Old abbreviations now passe?

laurakoko · Nov 25, 2004

old habits die HARD. I get dinged on the QD thing!!! How can Q D be misread for something else??? Like I understand MSo4, could be MgSo4, magnesium.... but

Q D????????

Home Health Columnist / Guide · Nov 25, 2004

from institute for safe medication practices:

[color=#397574]u cnt abbrv "patient safety"

http://www.ismp.org/msaarticles/cntprint.htm

[color=#397574]hospital and medical staff leadership is key to compliance with jcaho dangerous abbreviation list

"the real issue here is that enforcement of prohibited abbreviations requires more than asking pharmacists or nurses to alert prescribers to lapses in compliance. it's a system-wide problem that requires peer-to-peer interaction along with full support from hospital and medical staff leadership. hospitals that have been working on this initiative relentlessly for years report that the most effective way to enforce physician compliance is to make it a physician-owned process.(1,2) when educational efforts failed to produce significant change, these hospitals pursued operational changes, such as preprinted orders, targeted pages, and email reminders, to initially improve compliance. then, after enacting a zero tolerance policy, medical staff leaders interacted with physicians who were non-compliant. pharmacists and nurses still played a role in collecting data about non-compliance, and even notifying individuals when there was a lapse in policy. but the medical staff stepped up to the plate and addressed all issues of repeated physician non-compliance." http://www.ismp.org/msaarticles/hospitalprint.htm

from jcaho:

implementation tips for eliminating dangerous abbreviations

we asked accredited organizations how they have implemented theprohibited abbreviations requirement for national patient safety goal 2b. we received more than 100 responses, including lots of good ways to share the list of prohibited abbreviations and to achieve consistent compliance. here's how some organizations are effectively communicating their prohibited abbreviations list to staff:

http://www.jcaho.org/accredited+organizations/patient+safety/05+npsg/tips.htm

the purpose of the joint commission's national patient safety goals is to promote specific improvements in patient safety. the goals highlight problematic areas in health care and describe evidence and expert-based solutions to these problems. recognizing that sound system design is intrinsic to the delivery of safe, high quality health care, the goals focus on system-wide solutions, wherever possible.

questions about the scoring, follow-up, and disclosure of non-compliance with the npsgs

2005 jcaho patient safety goals include:

goal: improve the safety of using medications.

remove concentrated electrolytes (including, but not limited to, potassium chloride, potassium phosphate, sodium chloride >0.9%) from patient care units.
standardize and limit the number of drug concentrations available in the organization.
identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used in the organization, and take action to prevent errors involving the interchange of these drugs.
[color=#dc143c]new: look-alike/sound-alike drug list

goal: accurately and completely reconcile medications across the continuum of care.

during 2005, for full implementation by january 2006, develop a process for obtaining and documenting a complete list of the patient's current medications upon the patient's admission to the organization and with the involvement of the patient. this process includes a comparison of the medications the organization provides to those on the list.
a complete list of the patient's medications is communicated to the next provider of service when it refers or transfers a patient to another setting, service, practitioner or level of care within or outside the organization.

goal: improve the effectiveness of communication among caregivers.

for verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the order or test result "read-back" the complete order or test result.
standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organization.
measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.

akcarmean, LPN · Nov 25, 2004

Thanks for the info

**canoehead, BSN, RN** · Nov 25, 2004

Why are nurses doing the PI, and taking responsibility for correcting the MD mistakes? Where in the hospital do you see one profession doing another's work, except for nursing? Are we just the hospital secretaries? And then the docs get annoyed when we point out the errors and tell us to fix them ourselves by writing verbals? I know at my hospital they had nurses attaching sticky notes and stamps to "remind" the docs to do their jobs, NOT telling the docs to darn well do their own work.

kim93079 · Nov 25, 2004

We not only were taught abbreviations but we had to test on them. We are also told only use approved ones and keep it short and sweet.

mcmike55 · Nov 25, 2004

We just had our "jay-co" visit, and am happy to say that we passed with flying colors!

However, we, as most of you, have been fighting about the list of now unapproved abbreviations.....you know, the ones that we grew up on, were tested on in school, and put our pt's lives on the line to read correctly each day.

I will be one of the first to agree that many, maybe most, of them are dangerous. You know hard to read, and don't make sense. That said, some I am very willing to get rid of. I have a problem with some basics like "cc"??

Ok, I know, depending on who writes it, it could be a problem, but COME ON!!

TAKE SOME RESPONSIBILITY TO WRITE PLAINLY!!!

At our hospital, we have a hit list of abbreviations not to use any more: cc, MSO4, OD, QD, BID, the list goes on and on.

But there on a surgical permit, the doc writes: LST for laparoscopic tubal ligation, or uses R OR L with (and without) a circle for left or right, which is not correct anymore. But, administration does not say anything to them.

