AORN Guidance Statement “Do-Not-Use” Abbreviations, Acronyms by t354gt


									  AORN Guidance Statement: “Do-Not-Use” Abbreviations,
           Acronyms, Dosage Designations, and Symbols

                      Preamble                                   centers, preanesthesia and postanesthesia care
                                                                 units, cardiac catheterization departments,
Confusing or easily misinterpreted abbreviations,                endoscopy suites, radiology departments, and all
acronyms, or symbols put caregivers at risk for                  other areas where operative and other invasive pro-
making errors and compromising patient safety.                   cedures may be performed. Patient safety in the
Unintentional as an error may be, a misplaced dec-               perioperative setting may be improved by focusing
imal point, a “U” interpreted as a “0” (zero), QOD               on communication among caregivers through the
confused for QID, or AS misinterpreted as OS puts                creation of a standardized list of “do-not-use”
patients at risk for medical error with potential cat-           abbreviations, acronyms, and symbols.
astrophic results (eg, overdose, inadequate dose,                    Effective Jan 1, 2004, the Joint Commission on
omission due to laterality error, wrong medication               Accreditation of Healthcare Organizations (JCAHO)
administered, error in frequency of administration).             developed a list of dangerous abbreviations,
Improving communication through reducing and                     acronyms, and symbols that are not to be used within
standardizing abbreviations, acronyms, and sym-                  accredited health care facilities (Table 1). This
bols is a significant step toward reducing the                   requirement is intended as a means to improve com-
occurrence of errors related to the inability to                 munication among caregivers (see National Patient
accurately read and interpret written medical                    Safety Goal #2).1 The Joint Commission’s minimal list
orders and transcribed verbal orders.                            of required do-not-use abbreviations, acronyms, and
   The purpose of this guidance statement is to                  symbols is the beginning of a process to assist organi-
heighten the awareness of perioperative registered               zations with the expansion of their error-prevention
nurses concerning the dangers associated with the                programs to improve safety for patients. The Joint
use of abbreviations, acronyms, and symbols, with                Commission recommends that organizations limit the
the goal of eliminating their use in health care doc-            use of abbreviations initially by eliminating nine spe-
umentation. All perioperative settings should                    cific error-prone abbreviations from health care doc-
address the issue of error-prone abbreviations.                  umentation. Seven additional error-prone abbrevia-
These practice settings include, but are not limited             tions, acronyms, or symbols will be reviewed on an
to, hospital operating rooms, ambulatory surgery                 annual basis for inclusion on the official do-not-use

Table 1
               Do Not Use                               Potential Problem                          Use Instead
U (for unit)                               Mistaken for “0” (zero), the number “4”      Write “unit”
                                           (four), or “cc.”
IU (for international unit)                Mistaken for IV (intravenous) or the         Write “International Unit”
                                           number 10 (ten).
Q.D., QD, q.d., qd (daily)                 Mistaken for each other. The period after    Write “daily”
Q.O.D., QOD, q.o.d., qod (every other day) the Q can be mistaken for “I” and the        Write “every other day”
                                           “O” mistaken for “I.”
Trailing zero (X.0 mg)*                      Decimal point is missed.                   Write X mg
Lack of leading zero (.X mg)                                                            Write 0.X mg
MS                                           Can mean morphine sulfate or magne-        Write “morphine sulfate” or
MSO4 and MgSO4                               sium sulfate; confused for one another.    “magnesium sulfate.”

    1. Applies to all orders and all medication-related documentation that is handwritten (including free-textcomputer
entry) or on preprinted forms.
*Exception: A “trailing zero” may be used only where required to demonstrate the level of precision of the value being
reported, such as for laboratory results, imaging studies that report size of lesions, or catheter/tube sizes. It may not be
used in medication orders or other medication-related documentation.
Reprinted with permission from Joint Commission on Accreditation of Healthcare Organizations,
/accredited+organizations/patient+safety/06_dnu_list.pdf (accessed 31 Jan 2006).

