WhiteCoat

Do Not Use These Medical Abbreviations!

I’m about fed up with the chart police dinging me for writing “unapproved abbreviations.” This whole “Do Not Use List” is another Medical Marijuana Advocates idea that has just gone too far.

  • I can’t write “U” anymore because it could be mistaken for any of the following: “0,” “4” or “cc”
  • I can’t write QD or QOD because the period after the Q might be mistaken for an “I” and the “O” might be mistaken for an “I”
  • I can’t write “MS” for morphine sulfate because someone might confuse it for magnesium sulfate. Similarly, MSO4 and MgSO4 might be confused.

We’re soon going to be blessed with even more additions to the “Do Not Use List”:

  • Don’t write “> or <” because they could be mistaken for the number “7” or the letter “L”
  • Don’t write “&” because it could be mistaken for the number “2”
  • Don’t write “cc” because it could be mistaken for “U” (units) when poorly written. Instead we will have to write out the term “ml” instead.

There are other “safety measures” to keep us from hurting ourselves, but these are the ones that stick out most in my mind.

Now hold on a second while I get my soapbox.
Tap tap tap. Is this thing on?
There, that’s better.

The “U” for units might get confused with a number “0”
Maybe there could be some confusion.
Now let me ask the nurses a question: If you get an order for “500 reg insulin SQ,” are you going to
(a) question the order or
(b) fill up a 30 cc syringe (HA! I wrote “cc” instead of “ml” – cc cc cc cc cc) with regular insulin and inject a bolus the size of a kiwifruit under someone’s skin?
Would any medically trained person give “50 regular insulin” instead of “5 u regular insulin” to someone with a glucose of 250? I didn’t think so.
So this rule must have been written for people who have no knowledge of how to use insulin – just in case the housekeeping staff wants to get into the act and start treating hyperglycemia on the sly.
While I’m at it, will all of the communications from Medical Marijuana Advocates be required to go without the “cc” designation, too? What a waste of trees. Have to write a new letter to every addressee.

We can’t use MSO4 and MgSO4 because someone might not know that MSO4 is morphine and MgSO4 is magnesium
Would anyone question why a physician was giving a patient with a kidney stone 10 mg of Magnesium for pain? Considering that the dose of magnesium is usually 1000 mg, would it not set off a red flag in a normal person’s mind when you have to use a micropipette to get the proper dose of a medication and then administer three drops to medicate the patient?
And what better way to terminate an episode of torsades de pointes than 1 gram of morphine IV over 30 minutes? Just think, junkies from miles around would figure out ways to put themselves into cardiac arrhythmias just to get treated in your ED! I can see them now: Hey! Wait a minute, JACK! NOOOObody said nothing about no motherf%#$ing shocks!

The ampersand “&” might be mistaken for a “2”
First, I want to know who even writes ampersands any more. Then I want to see how someone can morph an ampersand into a number 2. Right after that, they can go to my bank and turn the $155 dollars in my checking account into a king’s ransom. Not happening.

“> or <” could be mistaken “7” or “L” and “cc” could be mistaken for “U” (units) when poorly written

I understand how an order to give “10 cc insulin SQ if BGL 7 350″ would be confusing. I routinely dose insulin by “cc” instead of “units” and I frequently see blood glucose levels more than 7000 in my daily practice (the normal glucose level is between >0 and 110). I thought long and hard about this one, though, and have come to the conclusion that we should probably stop using the “ml” term also. Because if written poorly, “ml” might actually appear to be the number “11111” which could accidentally increase the dosage of any medication by 11111-fold.
See?ml.gif Instead, I propose that we use the symbol from the Artist Formerly Known as Prince:prince_symbol.gif
Think of how many times we could avert the tragedy of some poor patient getting a 50011111 bolus of saline.

A period in Q.D or the letter “O” in QOD might be mistaken for an “I”
Good point. But because they are so confusing, we shouldn’t just stop at using “.” and “O” with Q.D. and QOD, we should stop using them altogether. By doing so, we would avoid confusing orders such as “STIP patient’s ciumadin NIW”
And this whole thing just gives me flashbacks about one time when I narrowly escaped ordering emergency dialysis for a patient whose potassium level looked like it was “315” on the computer printout. Boy was I embarrassed. Oh, and I almost forgot the time I nearly intubated a patient whose pH appeared to be 7144. Phew!

