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MEDICATION RELATED DANGEROUS ABBREVIATIONS, SYMBOLS C.43 AND DOSE DESIGNATIONS CASA IS COMMITTED TO IDENTIFYING AND IMPLEMENTING A LIST OF ABBREVIATIONS, SYMBOLS AND DOSE DESIGNATIONS DEEMED DANGEROUS, THAT WILL NOT BE USED IN MEDICATION-RELATED DOCUMENTATION. INTENT AND INTERPRETATION The use of some abbreviations, symbols and dose designations has been identified as an underlying cause of serious, even fatal medication errors. Patient safety will be improved by eliminating the use of these abbreviations, symbols and dose designations. This policy does not apply to Laboratory Results. Laboratory results will need to follow its applicable standards of accreditation. PROCEDURE 1. Dangerous Abbreviations, Symbols and Dose Designation List The Institute for Safe Medication Practices Dangerous Abbreviations, Symbols and Dose Designations List (Appendix A) applies to all Medication-Related Documentation in the following circumstances: a. When hand written or entered as text into a computer; and b. On any pre-printed forms or labels related to medication use. 2. Responsibility CASA shall update the Dangerous Abbreviations, Symbols and Dose Designation List (Appendix A) at an interval not to exceed three years; and, a. Nursing staff and physicians will be educated at orientation and when changes are made to the policy. 3. Definitions Medication-Related Documentation are those portions of the clinical record that contain medication names, symbols, dosages or other medication information. These include, but are not limited to the following: Medication orders Progress notes Medication administration record Protocols, standards, or guidelines Authorized Signature: Original signed by Denise Milne CASA Chief Executive Officer Prescriptions Discharge summaries Labels Consultation reports Effective Date: Cancels & Supersedes: Date of Last Review: March 4, 2014 October 4, 2013 February 2014 APPENDIX A Institute for Safe Medication Practices – Dangerous Abbreviations a SPECIAL ISSUE - do not use these dangerous abbreviations or dose designations – 2013 update Abbreviation/Dose Expression Intended Meaning Misinterpretation Correction Apothecary symbols dram minim Misunderstood or misread (symbol for dram misread for “3” and minim misread as “mL”). Use the metric system. AU aurio uterque (each ear) Mistaken for OU (oculo uterque each eye). Don’t use this abbreviation. discharge discontinue Premature discontinuation of medications when D/C (intended to mean “discharge”) has been misinterpreted as “discontinued “when followed by a list of drugs. D/C Use the complete spelling for drug names. Drug names ARAºA vidarabine cytarabineARAºC AZT zidovudine (RETROVIR) azathioprine CPZ COMPAZINE (prochlorperazine) chlorpromazine DPT DEMEROLPHENERGANTHORAZINE diphtheria-pertussistetanus (vaccine) HCl hydrochloric acid potassium chloride (The “H” is misinterpreted as “K.") HCT hydrocortisone hydrochlorothiazide HCTZ hydrochlorothiazide hydrocortisone (seen as HCT250 mg) MgSO4 magnesium sulfate morphine sulfate MSO4 morphine sulfate magnesium sulfate MTX methotrexate mitoxantrone TAC triamcinolone tetracaine, ADRENALIN,cocaine ZnSO4 zinc sulfate morphine sulfate Abbreviation/Dose Expression Use “discharge” and “discontinue.” Intended Meaning Misinterpretation Correction Stemmed names “Nitro” drip nitroglycerin infusion sodium nitroprusside infusion “Norflox” norfloxacin NORFLEX mg microgram Mistaken for “mg” when handwritten. Use “mcg.” once daily Misinterpreted as “right eye” (OD”oculus dexte”)and administration of oral medications in the eye. Use “daily.” TIW or tiw three times a week. Mistaken as “three times a day.” Don’t use this abbreviation. per os orally The "os”can be mistaken for “left eye.” Use “PO,” “by mouth,” or “orally." o.d. or OD Abbreviation/Dose Expression Intended Meaning Misinterpretation Correction q.d. or QD every day Mistaken as q.i.d., Use “daily”or “every day.” especially if the period after the “q” or the tail of the “q” is misunderstood as an “i.” qn nightly or at bedtime Misinterpreted as “qh”(every hour). Use “nightly.” qhs nightly at bedtime Misread as every hour. Use “nightly.” q6PM, etc. every evening at 6 PM Misread as every six hours. Use 6 PM “nightly.” q.o.d. or QOD every other day Misinterpreted as “q.d.” Use “every other day.” (daily) or “q.i.d.”(four times daily) if the “o” is poorly written. sub q subcutaneous The “q” has been mistaken Use “subcut.” or write “subcutaneous.” for “every”(e.g., one heparin dose ordered “sub q 2 hours before surgery misunderstood as every 2 hours before surgery). SC subcutaneous Mistaken for SL (sublingual). Use "subcut.” or write "subcutaneous." U or u unit Read as a zero (0) or a four (4), causing a 10-fold overdose or greater (4U seen as “40” or 4u seen as “44”). IU international unit Misread as IV (intravenous). Use units. cc cubic centimeters Misread as “U” (units). Use “mL.” x3d for three days Mistaken for “three doses.” Use for three days. BT bedtime Mistaken as “BID” (twice daily). Use “bedtime." ss sliding scale (insulin) Mistaken for “55.” or ½ (apothecary) > and < greater than and less than / (slash mark) separates two doses Misunderstood as the Do not use a slash mark to separate doses. or indicates “per” number 1 (“25 unit/10 units” read as “110” units. Use “per” Name letters and dose numbers run together (e.g., Inderal40 mg) Inderal 40 mg Misread as Inderal 140 mg. Always use space between drug name, dose and unit of measure. Zero after decimal point (1.0) 1 mg Misread as 10 mg if the decimal point is not seen. Do not use terminal zeros for doses expressed in whole numbers. No zero before decimal dose (.5 mg) 0.5 mg Misread as 5 mg. Always use zero before a decimal when the dose is less than a whole unit. “Unit” has no acceptable abbreviation. Use “unit.” Spell out “sliding scale.” Use “one-half” or use “½.” Mistakenly used opposite of Use “greater than” or “less than.” intended.