2006 Standards, Recommended Practices, and Guidelines                                                                 239
Do-Not-Use Abbreviations

Table 2
            Do Not Use                           Potential Problem                      Use Instead
> (greater than)                       Misinterpreted as the number “7”     Write “greater than”
< (less than)                          (seven) or the letter “L.”           Write “less than”
                                       Confused for one another.
Abbreviations for drug names           Misinterpreted due to similar        Write drug names in full
                                       abbreviations for multiple drugs
Apothecary units                       Unfamiliar to many practitioners.    Use metric units
                                       Confused with metric units.
@                                      Mistaken for the number “2” (two). Write “at”

cc                                     Mistaken for U (units) when poorly Write “mL” or “milliliters”
µg                                     Mistaken for mg (milligrams), result- Write “mcg” or “micrograms”
                                       ing in one thousand-fold overdose.
Reprinted with permission from Joint Commission on Accreditation of Healthcare Organizations,
/accredited+organizations/patient+safety/06_dnu_list.pdf (accessed 31 Jan 2006).

list. Implementing this change in practice keeps an         (NCCMERP), to be considered annually as potential
organization on a trajectory focused on patient safety      error-prone abbreviations to be included on the
as a number-one priority.                                   official do-not-use list.
                                                               Furthermore, AORN strongly recommends con-
            Guidance Statement                              sideration be given to the selection of problem-
                                                            prone, high-risk, high-volume abbreviations,
AORN recommends that all perioperative settings             acronyms, and symbols unique to the perioperative
implement the Joint Commission’s National Patient           practice setting when augmenting the minimally
Safety Goal #2, adopt the minimum required list of          required list of do-not-use items. At a minimum,
do-not-use abbreviations, educate perioperative regis-      abbreviations related to laterality should be elimi-
tered nurses regarding the removal of these items           nated from all documentation within the perioper-
from all health care documentation, and monitor             ative setting (Table 3).
compliance with this activity. Table 1 represents the          Further sources of information to help guide in
Joint Commission’s official list of do-not-use abbrevia-    the selection of do-not-use items may be derived
tions, acronyms, and symbols, published Jan 1, 2004.        from a review of problem-prone, high-risk, high-vol-
    The minimum required list is the first step in ful-     ume abbreviations, acronyms, and symbols found
filling JCAHO’s National Patient Safety Goal #2.            within handwritten, preprinted, and electronic forms
With the goal of eliminating all abbreviations from         of perioperative communication, such as
the health care setting, the Joint Commission is               ♦ surgical procedure list,
encouraging, but not mandating, each organization              ♦ surgeon preference or procedure cards,
to voluntarily expand the above list with the addi-            ♦ perioperative documentation (ie, preopera-
tion of the do-not-use abbreviations, acronyms, and                tive, intraoperative, postoperative),
symbols identified as possible future inclusions to            ♦ progress notes,
the “Official ‘do not use’ abbreviations list.” Items          ♦ specimen labeling,
in Table 2 have been identified by the Joint Com-              ♦ consent,
mission, in concert with the Institute for Safe Med-           ♦ history and physical,
ication Practice (ISMP), United States Pharmacope-             ♦ surgical schedules,
cia (USP), and the National Coordinating Council               ♦ staff orientation and competency materials, and
for Medication Error Reporting and Prevention                  ♦ patient teaching materials.

 240                                                        2006 Standards, Recommended Practices, and Guidelines
                                                                                 Do-Not-Use Abbreviations