Attention Medical Marijuana Advocates …
Here’s a patient safety measure for you:
If health care providers are so incapable of determining whether a dose of medication is 100 times more than it should be and are at such a loss of medical knowledge that they can’t remember whether to use morphine or magnesium for pain management, they either need to call the physician to clarify the order or they need to find another profession.

Maybe they could work for the Joint Commission. Betcha they’d fit right in.

Update:
Want to see one solution to the medical abbreviation problem? Check out this post on physician handwriting.

44 Responses to “Do Not Use These Medical Abbreviations!”

  1. Christine says:

    Don’t give JCAHO any more ideas or we’ll all be charting “50 milliliters” or “50 cubic centimeters.”

  2. Doctor Bee says:

    The JCAHO nuts came to see us last week. We aren’t allowed to use “QD” at my institution; we must use “daily” or “q day” instead. In filling out the gajillion charts I had last week, I wrote “QD” in one of them and OF COURSE that was the one they audited. Asswipes.

    At least we still got full accreditation, even if I still bungled something so completely asinine up.

    • Ava says:

      Wow….I sincerely hope you NEVER treat anyone in my family – or anyone I know. If you are not concerned about clarity in the medical record (a legal document that can be your own personal professional downfall in court), then I worry about your patients. Physicians and all other treating professionals have to stop using the volume of reports required for patient care as an excuse for laziness. Write it out or dictate it in full or you will personally lose. It’s about LIFE people….not about your failings as a professional individual.

      Do not dictate in a car with the top down. Do not dictate on a cell phone. Do not dictate in a hot tub, bath tub, or shower. Do not dictate in the OR. Do not dictate next to machines in the ICU. Do not dictate at any sporting event. It would seem that a HIPAA violation discussion should also take place.

      If you are responsible for documenting your own transcription, WRITE IT OUT COMPLETELY. Do not use texting language. Remember, other non-medical professionals (including lawyers and patients who will sue you) are reading your report.

      You are all professionals. Behave like it.

  3. CardioNP says:

    LOL at the junkie scenario.

    We use a fully computerized EMR where I work.
    All notes are typed and there is electronic order entry.
    So can somebody at Joint Commission ‘splain to me how QD or MgSO4 is going to be misread when it is typed?

    I have had the abbreviation Nazis after me when I use ms for milliseconds in a pacemaker progress note. Golly gee, don’t think morphine or mag were involved in checking thresholds.

    And ya can’t even use CC for chief complaint!!

  4. exi says:

    The MSO4 / MgSO4 thing… that’s just hil-fucking-arious. I love it.

  5. Christine says:

    Dr. Bee- not even allowed to use q day here. It has to be “daily.” *whatever*

  6. Carol says:

    I work in community pharmacy and once saw an order for Indocid 25 mg tid. Turned out the dr supposedly wrote Duvoid 25 tid. I pulled the rx and looked at it again. Nope, still looks like Indocid to me! Perhaps the problem isn’t the short forms, it’s the doctors with sloppy writing? One dr at our local emerg room regularly block prints her rx’s. I love this dr!

  7. If it’s hard to read, mistakes happen. But if it’s printed, it helps. Communication requires a message, a sender and a receiver. Sometimes the sender has to be considerate of the fact the receiver is not actually bright. I am still getting calls from pharmacists about some stupid thing they misread… How often do they miss the refills, even though I now have printed proof I included authorizations for an entire year? Notably, I should point out it is only a couple of pharmacists who are recurrent offenders. I think they bought their PharmD at the same retail establishments they serve.

    I should also say that some medical schools are now teaching students to write out the entire prescription and not to use any abbreviations. Whoever is at fault, doctors, nurses, pharmacists or others, these mistakes are cheap to fix.

  8. HIBGIA says:

    while I in general agree, I’ve got to give an example against your MSO4 rant…

    Magnesium is a good migraine abortion med. So…did I wright MSO4 or MgSO4? I guess it depends on if I’m a candyman or not (ie, do I give morphine for migraines…which is a “no”, by the way)

  9. Donna says:

    They have people policing that either haven’t ever done the job or were so lousy at it they became the boss. typical corporate…There thinking is this lets hire somebody who knows nothing about the job makes the rules and make up crap to give ourselves something to do so we feel vaule and can verify the big bucks were making…yeah thats it lets keep the helathcare staff so paranoid about there charting that the patient see even less of them….Stupid corporate….
    Bet they would feel different if they were the patient..

