, right eye, or both eyes when referring to eyes. (1)

Another set of inconsistently used abbreviations are used to indicate "subcutaneous." The abbreviation "SC," can be mistaken for "SL" (ie, sublingual) and "SQ," can be mistaken as "5 every." Clinicians should write sub-Q, subQ, or subcutaneous instead.

Another abbreviation that can contribute to confusion is "cc," which can be mistaken for "U" if it is poorly written. The Joint Commission suggests using "mL" or "milliliters" instead. (1) These three examples of potentially confusing abbreviations, symbols, or dose designations are some that facilities may want to consider eliminating. (1)

The standard does not require hospitals to develop an approved list of abbreviations, but they must develop a do-not-use list. (1) Abbreviations on the do-not-use list should not be used in any format, including upper or lower case letters or with or without periods. The Joint Commission intends to assess compliance with this safety goal and related standards by reviewing patient care records and determining the degree of adherence to these recommendations.

Health Care Industry

Best practices for abbreviation use - Patient Safety First

AORN Journal, March, 2004 by Suzanne C. Beyea

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