Preventing Errors By Eliminating Mistake-Prone Abbreviations
Beth Ulrich, EdD, RN, CHE, FAAN, Editor

Abbreviations can be time savers when they are clear and their meanings are universally understood; but they can also cause errors that are sometimes fatal. We have long recognized illegible handwriting to be a major culprit in written orders and notes. While healthcare organizations are increasingly moving to computerized medical records as one way of attacking this problem, many organizations continue to use manual systems. The use of abbreviations has been found to contribute to errors in both computerized and manual entry systems.

Standardizing Abbreviations
In 2000, the Institute of Medicine  (IOM) report, To Err Is Human: Building a Safer Health System, brought needed attention to the issue of medication errors, noting that such errors had been found to account for about 7,000 deaths per year. In 2004, The Joint Commission introduced the “Do Not Use” list of abbreviations as part of its National Patient Safety Goal Requirements. These “do not use” abbreviations have continued to be a part of the annual National Patient Safety Goal Requirements. The requirement, which applies to all orders and all medication-related documentation when handwritten or entered as free text into a computer as well as to preprinted forms, states that healthcare organizations “Standardize a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization” (The Joint Commission, 2007a). The current list of Do Not Use abbreviations as well as the list of additional abbreviations, acronyms, and symbols that are proposed for possible future inclusion in the Do Not Use list can be found in Table 1 (The Joint Commission, 2007b).

A recent study, The Impact of Abbreviations in Patient Safety, examined the content, source, and impact of medication abbreviation errors (Brunetti, Santell, & Hicks, 2007). The study, which reviewed medication errors reported from 2004 to 2006 to a national medication error reporting system used by 682 facilities, found almost 30,000 medication errors attributable to abbreviations. The most frequent error related to abbreviations was the use of “qd,” which accounted for 43.1% of all errors. The other most common errors found were using “U” for units, “cc” for mL, “MSO4” or “MS” for morphine sulfate, and decimal errors. The large majority (81%) of the errors occurred during prescribing. Based on the results of this study, the researchers recommended that the Joint Commission’s Do Not Use list be expanded to include drug name abbreviations (such as PCN, DCN, TCN), stem abbreviations (amps, nitro, succs), m (mcg), cc (mL), and dose scheduling (BID, TID, QID).�

NNJ’s Policy on Abbreviations
Nephrology nurses can increase patient safety by not using these abbreviations themselves and by influencing others to not use them. The Nephrology Nursing Journal has implemented a policy of not using the abbreviations on the Joint Commission’s current “Do Not Use” list for medications and laboratory values as well as not using abbreviations which have been found to or are likely to increase errors. In the interest of patient safety, we encourage you to do the same.

Beth Ulrich, EdD, RN, FACHE, FAAN
Editor
E-mail: BethUlrich@aol.com