  10. ERnursey says:

    That was a great anti-JCAHO rant. Welcome to my club.

  11. Laura says:

    i’m right there with you. it all drives me crazy.
    but i thopught an ampersand was this &. oh well, great rant against the jcaho-gods and their minions.

  12. Tom says:

    Why not simply ignore these poindexters? Not only do I use prohibited abbreviations, but I put them in ALL CAPS so they can find them more easily and it also allows the nurses to read them more easily (I thought the point of healthcare had something to do with sick people, not bureaucrats).

  13. SeaSpray says:

    Sigh…I’m sorry this inane stuff happens. Like you need to be bogged down with these little things and that’s the problem…you have more important things to do (take care of patients)and yet A-L-L-L these “little” things add up and bog you all down with added paperwork. Yes details are important and quality control, etc. is good but too bad they don’t seem able to differentiate what IS important.

  14. WhiteCoat says:

    Laura’s right. I’m wrong. See, I got all hyped up on caffeine and look what happened. Thanks for the catch. I changed it above. Maybe “&” and “2” are a little closer. Still a stretch for me, though.
    By the way, the “@” symbol is actually called the “commercial at” or “the ‘at’ sign”
    Tom, we’re stuck because if the hospital is unaccredited, then they don’t get reimbursed as much and then we’re out of a job. Vicious cycle. The hospital is good to us, so we want to be good to them. Doesn’t mean that I can’t whine about it, though.
    Sea – You’re right. Throwing all this nonsense at the docs and nurses and then wonder why the care isn’t faster. Sometimes you just can’t win.

  15. Allen Vaida says:

    I am not sure who sent this to me but I felt I needed to respond. I will then go away and you can discuss among yourselves since I don’t belong to this blog and not sure I would want to.

    I think this initial posting and many of the reply’s only points to the long journey we have in order to change the culture of many healthcare professionals on their understanding of safety. I guess the IOM reports and evidence by the numerous reports where misinterpretation of error-prone abbreviations has caused deaths is not enough to change behavior. I only hope that the next generation of healthcare professionals will have a better appreciation of right and wrong. Patients have died because U for units has been misinterpreted as a zero. This can occur with written or print drug orders and prescriptions. With the increased use of U-500 insulin (yes you can use U in front of this product name) to maintain tight insulin dosing for diabetics it is not a rare occurrence to order and administered 150 units or 200 units of insulin. So I am not sure I would allude to a healthcare professional as being incompetent if a U for units is misinterpreted as a zero for 15 units or 20 units. The use of mL for metric units is what is used for labeling of medications, measuring devices for syringes, and devices used for oral administration of solutions. Why would anyone want to continue to use cc if it has contributed to errors and is not what the majority of companies and people use for measuring unless it feels good to be a non conformer or outliner in an area we shouldn’t tolerate this behavior. I would guess the initial poster also uses apothecary measures to prescribe doses and frequency of medications. Maybe he or she gets a ‘kick’ out of seeing if people get confused with their meaning. Many of the major health care journals, texts, and dictionaries have eliminated many of the error-prone abbreviations in their print and electronic publications. They see the value in not causing harm to patients for recommendations we know may help to help to eliminate these preventable errors.

    I will not go on to address each abbreviation that has caused harm and even death to patients that the initial poster has presented in a comical manner. I only hope that the majority of the readers of this blog understand that eliminating error-prone abbreviations is meant to prevent errors and stop harming patients.

  16. Dr. Tom Bibey says:

    My favorite was always the term “NIVSACBLE.” I coined it, and everyone in our hospital knew it stood for non-invasive vascular study of the arterial circulation of bilateral lower extremities.
    When the PC police came in they made me write it out, and I would scribble it so they would have to call, just for spite. One of them asked me one day what bilateral meant. Oh, well.
    Visit me at the world’s first physician bluegrass fiction writer’s web site.

    drtombibey.wordpress.com

  17. Nursesense says:

    Ahhh JCAHO soon they will be requiring us to spell out RN and MD, so that patients do not get confused and mistake those “abbreviations” for something else. OMG when will it end. Really, what are the qualifications to get hired as a ” JCAHO” employee? Not only are they nit picky it is plain ole insulting and degrading to go around making up the pitiful rules for health care professionals who da!n sure have more sense then commom sense.

  18. sheri says:

    maybe doctors and all medical staffers should learn how to write legibly. i dont understand why a prescription has to be scribbled. we wouldnt have to worry about not reading it correctly.

  19. sheri says:

    to all the posters here, if you lost a loved one due to some doctor’s sloppy writing, a pharmacist not understanding the writing and not being able to contact the dr to get actual wording (because they are too busy), or a nurse not understanding it and charting it incorrectly, etc., you would think differently about it. you are just used to having your way, you dont want to change and it hasnt affected you. YET

  20. sheri says:

    except allen, the only one who made sense here

  21. WhiteCoat says:

    This post was intended to be a parody. So what’s the point?
    In order to protect us from ourselves, the powers that be are consistently removing/changing things deemed to be “dangerous” until nothing is left. The emPHAsis is on the wrong sylLAble.
    Read my previous post on the “ED of the Future.” http://whitecoatrants.wordpress.com/2007/09/15/the-ed-of-the-future/
    Instead of looking at the root cause of the problem – physicians who have poor handwriting, the entire healthcare industry gets dinged to promote “safety.” If you have an issue with a physician’s handwriting, address that physician. Perhaps if a physician has persistently poor handwriting that results in a patient injury, that physician gets labeled as “unsafe” by the state licensing board. Then the physician has the choice between having a bad reputation/disciplinary action taken against him and learning to write better.
    The broad assertion that all physicians have poor handwriting is offensive.
    If you want physicians to create electronic medical records, don’t make the documentation requirements for each patient visit so onerous. We generate at least 15 pages of jibber jabber for each patient visit in our ED, including a three page physician note even if a patient wants to have belly button lint removed.
    Stop the micromanagement and focus on the problem. Implementing these abbreviations cannot and will not solve the issue of “some physicians’ poor handwriting”. Is making these changes going to help you read the other 90% of a sloppy physician’s orders? Of course not. The physicians with good handwriting probably don’t need to modify their abbreviations anyway – because you can read their writing.
    I stand by my assertion that any healthcare provider who blindly gives 100 ten milligram vials of morphine IM or 5 full syringes of insulin subcutaneously, due to a physician’s sloppy handwriting or otherwise, need not be providing patient care.

  22. Chloe says:

    Just a quick note – there was a fatality here in Australia a few years ago because a pool (non-regular) nurse at a nursing home misread 10U as 100 and administered 100 units of insulin to a patient (a plausible dose for many diabetics).
    The coroner recognised the use of an abreviation as a major contibuting cause for the death.

    There has also been a death recently because of a missed decimal point on a drug chart rewrite, causing a 10-fold overdose of Metoprolol being initiated in a heart failure patient.
    http://www.magistratescourt.tas.gov.au/decisions/coronial_findings/s/sheridan,_pearl_emily_-_2006_tascd_280

    These may seem trivial at the time, but it is the small problems, when left unchecked, that can snowball if they are not picked up early. All it takes is for all the little holes and problems to line up, and that is when something tragic occurs.

    Bad handwriting and lack of attention to detail is the bane of a Pharmacists life. In our department we often end up playing “guess what this doctor was thinking” (or not thinking!) with prescriptions and charts. Unclear handwriting, illegible strengths and made-up-on-the-spur-of-the-moment abbreviations are all regular problems.

    This can only be exacerbated when one of the parties (in our case mostly the doctors) do not have English as their first language. Abbreviations and sigs that are common in one country are rarely or never used in another. Eg. in Australia we only ever see Qd as an abbreviation from American trained doctors – it just isn’t used here and so can often be misread as QID, causing quite a bit of confusion, especially for less experienced staff. Another is doctors from Central Asia (India, Pakistan) useing NTG instead of GTN for glyceryl tinitrate. And while ASA is technically an abbreviation for aspirin (AcetylSalicylic Acid) I don’t think its widely used. In both cases we worked out from the dose, and a bit of patient background, what it was intended to be, but do you really want the people dispensing medication for your family to have to GUESS what the doctor was trying to order?

    We have actually had one doctor admit he didn’t know what the medications were on the chart he was rewriting, and instead of checking or using a reference (available on several computers on every ward) he just copied the shapes as best he could, and hoped noone would notice. The results would have been amusing, had it not been a legal document from which the nursing staff were expected to safely administer medications.
    We have other doctors (senior consultants) who we have taken presciptions back to for them to read, and they didn’t couldn’t read it either! Neither could they read their patient notes to clarify the situation.