WE DO, but as soon as the echo dies, it's over! :angryfire

I would like to see the rules applies all the way across the board, for all health care members. Docs, clean up your writing. You're busy, we're busy, but come on, this is for pt safety, and our licenses!

Does anybody think this is another sign of what I call "the dumbing down of society"? Spelling things completely out instead of using age old (fairly) standard abbreviations. Using pictures on drapes, instead of Put hands here.

Caution coffee hot (duh), don't drive with sunsreen in place on car windshield.

Come on people, take some responsibilty for your own actions!!!!

Wait, this is Thanksgiving, I don't need to be this riled up.

HAVE A GOOD ONE, EVERYBODY. :chuckle

4theBetterGetter, RN · Feb 1, 2005

stevierae[/size]]i just heard from a friend that, in nursing school nowadays, nurses are no longer taught things like "b.i.d." "q.i.d" "q6h" "h.s" and things like that--that, in fact, it is now required that, in nursing notes and even on the part of the physicians writing orders, that the actual phrase be written out--"twice a day" "evey 6 hours" or "at hour of sleep, before bedtime, or at 10 p.m." (choose the most appropriate)
have those of you who work med-surg noted this to be true on your post-op patients? if so, when did it all start, and do you know if it was a jcaho patient safety decision?
i am curious as to whether it affected other commonly used abbreviations, as well. for example, do the dosc now write "anti-embolic stockings" instead of simply "teds" and instead of writing "scds" do they actually write out "sequential compression devices?" do they write out "arterial blood gases" instead of "abgs?" "complete blood count" instead of cbc? just curious as to the exact rules, if any, involving this "no abbreviations" trend, and if it has changed your own charting practices.
i was reviewing a chart the other day in which "pas" was written on a line in which another order was crossed out. at first i thought it was the initials of the person who crossed out the order, but on closer inspection i saw that his initials were "pac."
since it was critical i know for sure what this meant, yet never having seen the term "pas" i called a nurse friend in the state in which the chart originated. she knew right away--it stood for "pneumatic antiembolic stockings." "whoda thunk it"--certainly not anybody in my neck of the woods. we call them scds or icds (intermittent compression devices) or simply "compression pumps" out here.
anybody else know them as "pas?"

don't know about pas ...we call em compression stockings...but yes we have to do away with the abbreviations too. has to do with med errors. it will take time to get used to it and change...there is that word again...old habbits but for the best i suppose.

Town & Country · Feb 6, 2005

The physicians are going to have to comply with this initiaitive just like everyone else in the health care field. If the physicians do not comply, Joint Commission will make life and fines on the hospital so significant that the hospitals will force physician compliance.

I'd like to know how many MED ERRORS have been caused by inability to decipher sloppy MD orders vs. these (IMO) legitimate abbreviations.

(yes I know, we clarify any orders that are not clear, but we also live in the real world and I daresay errors caused by physician chicken-scratching is 100:1 vs. the abbreviations. Just another example of nurses being the patsy.) :rolleyes:

NancyJo · Apr 27, 2005

We are no longer allowed to use QD, MS, MS04, U FOR UNITS, CC, QD, QOD. Our pharmacy also rejects the orders and sends a note to our secretary who is suppose to forward it on to us. We then are suppose to call the Doc for clarification orders also. It seems like all I did before was call Docs and now we have a whole new list of calls to make. Forget pt. care, I can't get off the phone long enough to do any some days. Anyway Have been told that the abbreviation thing is a JCAHO thing. Think of me over the next few days JCAHO arrived today and as always everyone has went ape, over the deep end and are at each others throats and this only day one. Geez! :uhoh3:

barefootlady, ADN, RN · Apr 27, 2005

I think I have answered this question before, but here goes again. If I know the doctor meant everyday and has written QD, I just rewrite the order, place a tab for signature on the side of the sheet, sign the order off and make sure he signs it on the next rounds. You are right when you say a nurse could be on the phone all day just trying to get the rewrite of orders done just the way pharmacy and JCAHO demand without ever doing a thing for the patients. The doctors I worked with were very grateful I did not bother them with this type of call and always signed the rewrite. Now, if I could not read it, was not sure what the doctor wanted, or something else was wrong I went ahead and called the doctor for clarification. We are nurses and we do need to use some common sense in these matters.

NancyJo · Apr 28, 2005

Agree with you barefootlady. I guess my post looked like all I do is talk on the phone when i meant that is all I would do. I like you rewrite the order and flag them for the Doc, and yes they do appreciate that. I do work with a couple who when we first started this were calling all the time and getting reamed, because they felt it was the only way the Docs would quit writing them. Guess what it didn't work, we're still rewriting alot of orders.

nightmare, RN · Jul 19, 2007

I've lost count of the number of times I've corrected a hastily rewritten drug prescription sheet that one of my collegues has written mg.instead of mcg especially for levothyroxine. I had to have a doctor translate what he had written for a patient last night because I couldn't read it! :nono: