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The Hospitalist. 2006 September;2006(09):

September 1, 2006 | The Hospitalist

In addition to this minimum list, each organization should consider which abbreviations, acronyms, symbols, and dose designations it commonly uses; examine the risks associated with usage; and develop strategies to reduce usage. Hospitals also may wish to look to expert resources such as the Institute of Safe Medication Practices (ISMP)—available at www.ismp.org/Tools/abbreviationslist.pdf—and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)—available at www.nccmerp.org/dangerousAbbrev.html—to develop a list of prohibited abbreviations. Finally, organizations may wish to consider the Joint Commission list (see table below) of abbreviations, symbols, and acronyms for future possible inclusion in the official “do not use” list.

The Most Commonly Reported Sentinel Events for Hospitals

The Joint Commission Sentinel Event Database reveals that 87% of the reported sentinel events occur in hospitals (including psychiatric hospitals). The top five sentinel events at general hospitals, reported between January 2001 and December 2005, are 1. Wrong site surgery; 2. Operative/post-operative complications; 3. Medication errors; 4. Delay in treatment; and 5. Falls.

Sentinel event-related data, reported to the Joint Commission from accredited organizations, demonstrates the need of the Joint Commission and accredited healthcare organizations to continue to address these serious adverse events. The data also support the importance of the National Patient Safety Goals and focusing energies on addressing serious errors within healthcare organizations.

Sentinel event statistics, including information about the root causes of specific events, and Sentinel Event Alert patient safety newsletters that offer practical strategies for avoiding specific types of events are available on the Joint Commission Web site: www.jointcommission.org. Click on the “Sentinel Events” tab for past issues and to sign for free issues of Sentinel Event Alert via e-mail.—WJ

A Comprehensive Effort

In addition to the Joint Commission National Patient Safety Goal, the Food and Drug Administration (FDA), ISMP, and National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) all encourage the avoidance of abbreviations in prescribing medications. The Joint Commission is also reaching out to medical schools and residencies to encourage avoidance of abbreviations, so that future physicians will not even have abbreviations in their skill set.

Risk Reduction Strategies

To comply with this National Patient Safety Goal Requirement, hospitals may wish to consider implementing the following risk reduction strategies:

Examine medication error data in the organization. By identifying and selecting an organization-specific set of prohibited abbreviations, it will be much easier to gain support to eliminate certain abbreviations that have been found to be problematic at that organization.
Provide simplified alternative abbreviations. For example, some staff members may resist writing out “international units” in place of “IU.” A simpler alternative such as “Intl Units” may be a solution.
Make the list visible. Print the list on brightly colored paper or stickers and place it in patient charts.
Provide staff with pocket-sized cards with the “do not use” list.
Print the list in the margin or bottom of the physician order sheets and/or progress notes.
Attach laminated copies of the list to the back of the physician order divider in the patient chart.
Send monthly reminders to staff.
Delete prohibited abbreviations from preprinted order sheets and other forms.
Work with software vendors to ensure changes are made to be consistent with the list.
Take a digital picture or scan the document containing the prohibited abbreviation and send it via e-mail directly to the offending prescriber to call attention to the issue.
Direct the pharmacy not to accept any of the prohibited abbreviations. Orders with dangerous abbreviations or illegible handwriting must be corrected before being dispensed.
Conduct a mock survey to test staff knowledge.
At every staff meeting give patient safety updates, including information about the prohibited abbreviations.
Ask all staff to sign a statement that he or she has received the list and agrees not to use the abbreviations.
Promote a “do-not-use abbreviation of the month” policy.
Develop and implement a policy to ensure that staff refer to the list and take steps to ensure compliance. Consider including a policy that states if an unacceptable abbreviation is used, the prescriber verifies the prescription order before it is filled.
Monitor staff compliance with the list and offer additional education and training, as appropriate.