    We are all human and make mistakes or have bad days, but we should probably try to see the effect our little slips or short cuts have on others, and try to minimise them where possible, in the interests of inter-professional harmony.

  23. R Alanko MD says:

    To all who complained about physician handwriting in prescriptions, you have a point. BUT, this rule applies to progress notes , H&Ps and, indeed , all documentation in the chart in addition to orders. It applies to TYPED entries as well. Will you now complain about the font I used?

    If a nurse or pharmacist misreads my TYPED H&P or orders, how is that my fault? Someone that incompetent needs to be removed to Administration or JCAHO.

  24. LA says:

    Those abbreviations are all banned at our hospital in So Cal, too.

  25. medical records says:

    Get a clue Doctors. If your hand writing wasn’t so f&@#ing horrible, we would not have these issues to contend with. Forget The Joint for just one second. Don’t you realize that your scribble in the charts is used for so many other areas than just patient safety? Everything you write is used in some area of coding, reimbursement, fraud alert, quality control, data mining, the list goes on and on. Why do you consider yourselves so important and above all the people you have to work with, who have to read your scribble and try to decipher it just to do their jobs. You would think we were asking you to donate a damn kidney. We are asking you to write legibly. Oh I can hear it now….”we are so damn busy we can’t do anything but put the tip of the pen to the paper and move it back and forth is some squiggly manner.” Yeah, well thanks to you being a total a$$ the rest of us have to run around asking each other….”what the hell does this say?” So no, Mr. Big Shot Doctor, it is not because we are in the wrong profession or perhaps less intelligent that you…we question because you have given us NO reason to trust ANYTHING you write.

    When you stop hyperventilating and uncontrollably shaking, read this.
    If you can’t read a physician’s writing, then don’t fill the order and tell your nursing supervisor and/or administration. If you can’t bill for it, go to the hospital administration or don’t submit the bill. One of the conditions of participation in Medicare is that the entries must be “legible and complete.” If you submit bills for illegible chart entries, you and the hospital could get de-listed.
    If you would blindly give 500 units of insulin or 1 gram of morphine to a patient, then yes, you ARE in the wrong profession and you will never convince me otherwise.
    P.S. I happen to have very nice handwriting and am offended by your generalization that doctors all write illegibly.

  26. medical records says:

    Now that I have stopped “hyperventilating and shaking uncontrollably”, I am able to respond to you. So you are the one “Physician” who takes offense to being generalized with all doctors who write illegibly. You are the minority in this case, but I’m a big enough person to apologize for insulting your handwriting. I’m very sorry!

    While I agree that the conditions of participation for Medicare state that entries must be “legible and complete”, you still have physicians who will argue that their handwriting is perfectly legible. Then you will have that same physician pass his/her handwriting around to three or even four of his/her colleagues who will agree that his/her handwriting is legible. Then when it is suggested that they further pass the handwriting around to three (as determined by Medicare and JCAHO) other people to read it, none of whom can read it, you can rest assured that you have now insulted this physician to the point that he will no longer attend to patients in your facility. By the time you get to billing for that patient, which of course is after the patient has been discharged, try getting the doctor to correct his poor documentation, interpret his illegible handwriting, complete his dictations, or simply sign for telephone orders. If every facility had to wait until the “legal medical record” was actually legal before they billed for services, they would never be able to bill.

    Hmmmm. I would consider changing the staff bylaws to make a physician eligible for suspension of staff privileges and/or removal from staff if warned about poor handwriting and it does not improve. Then it becomes a reportable event if the handwriting doesn’t improve. Pick three random staff members to read the physician’s writing and if they cannot do so, the physician is deemed to have illegible writing.
    If three of the physician’s colleagues can all read the handwriting, ask the colleagues to individually tell you what the handwriting says.

    This blog started off discussing the JCAHO “Do not use” abbreviation list, which is somewhat ridiculous to pin point on a handful of abbreviations as the cause of 48,000 to 98,000 medication error related deaths in the United States each year. The “do not use” list, JCAHO and their patient safety standards, and Medicare’s requirement that physicians write “complete and legible” orders, are all mere droplets in an ocean of health care safety issues.

