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VOLUME 18 NO.5 MAY 2003
JCAHO NATIONAL PATIENT SAFETY GOALS - 2003 UNACCEPTABLE ABBREVIATIONS
Patient Safety Goal #2 requires organizations to standardize the abbreviations, acronyms, and symbols used throughout the organization including a list of abbreviations, acronyms, and symbols NOT to use. This JCAHO safety goal applies to ALL clinical documentation, including all types of orders, progress notes, consultation reports, and operative reports.
The Jamaica Hospital Medical Center Medical Board has approved the following list of unacceptable abbreviations:
Policy:
1) In order to reduce the use of error-prone abbreviations and confusing dose designations written on medication orders, and in the medical record, the following list of abbreviations and symbols will not be accepted.
2) Orders containing unacceptable abbreviations will be returned to the prescriber and a new order shall be written.
Do not use these dangerous abbreviations or dose designations
|
Abbreviation/Dose Expression |
Intended Meaning |
Misinterpretation |
Correction |
|
AD/AS/AU and OD, OS, OU |
Right ear, Left ear, both ears and Right eye, Left eye, both eyes |
Easily confused with OD, OS, OU (Right eye, Left eye, both eyes) and OD for daily |
Use "Right Ear, Left ear, both
ears and Right eye, Left eye, both eyes" |
|
cc |
Cubic centimeters |
Misread as "U" or add two "00" to the strength |
Use "ml" |
|
QD or q.d. |
Every day |
Mistaken as q.i.d., or QOD |
Use "daily" or every day |
|
QOD or q.o.d. |
Every other day |
Mistaken as QD, OD or q.i.d. |
Use "every other day" |
|
SQ or SC or sc |
Subcutaneous |
Mistaken for SL (sublingual) |
Use "subcutaneous" |
|
µg or mcg |
Microgram |
Mistaken for "mg" |
Use "Microgram" |
|
U or u |
International units, units |
Read as zero (0) or a four (4), potentially causing a 10-fold or more increase in dosage. (4u may be interpreted as "40" or "44") |
Use units |
PRESCRIBING, DISPENSING AND ADMINISTERING FORMULARY COMBINATION MEDICATIONS
The number of drugs available in fixed combination has increased over the past few years. In an effort to maintain continuity of care in a timely manner, the Pharmacy, Therapeutics and Nutrition Committee recommended and the Medical Board approved the following policy and procedure:
Policy:
When a combination medication is prescribed, and only the individual agents of that combination are available in the hospital formulary, the pharmacist shall dispense and nurse shall administer the individual agents that make up the combination product.
Procedure:
a) Physician/Prescriber: (Drug Ordering)
1) The physician/prescriber writes a medication order for a combination product with the knowledge that the individual agents in the combination will be dispensed separately.
2) All non-formulary medication orders for combination products shall be handled as a pharmacist intervention.
b) Pharmacist: (Drug Dispensing)
1) The pharmacist will enter the individual drugs on the patient profile and dispense them.
2) In addition, an auxiliary label will be affixed to the initially dispensed drugs to alert the medical and nursing staff.
c) Nurse: (Drug Administration)
The nurse will compare the auxiliary label with the individual drug labels and make the necessary notation on the medication administration record.
The following is a list of combination drugs for which the components are available in the JHMC hospital formulary and will be dispensed:
|
COMBINATION DRUG |
FORMULARY ALTERNATIVES DISPENSED |
|
ACCURETIC (Quinapril/Hydrochlorothiazide) 10/12.,5, 20/12.5, 20/25 |
ACCUPRIL (Quinapril) Hydrochlorothiazide |
|
ALDACTAZIDE (Spironolactone/Hydrochlorothiazide) 25/25, 50/50 |
Spironolactone Hydrochlorothiazide |
|
AVALIDE (Ibesartan/Hydrochlorothiazide) 150/12.5, 300/12.5) |
AVAPRO (Ibesartan) Hydrochlorothiazide |
|
AVANDAMET (Rosiglitazone/Metformin) 1/500, 2/500, 4/500) |
AVANDIA (Rosiglitazone) Metformin |
|
DIOVAN HCT (Valsartan/Hydrochlorothiazide) 80/12.5, 160/12.5, 160/25 |
DIOVAN (Valsartan) Hydrochlorothiazide |
|
GLUCOVANCE (Glyburide/Metformin) 1.25/250*, 2.5/500, 5/500 |
Glyburide Metformin |
|
HYZAAR (Losartan/Hydrochlorothiazide) 50/12.5, 100/25 |
COZAAR (Losartan) Hydrochlorothiazide |
|
Lopressor HCT (Metoprolol/Hydrochlorothiazide) 50/25, 100/25, 100/50 |
Metoprolol Hydrochlorothiazide |
|
MONOPRIL HCT (Fosinopril, Hydrochlorothiazide) 10/12.5, 20/12.5 |
MONOPRIL (Fosinopril) Hydrochlorothiazide |
|
PRINZIDE (Lisinopril/Hydrochlorothiazide) 10/12.5, 20/12.5, 20/25 |
Lisinopril Hydrochlorothiazide |
|
TENORETIC (Atenolol/Chlorthalidone) 50/25, 100/25 |
Atenolol Chlorthalidone |
|
ZESTORETIC (Lisinopril/Hydrochlorothiazide) 10/12.5, 20/12.5, 20/25 |
Lisinopril Hydrochlorothiazide |
*No equivalent available, treated as non-formulary drug
PATIENT SAFETY AND PREVENTING MEDICATION ERRORS
Numerous medication errors are prevented every day by healthcare practitioners who are diligent enough to fully investigate situations that “just don’t seem right,” even after there has been an initial confirmation by an authoritative source. Taking this “extra step” can often prevent patient harm.
When medication orders do not seem quite right, pharmacists, nurses, and physicians must take that “extra step” to verify an order before a medication is prescribed, dispensed, or administered to a patient. During orientation of new staff, and continuing education of current staff, we must instill the thought that the “reasons” cited below are unacceptable responses if an order is questioned. The following statements are not acceptable and should not dissuade anyone from performing additional follow-up to a questionable medication order.
· “That is what the doctor ordered”
· “The attending told me to order it that way”
· “The patient (or Mom) says that’s how they take it at home”
· “It was published in recent literature (journal reference cited)”
· “This is a special case”
· “The patient’s been titrated up to that dose”
· “The patient is on a protocol”
· “The dose is from the patient’s old chart”
· “It’s on the list of meds the patient gave me”
· “We always give it that way”
Source: ISMP Medication Safety Alert! July 11, 2001
|
MEDICATION ERROR PREVENTION TIP The following are some examples where physicians' orders are the cause or a contributing factor in medications errors: • Illegible orders • The use of ambiguous and dangerous abbreviations • The use of dangerous ways of expressing strengths • Incomplete orders • Verbal orders |
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