Table 3
                                                                      ISMP Medication Safety Alert 8 (Nov 27, 2003). Also
               AORN RECOMMENDATIONS                                   available at
Error-Prone             Potential              Preferred              .pdf or
Abbreviation            Problem                  Term                 (accessed 8 Sept 2005).
                                                                  Joint Commission on Accreditation of Healthcare Organiza-
   L, R, Bil     Illegibility leads to     Write out “left,”          tions. “Medication errors related to potentially danger-
                 confusion related to      “right,” and               ous abbreviations,” Sentinel Event Alert 23 (September
                 correct identification    “bilateral”                2001). Also available at
                 of laterality                                        news+letters/sentinel+event+alert/sea_23.htm (accessed
                                                                      8 Sept 2005).
                                                                  “New Joint Commission ‘do not use’ list: Abbreviations,
    Another strategy to improve communication                         acronyms, and symbols,” American Academy of Physi-
among caregivers is a process to ensure that the                      cal Medicine and Rehabilitation,
signatures of the provider initiating the medical                     /hpl/pracguide/jcahosymbols.htm (accessed 7 Sept
order and the caregiver transcribing the verbal                       2005).
                                                                  “Recommendations to enhance accuracy of prescription
order are legible. AORN suggests that all health                      writing,” (adopted Sept 4, 1996, revised June 2, 2005)
care providers use block print and sign their names                   National Coordinating Council for Medication Error
to all written and verbal orders. The extra step of                   Reporting and Prevention (NCCMERP), http://www
block-printing the name affords the caregiver an             (accessed
opportunity to contact the provider if a question,                    8 Sept 2005).
concern, or issue were to arise related to the writ-
                                                                  Implementation/Staff Education
ten order. If the caregiver is unable to read the writ-           Beyea, S C. “Best practices for abbreviation use,” AORN
ten order, confusion or misinterpretation could                      Journal 79 (March 2004) 641-642.
result and lead to an adverse patient event.                      “Five dangerous medical abbreviations,” Ohioans First,
    This guidance statement reflects suggested minimal     
requirements to promote safety in patient care. It is not            (accessed 7 Sept 2005).
                                                                  “Implementation tips for eliminating dangerous abbrevi-
to be considered an all-inclusive listing of error-prone             ations,” Joint Commission on Accreditation of Health-
abbreviations, acronyms, dosage designations, or sym-                care Organizations,
bols. It is the responsibility of the health care practi-            +organizations/patient+safety/05+npsg/tips.htm
tioner, in concert with the patient care organization, to            (accessed 8 Sept 2005).
ensure that documentation clearly and unambiguously               “Maximizing patient safety in the medication use
                                                                     process: Practice guidelines and best demonstrated
reflects the individualized treatment of the patient.                practices,” Wisconsin Patient Safety Institute,
NOTES                                                                Saft_2002.pdf (accessed 31 Jan 2006).
    1. “National patient safety goals,” Joint Commission          “Patient safety program,” US Department of Defense,
on Accreditation of Healthcare Organizations, http://www    (accessed 7 Sept                 2005).
(2004) and          “Preventing medical errors: More on dangerous abbrevia-
/patient+safety/npsg.htm (2005–2006) (accessed 7 Sept                tions,” Patient Safety News, Show #25, March 2004, US
2005).                                                               Food and Drug Administration, http://www.accessdata
    2. “Official ‘do not use’ list,” Joint Commission on    /psn/transcript.cfm?show=25
Accreditation of Healthcare Organizations, http://www                (accessed 31 Jan 2006).        Regional Medication Safety Program for Hospitals: Health
(accessed 7 Sept 2005).                                              Care Improvement Foundation. Medication Safety Solu-
                                                                     tions Kit, information available from Delaware Valley
RESOURCES                                                            Healthcare Council,
                                                                     /details.asp?ID=CQe3RU219Ngec94UQJ3g. Also avail-
Abbreviations Lists                                                  able from ECRI, /products_and
Hicks, R W; Cousins, D D; Williams, R L. Summary of                  _services/products/medication_safety/medsafety
    Information Submitted to MEDMARX in the Year                     brochure.pdf (accessed 7 Sept 2005).
    2002: The Quest for Quality (Rockville, Md: US Phar-
    macopecia Center for the Advancement of Patient
    Safety, 2003) 41-44.                                          Approved by the AORN Board of Directors,
Institute for Safe Medication Practices. “ISMP’s list of error-   November 2005. Scheduled for publication in the
    prone abbreviations, symbols, and dose designations,”         AORN Journal in 2006.

2006 Standards, Recommended Practices, and Guidelines                                                                 241

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