    Exactamundo

    Ask yourself this question, “when do we stop teaching the same old techniques to medical school students?” The health care system is out of control. Too many rules, regulations, requirements, policies and procedures, conditions, etc. that one cannot see the forest for the trees. It is called resistance. Everybody, physicians included, are so tired of being told what to do to remain compliant that they loose the desire to practice medicine. Patients waiting for an opportunity for the “system” to mess up so they can sue somebody. Free health care to non tax paying immigrants. Skyrocketing costs. Depletion of our National health care resources.

    Exactamundo #2. I think we’re on the same side of the ring in this fight.

    Your “very nice” handwriting is greatly appreciated by those of us who have to read it.

    P.S. I was kidding about being offended …

  27. medrecgal says:

    I have seen a reasonable solution to this handwriting problem: computerized records. They are not a cure all, by any means, but at least the content is always legible. There are other problems with abbreviations that occur even when the text itself is legible, and sometimes I think practitioners become so habituated to quick texting certain phrases in that you’re left scratching your head wondering what the heck they really meant to say.

    But…it still beats dealing with the at times crazy handwriting, by a long shot!

  28. teresa says:

    Well, here’s a case where two patients had the potential to be harmed because of the rules not allowing abbreviations:

    http://docsontheweb.blogspot.com/2007/11/q-d.html

    Fortunately, neither patient appears to have suffered harm, but the sword cuts both ways. You make dumb rules, and dumb things are bound to happen. Sooner or later, someone’s going to get hurt by those with legalistic tendencies.

  29. Marsha says:

    From a coding and billing standpoint, illegible writing further clouds getting correct reimbursement, and can negatively impact the facility’s financial health. I believe the Non-approved Abbreviation List is a product of illegible handwriting on the part of many Drs. DRGs and APCs are here,Drs, and soon, when we are required by the powers that be (CMS and WHO among others) to use ICD-10 you will be asked to be a lot more specific in your diagnoses and handwriting so the visits can be accurately coded and reimbursed. DRG’s were built on a flawed system because there was not enough diagnositic specificity and is the reason hospitals are now feeling the effects of CMS regulations in low reimbursement and length of stay issues. Yes, you can go to another hospital to practice when your penmanship sucks so bad that you are asked to hire a scribe, but the new hospital will soon be onto your ways. If Drs had to pay the difference per patient bill in what DRG or APCs could have been billed with the specific documentation to support co-morbid conditions, we would see a change in the notes and orders, including abbreviations. Please step up to the plate and clearly diagnose every conditon you treated during the hospital stay and legibly document for the sake of your patients, Doctors! Continuing medical care often can’t be given appropriately because the handwriting, including abbreviations, is illegible. When you say a diagnosis is “possible” or “probable”, coding rules state that can’t be coded when the patient is considered an outpatient surgery or observation case until you document that the condition actually exists. Payment for those “garbage symptom codes” (in the 700-series) like “chest pain” is not close to payment for the diseases found to be behind the chest pain like GERD, or even angina pectoris due to CAD. However, we cannot code what you don’t document. Outpatient cases are not physician queried in most hospitals and the hospital is getting paid less than they should only because the documentation does not support the longer length of stay for the illness, due to incomplete or illegible documentation, in more cases than the hospitals care to admit. Thanks.

  30. enough says:

    With all respect to all … better go get some classes to improve you handwriting! Guess some people are arrogant enough to argue forever.

  31. Small Apothecary Jars says:

    I found your site on technorati and read a few of your other posts. Keep up the good work. I just added your RSS feed to my Google News Reader. Looking forward to reading more from you….

  32. Rodger Ling says:

    Perhaps if medical errors were not the 8th leading cause of death in this country (at least that’s the stat I keep hearing), then these kinds of rules wouldn’t be necessary. Grow up, Docs! Writing things out is not going to kill you, nor anyone else.

  33. Great rant. I liked the illustrative example involving a micropipette.

  34. Chicago says:

    Anybody who thinks that only incompetent practitioners misunderstand written directions and abbreviations is completely mistaken. Everyone is human; everyone makes mistakes. Hopefully the complainers’ own arrogance won’t cause a patient harm because they can’t grow up enough to follow the rules. JCAHO puts regulations into effect for a reason, not just because they like doing it.

