Download Dangerous Abbreviations, Symbols and Dose Designations

Administrative
Manual
MHS
SMOL
Subject:
ABBREVIATIONS/ACRONYMS/SYMBOLS
Number: ADM-PHI-20
Section:
Personal Health Information/Privacy
Page 1 of 1
Initial Approval Date:
November 29, 2007
Review Date:
June 25, 2012
Revised Date:
June 25, 2009
Approved by: Senior
Leadership Team
Prepared by:
Patient Records Committee
Director, Quality & Risk Management
Policy Coordinator
Endorsed by:
Patient Records Committee – May 23, 2009
Professional Advisory Committee – June 19,
2009
Issued by:
Vice President of Finance, Information
Management and Chief Financial Officer
POLICY
Purpose:
The purpose of this policy is:
▪
To provide direction regarding the use of abbreviations/acronyms/symbols in the personal
health information (PHI) record, specifically to implement Institute for Safe Medication
Practice’s ‘Do Not Use’ list and list of ‘Error-Prone Abbreviations, Symbols, and Dose
Designations’.
▪
To define specific key documents in which abbreviations are prohibited and to discourage
their use throughout the remainder of the personal health information record to manage the
risk arising from the misinterpretation of abbreviations.
Policy Statement:
Drug names will not be abbreviated.
Drug names, dosage units, and directions for use will be written out fully without the use of
abbreviations, symbols, and dose designations in orders, computer-generated labels,
medication administration records, storage bins, shelf labels, and reprinted protocols.
Abbreviations, acronyms and symbols are not permitted in the following contexts and/or reports:
▪
▪
▪
▪
The recording of the final diagnosis or in the description of treatment procedures.
The discharge/front sheet or discharge summary.
The wording of consents.
Units of measurement must conform to the Metric System International (SI) units.
The use of abbreviations and/or acronyms is discouraged in the remainder of the personal
health information record. When an abbreviation is used, it must be preceded by the word(s)
fully written out, e.g. personal health information record (PHI) record. The abbreviation or
acronym can only be used in the same documentation event.
Administrative
Manual
MHS
SMOL
Subject:
ABBREVIATIONS/ACRONYMS/SYMBOLS Number: ADM-PHI-20
Section:
Personal Health Information/Privacy
Prepared by:
Patient Records Committee
Director, Quality & Risk Management
Policy Coordinator
Endorsed by:
Patient Records Committee – May 23, 2009
Professional Advisory Committee – June 19,
2009
Issued by:
Page 1 of 2
Initial Approval Date:
November 29, 2007
Review Date:
June 25, 2012
Revised Date:
June 25, 2009
Approved by: Senior
Leadership Team
Vice President of Finance, Information
Management and Chief Financial Officer
PROCEDURE
Step
Action
Responsibility
1.
Be aware of the Institute for Safe Medication Practices ‘Do
Not Use’ list (Appendix 1), and the ‘List of Error-Prone
Abbreviations, Symbols and Dose Designations’ (Appendix 2),
and do not use abbreviations, symbols and dose designations
in your practice.
All Clinicians
2.
Conduct a random audit of consent forms, description of
treatment procedures and discharge summaries, and
discharged and concurrent records on a quarterly basis for
each program and/or service.
3.
Audit all orders received for use of abbreviations listed in the
‘Do Not Use’ list. Contact physicians/nurse practitioner to
clarify the order before processing.
Pharmacy Staff
4.
Audit documentation in the client’s personal health information
record for the use of abbreviations, acronyms, and symbols.
Report findings to the Program/Team Manager.
Assigned Staff
5.
Distribute the findings to the Service Chiefs/Clinical Program
Directors/Leaders.
Patient Records &
Registration Services
6.
Document follow up and actions taken for instances of noncompliance to the policy, including coaching/mentoring/
information sharing/education.
Service Chiefs/
Clinical Program
Directors/Leaders
7.
Provide documentation of action taken to the Patient Records
Committee for reporting to the Professional Advisory
Committee
Service Chiefs/
Clinical Program
Directors/Leaders
Patient Records &
Registration Services
Step
Action
References:
Institute for Safe Medication Practices Canada ‘Do Not Use
Dangerous Abbreviations, Symbols and Dose Designations’
www.ismp-canada.org/dangerousabbreviations.htm
Institute for Safe Medication Practices Canada ‘ISMP’s List of
Error-Prone Abbreviations, Symbols, and Dose Designations’
www.ismp.org
Religious Hospitallers of Saint Joseph of the Hotel Dieu of
Kingston, Administrative Policy #2820 ‘Interprofessional
Documentation: Minimum Standards’
Cross-References:
Providence Care Clinical Practice Manual Policy and
Procedure #CLIN-PP-54 ‘Safety Reporting and Incident
Management’
Subject: ABBREVIATIONS/ACRONYMS/SYMBOLS
Procedure #ADM-PHI-20
Page 2 of 2
Responsibility
Providence Care
Abbreviations/Acronyms/Symbols
#ADM-PHI-20
Appendix 1
Do Not Use
Dangerous Abbreviations, Symbols and Dose Designations
The abbreviations, symbols, and dose designations found in this table have been reported as being frequently
misinterpreted and involved in harmful medication errors. They should NEVER be used when communicating
medication information.
