unacceptable abbreviations - compliance problems

ayndim · Jul 23, 2004

Where I work, a list has circulated of unacceptable abbreviations. Among them...U (must write units), MgSO4 and MSO4 (must write out morphine or mag sulfate), and must use mcg for microgram. I believe this to be excellent policy. However, the hospital has also deemed QD unacceptable...doc must write out "every day". Also a good policy. However, there is a huge deal with the docs not complying, especially with the QD policy. Each time this is written in the record, the order cannot be carried out until clarified verbally, and the doc must come rewrite. It makes a lot of extra work for the nurses, who must call frequently during the day! Has anyone also had this problem in their facility, and how was it handled? This will be a problem for us only for a few more months, as we are going computerized! But it is still a time-consuming issue!

Why on earth did we take chemistry then? I am still a student but I thought one reason we took it was so that we would recognize those abbreviations.

barefootlady, ADN, RN · Jul 23, 2004

This has been an ongoing problem at many of the hospitals here. The doctors are not going to change, they write orders just like they wrote them for years, we called and called, we informed them they were supposed to rewrite these orders, and that meds/tx could not be done until orders were clarified. Finally, we just started rewriting the orders ourselves, noting them and using a sticky tab for the docs to sign when they made rounds. Not a one of them got huffy or angry with the nurses who did this. In fact, they said thanks more than once, since it cut down on the calls to them and allowed them to continue to ignore a policy change they said they did not support. I generally support the complete writing of orders, it cuts down on mistakes and meds and treatments are spelled out so there should be a clear understanding of want is ordered. I do not understand why CC was banned. CC=ML was taught for years, why now is it not acceptable? That has been the only change that has been hard for me to comply with.

Home Health Columnist / Guide · Jul 23, 2004

see the institue for safe medication practice website: www.ismp.org

prescribers should avoid the use of abbreviations including those for drug names as they can frequently misunderstood.

it's been over 2 years since we published a list of abbreviations, symbols,and dose designations that have contributed to medication errors. now,with the 2004 jcaho national patient safety goals calling for organizational compliance with a list of prohibited "dangerous" abbreviations, acronyms and symbols, we thought an updated list would be useful.

since jcaho has specified that certain abbreviations must appear on the organization's list, we've highlighted these items with a double asterisk (**). also, effective april 1, 2004, each organization must include at least three additional items on their list. however, we hope that you will consider others beyond the minimum jcaho requirement. selections can be made from the attached list. these items should be considered for handwritten, preprinted, and electronic forms of communication.

[color=#606420]ismp list of error-prone abbreviations, symbols, and dose designations

ismp's list of high-alert medications

what drug names are frequently confused?

http://www.usp.org/patientsafety/briefsarticlesreports/qualityreview/qr762001-03-01.html

Tweety, BSN, RN · Jul 23, 2004

Why on earth did we take chemistry then? I am still a student but I thought one reason we took it was so that we would recognize those abbreviations.

No all chemical abbreiviations are on the list. Just those like morphine sulfate that can be confused with mag sulfate. We can still use KCL and NA, etc.

Those policies are put into place to avoid errors because handwriting is sloppy or the transcribers eyes playing tricks on them. I've seen QID orders transcribed as QOD, and QD orders written as QID. Better to have it spelled out than guess.

Thankfully, we don't have to call to clarify, that does sound like a lot of work. But perhaps over time the docs will get it into their head to follow the policy after being bothered a number of times.

KacyLynnRN · Jul 23, 2004

This has been a problem at the hospital where I work too...the docs have picked up on most of the abbreviations except occasionally still write out QD instead of "every day" or "daily" and U for units. The nice thing is, all the nurses on my floor got together and threw a FIT in our staff meeting, because we were wasting SOOOOO much time calling docs back to clarify orders and have them come to rewrite...now they changed the policy, and the pharmacist has to call the doc! Woo-hoo! There IS justice in the world!! :chuckle

ayndim · Jul 23, 2004

No all chemical abbreiviations are on the list. Just those like morphine sulfate that can be confused with mag sulfate. We can still use KCL and NA, etc.
Those policies are put into place to avoid errors because handwriting is sloppy or the transcribers eyes playing tricks on them. I've seen QID orders transcribed as QOD, and QD orders written as QID. Better to have it spelled out than guess.
Thankfully, we don't have to call to clarify, that does sound like a lot of work. But perhaps over time the docs will get it into their head to follow the policy after being bothered a number of times.

Thanks for clarifying. Makes me happier about taking chem over the summer. :chuckle Really I know that there must be other reasons we need chem too.

jemb · Jul 23, 2004

My only gripe about writing things out instead of abbreviating is that the space for us to write is only about this big !

cnyrn · Jul 23, 2004

I am more concerned over MD writing order that is illegible and vague, requires 3 nurses and ward clerk to decipher, then a follow up phone call verify and clarify. MD gets annoyed, we say "if we could read your orders....."

Next day, same old, same old.

seanymph · Jul 23, 2004

We were just talking of this last night at work and one nurse said she received a pt. from ED and the physician wrote to give a medication "UDT" and she could not figure out what it meant. The nursing supervisor happen to be sitting there and so she asked her and she said it means "under da tongue". The nurse couldn't believe it and told her that it was not appropriate :nono: and the nursing supervisor said "well, he does it all the time." and would not let her call and clarify the order. :eek:

Havin' A Party!, ASN, RN · Jul 23, 2004

... more concerned over MD writing order that is illegible and vague, requires 3 nurses and ward clerk to decipher...

Yep!

Hahahahahahahahahahahahahahahahahaha!

mattsmom81 · Jul 23, 2004

No way will I call a doctor back to clarify an order I understand perfectly..this is just a waste of MY time. I will rewrite it, but if pharmacy wants the doctor called THEY can call and remedy it. I tire of other depts dictating our job.

It is hard to undo 30 some years of writing orders; I have trouble remembering the new rules too. Nor have I seen many errors 'just' due to these abbreviations alone.... errors are due to multiple factors, IMO.