    So give me the hard evidence showing me that the patient harm results from using these “baaaaaad” abbreviations and not from the doctor’s poor handwriting. If the handwriting sucks, what difference does it make whether something is abbreviated one way or another?
    If you don’t have the knowledge to differentiate between proper doses of magnesium and morphine, you shouldn’t be dispensing the medications.
    What bothers me more than being called “arrogant” because I chose to highlight the obvious is that some less informed people have apparently taken the Joint Commission’s recommendations hook, line, and sinker without thinking them through. Watch out for those cliffs.

  35. Chicago says:

    Healthcare Benchmarks Qual Improv. 2007 Nov;14(11):126-8.

    Jt Comm J Qual Patient Saf. 2007 Sep;33(9):576-83.

    J Hosp Med. 2007 Jul;2(4):212-8.

    Sentinel Event Alert. 2001 Sep;(23):1-4.

    Jt Comm Perspect. 2001 Nov;21(11):10-1.

    Really, how hard is it to just write out?

    How hard is it – not at all. It just takes more and more time.
    Kind of like TJC forcing all pharmacists to confirm all written prescriptions by telephone. How hard would that be? All you’d have to do is dial a phone number and speak to the doc, right? If you’re a practicing pharmacist, you’d know that your productivity would tank and then your boss would give you an ultimatum to shape up or ship out. If you’re not a practicing pharmacist and just carry a clipboard around all day telling everyone else what they do wrong, I don’t really hold much regard for your opinions.
    The only citation I could find online was to the second article from Luigi Brunetti who happens to be a pharmacist. This article just proves my point. Look at the case examples.
    Case 1 an order is written for “acyclovir (unknown dose) with HD.” The pharmacist interprets the “HD” to be “TID.” Apparently the pharmacist doesn’t contact the physician to ask about the dose and doesn’t check to see whether the dose should be modified with someone in renal failure. Order wasn’t clear and pharmacist didn’t confirm. You can blame the error on “abbreviations” but the root cause of the problem is the physician’s sloppy order and that pharmacist’s lack of knowledge.
    Case 2 was a mix-up between “micrograms” and “milligrams.” Neither the nurse nor the pharmacist caught on that the patient was being given ONE THOUSAND times the proper dose of medications. Did they check the proper dose before giving the medication? Doubt it. Lack of knowledge masquerading as “abbreviation error.”
    Case 3 involved a patient who was given an MDX/GI cocktail containing lidocaine. The patient was allergic to lidocaine. Nevertheless, the pharmacist prepared the compound and sent it to the patient’s bedside. Did the pharmacist check the patient’s allergies before dispensing the medication? Doubt it. Both physician and nurse stated that they did not know lidocaine was in a GI cocktail. Lack of knowledge masquerading as “abbreviation error.”
    You can pull a Mark Twain on the data all you want. The bottom line is that these problems are caused by poor handwriting and by people failing to take the time to learn about the medications they give. If you blindly give 1 gram of Morphine IV piggyback because you misunderstood the Magnesium order, you have no business giving any medication at all. You’re a danger whether the medication is written out or abbreviated.
    Maybe the “do not use list” will avert a few medication errors, but the underlying problems will persist. The low morale and disgust for the medical profession caused by the new “directives” the Joint Commission spits out on a regular basis create far more of a danger than me writing “cc” or “TID.”

  36. Ariel says:

    This JOINT commission is simply a bunch of narccissistic lawyers, “healthcare administrators” and the regular quislings among nurses that don’t want to do real work anymore. These people are soooo self-absorbed and egomaniacal that they won’t even smile when they come to “inspect” a place. They came to our magnet hospital and “complained that the flowerbeds outside were a potential harm because there was some dirty soil on te pavement among other stupid things. They make people pee in their pants just for the sheer mention that they are coming.

    Just another bunch of laughable bureaucrats that do about as much to improve healthcare in this country as the US congress.

    And we were even instructed how to talk to them if they asked questions. Goddammit, these people are worse than the KGB.

    Another reason to find some other things to do for sure.

  37. Pat Brown, RN says:

    Joint Commission can kiss my fat fanny qd and prn….and some of these responders need to take a damn Zoloft and chill out!!!