Abbreviation
Intended Meaning
U
unit
IU
international unit
Abbreviations
for drug
names
QD
QOD
Every day
Every other day
OD
Every day
OS, OD, OU
Left eye, right eye, both
eyes
D/C
Discharge
cc
cubic centimetre
ISMP Canada July 2006
µg
microgram
Symbol
Intended Meaning
@
at
>
<
Problem
Mistaken for “0” (zero), “4” (four), or
cc.
Mistaken for “IV” (intravenous) or
“10” (ten).
Misinterpreted because of similar
abbreviations for multiple drugs;
e.g., MS, MSO4 (morphine
sulphate), MgSO4 (magnesium
sulphate) may be confused for one
another.
QD and QOD have been mistaken
for each other, or as ‘qid’. The Q
has also been misinterpreted as “2”
(two).
Mistaken for “right eye”
(OD = oculus dexter).
Correction
Use “unit”.
Use “unit”.
Do not abbreviate drug names.
Use “daily” and “every other
day”.
Use “daily”.
May be confused with one another.
Use “left eye”, “right eye” or
“both eyes”.
Interpreted as “discontinue
whatever medications follow”
(typically discharge medications).
Use “discharge”.
Mistaken for “u” (units).
Use “mL” or “millilitre”.
Mistaken for “mg” (milligram)
resulting in one thousand-fold
overdose.
Use “mcg”.
Potential Problem
Correction
Mistaken for “2” (two) or “5” (five).
Use “at”.
Greater than
Less than
Mistaken for “7”(seven) or the letter
“L” .
Confused with each other.
Use “greater than”/”more than”
or “less than”/”lower than”.
Dose
Designation
Intended Meaning
Potential Problem
Trailing zero
X.0 mg
Decimal point is overlooked
resulting in 10-fold dose error.
Never use a zero by itself after
a decimal point.
Use “X mg”.
Lack of
leading zero
. X mg
Decimal point is overlooked
resulting in 10-fold dose error.
Always use a zero before a
decimal point. Use “0.X mg”.
Correction
Adapted from ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations 2006
Report actual and potential medication errors to ISMP Canada via the web at
https://www.ismp-canada.org/err_report.htm or by calling 1-866-54-ISMPC. ISMP Canada
guarantees confidentiality of information received and respects the reporter’s wishes as to
the level of detail included in publications.
Institute for Safe Medication
Practices Canada
Institut pour l’utilisation sécuritaire
des médicaments du Canada
Permission is granted to reproduce material for internal communications with proper attribution. Download from: www.ismp-canada.org/dangerousabbreviations.htm
Appendix 2
Providence Care
Abbreviations/Acronyms/Symbols #ADM-PHI-20
Page 1 of 2
List of Error-Prone Abbreviations, Symbols, and Dose Designations
Abbreviations
AD, AS, AU
Intended Meaning
Misinterpretation
Correction
Right ear, left ear, each ear
Mistaken as OD, OS, OU
(right eye, left eye, each eye)
Use “right ear”, “left ear”, or “each ear”
BT
Bedtime
Mistaken as “BID” (twice daily)
Use “bedtime”
IN
Intranasal
Mistaken as “IM” or “IV”
Use “intranasal” or “NAS”
HS
Half-strength
Mistaken as bedtime
Use “half-strength” or “bedtime”
hs
At bedtime, hours of sleep
Mistaken as half-strength
qn
Nightly or at bedtime
Mistaken as “qh” (every hour)
Use “nightly” or “at bedtime”
q.o.d. or QOD**
Every other day
Mistaken as “q.d.” (daily) or “q.i.d.”
(four times daily) if the “o” is poorly
written
Use “every other day”
SC, SQ, sub q
Subcutaneous
SC mistaken as SL (sublingual);
SQ mistaken as “5 every”; the “q”
in “sub q” has been mistaken as
“every” (e.g. heparin dose
ordered “sub q 2 hours before
surgery” misunderstood as every
2 hours before surgery)
Use “subcut” or "subcutaneously”
Sliding scale (insulin) or ½
(apothecary)
Mistaken as “55”
Spell out “sliding scale”; use “onehalf” or “½ “
ss
Dose Designations
and Other
Information
Abbreviations such
as mg. or mL. with a
period following the
abbreviation
Large doses
without properly
placed commas
(e.g., 100000 units;
1000000 units)
Intended Meaning
Misinterpretation
Correction
The period is unnecessary and
could be mistaken as the number
1 if written poorly
Use mg, mL, etc. without a terminal
period
100,000 units
100000 has been mistaken as
10,000 or 1,000,000
1,000,000 units
1000000 has been mistaken as
100,000
Use commas for dosing units at or
above 1,000, or use words such as
100 “thousand” or 1 “million” to
improve readability
mg
ml
Symbols
Intended Meaning
Misinterpretation
Correction
For three days
Mistaken as “3 doses”
use “for three days”
Greater than and less than
Mistaken as opposite of intended;
mistakenly use incorrect symbol;
“<10” mistaken as “40”
Use “greater than” or “less than”
@
At
Mistaken as “2”
Use “at”
&
And
Mistaken as “2”
Use “and”
+
Plus or and
Mistaken as “4”
Use “and”
°
Hour
Mistaken as a zero (e.g., q2°
seen as q 20)
Use “hr”, “h”, or “hour”
x3d
> and <
Subject: ABBREVIATIONS/ACRONYMS/SYMBOLS
Procedure #ADM-PHI-20
Appendix 2
Page 2 of 2