unacceptable abbreviations - compliance problems

[luvbug9956]

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!

[txspadequeenRN, BSN, RN]

Yes yes yes, this has caused a big deal for me. I had just learned to stop using military time then they throw this at me. NO u, qd, bid, qid, qod thanks to JAHCO.:angryfire

[plumrn, BSN, RN]

We are having a rough time with this also. Some of the doctors are trying hard to get it right. Some of the others aren't even trying. We nurses get stuck with having to rewrite their orders or pharmacy won't fill them. When we catch a doctor using the outlawed abbreviations, we tell them right there to fix it. Most of the time they are gone before we catch the error(s). We get upset with pharmacy calling us all day to fix the docs orders, but then again they are just doing their job, and helping us to keep right with the surveyors.

[becksgr]

actually under the new guidelines there is to be no abbreviations used for meds, ie KCL MOM HCTZ MgSO4 etc Pain in the rump that JCAHO business :angryfire

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.

[flashpoint]

A lot of the reason for the change is that there have been errors made because of abbreviations that look similar and because of sloppy handwriting. CC can look like 11, MgSO4 and MSO4 have been confused, and U for units can look like a number of different things. We had an order for sliding scale insulin on a patient who ended up getting 24 units of regular instead of 2 because the doctor's U looked like a 4...the error went on for 5 days before a nurse caught it. We no longer let med aides give insulin and we banned U before JACHO did...

I agree it's a huge pain in the butt, but if hospitals want to keep their accreditation, we have to do it.

[berry]

just one more example working towards the lowest comman denominator, If someone cant understand 2gtt OU maybe they should not be putting anything in somebody's eyes, or if a nurse honestly thinks a order says MgSO4 4mg IV prn for pain is right they need to stay as far away from pts as possible.

The best way to get mds to comply i found was to let the MD who serves a QA for the md group who work in my ER and pointed out the list with JACHO's note about chart failure and then he made it clear to the rest of the group that any chart going to court with those abb. would have a hard time standing up to a lawyer and would have 0 ground to stand on if a med error was made. They are all trying we still get a few that are wrong but hell I still forget to write out R/L eye everytime

[flashpoint]

We all know that most of the rules are because someone somewhere made an error because there wasn't a rule for it or against it...then some judge or jury ruled against the person who made the error in the first place. We have rules like, "At no time, shall all drawers on a filing cabinet be pulled out at the same time," and "Throwing of scissors, scalpels, needles, etc is not allowed under any circumstance," because someone hurt her back trying to hold up a falling file cabinet and someone got cut trying to catch a flying scalpel...most of the stupid rules and common sense rules are in place to avoid lawsuits and to protect the institution from people who shouldn't be there in the first place...but...

If we want to maintain accreditation, the rules must be followed...sigh.

[husker-nurse, LPN, LVN]

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 and the nursing supervisor said "well, he does it all the time." and would not let her call and clarify the order.

As far as I'm concerned, any doc that refuses to clarify his written order would get the "WDDU" (write da doc up) tx.

[barefootlady, ADN, RN]

Personally, that supervisor would be giving that med since she "knows" what that abbrev. means. I would be doing a little writing up of her too.