  38. R.E.S. says:

    For collage, I am doing a research on the ban of medical abbreviations. I am studying to be a medical coder and biller. I have a paper due on the errors made because of medical abbreviations. In my research, I read the White Coat Rants article, and the following blog. Some of the doctors and others have legitimate complaints. Medical and pharmaceutical staff should use common sense. But, wouldn’t you rather error on the side of caution that on the side of carelessness? I have read a number of cases where misread abbreviations led to serious problems, and death. There are enough people that die because medicine cannot help them, without having people die unnecessarily. How many patients die because open heart surgery cannot save them? How many cancer patients are lost because chemotherapy cannot help them? How many vehicle accident victims don’t make it because they are to far gone for medical attention to save them? In light of that, shouldn’t a doctor/nurse/etc. do everything in their power to save the patients that don’t have to die? It takes more time and effort to write everything out, but this is not about you. It’s about the people who could loose their lives if the abbreviations are read incorrectly. Yes, Dr. So-in-so saved a few seconds on the report, but what about the person that died because of it? What about the things they planned to do yet in their life? What about their widow, their fatherless or motherless children? What if it was your wife/husband/child/mother/father/etc. that died from someone’s negligence?


    I have read a number of cases where misread abbreviations led to serious problems, and death.

    Were the “serious problems and death” due to the *abbreviations* or due to the inadequate medical knowledge of the person making the mistake? Show me evidence that proves a causal connection between abbreviations and bad outcomes where poor medical knowledge is not involved.
    You can make all the emotional pleas you want, but if you want to address the facts, you still have not shown how abbreviations alone kill people. I’d like to see evidence of how many fewer deaths and “serious problems” have occurred since this silly mandate was created. Until I see that information, in my eyes JCAHO is benefiting itself by perpetuating a myth.

  39. Kiko says:

    Go have life and stop arguing. If your hospital doesn’t get accredited you will either go home or look for another job. Like it or not, you need to do it. Med exec. will beat your lazy *** and you will OBEY hehehehehehhe
    Do you understand my English???? If not, look at how and what you write for a pharmacist …. and how many times does he/she call you to correct your silly mistakes. Hallllllloooooo

  40. Tyrone says:

    IF, and this is a big IF, ALL hostitals under JHACO’s jurisdiction would simply say ‘no’ to the rules, what do you think would happen.

    It’s like the movie Bug’s Life when the ants resisted the request of the grasshoppers. We doctors, hospitals, nurses, etc… have the country by the short and curlies but we cower at every request JHACO and Medicare makes.

    Imagine if we ALL turned away unfunded, not sick patients from our ERs. Imagine if we ALL walked out of every single ER for one hour one day. Don’t you believe that kind of unity would be felt and heard in Washington? Well, it’s too good to think about because whenever I share it with a colleague, all I hear is fear that the profession might get in trouble. We’re already in trouble. We are being paid less and less for more and more stringent guidelines, etc…. EMTALA violates anti-slavery laws, but we just keep doing what they tell us.

    We just sit back, huddle in our stupid specialist groups, argue amongst ourselves, and never go after the enemy. Meanwhile, the AMA, which neither represents the interests of patients or doctors, prances around with idiotic proposals that decay the enjoyment of practicing medicine in this country.

    Do you think some FMG who grew up in calcutta is going to care about decreased reimbursements? I don’t know because I can’t understand him.

  41. B says:

    Maybe your not aware that people die all the time from mistakes like this…my neice being one of them

  42. patty says:

    Flash forward to 2012. Doctors/providers now using speech recognition to save them money. We medical transcriptionists take a cut in pay of about half because we have about half the work to do? We don’t have to deal with scribbled handwriting, we get to deal with garbled speech and catch all the mistakes that are made (i.e. someone without renal failure who has a creatinine of 10.9; another case of someone with an elevated creatinine, normal LFTs, on hemodialysis but final diagnosis is “chronic liver disease) and these are only a couple of examples. The point is that we save your asses a lot of time and you don’t even know it. I made under 10,000 dollars last year and a lot of very good MTs are getting out of the business because it’s not worth it. The risk is too high, we are concerned and very careful with documentation on people who are NOT our patients and the pay is getting lower all the time. Excuse me if I fail to sympathize with your “dangerous abbreviation” complaint. We MTs are responsible for making sure they are expanded properly and that is the last thing we have to complain about.

  43. […] meanings or can be easily mistaken for something else if handwriting is sloppy. There are some health care providers who believe that given the context and sufficient medical training, these abbreviations should not […]

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