WhiteCoat

Still Don’t Use These Abbreviations

Remember all of those “do not use” abbreviations?

I wrote a post about them a loooong time ago, but since then things have changed.

We went from written medical charting to almost exclusively computer [hack hack] generated medical records.
So the whole Joint Commission issue about a “>” looking like the number “7″ or the notation “cc” looking like two extra zeroes is – or at least should be – a moot point.
And I still believe that if someone can’t tell the differences in dosing between “MSO4″ and “MgSO4″ then they shouldn’t be prescribing or administering those medications. Again, it should be a moot point since orders have to be made from dropdown lists.
But some organizations don’t understand the concept of “moot.” Rules just keep

At the start of my shift, a very pleasant member of the chart review team was waiting to talk to me. This same member of the chart review team had reportedly chastised a nurse because she hadn’t completed a “medication reconciliation” on a young multiple trauma patient that was flown out of our ED to a regional trauma center less than 30 minutes after arriving. Because obviously whether the patient medication list states that he took Motrin and Zyrtec on an as-needed basis was going to have a profound effect on whether he would survive his rib fractures, hemopneumothorax, and open femur fracture. In fact, wasting time documenting nonessential information such as ASA scores and medication reconciliations will very likely have a detrimental effect on patient outcomes.

As a side note, it is rather sad that government regulations force hospitals to hire multiple full-time employees – mostly trained nursing staff – whose sole job is to comb through the work of those caring for patients in order to pick minute errors making no clinical difference in a patient’s treatment or outcome from a document that is likely thousands of words long. Then, instead of just making the changes themselves, they have to find whomever failed to properly document this nonessential information, interrupt them during their clinical duties, and stand over their respective shoulders while they correct their “errors.” Again, the documentation changes rarely if ever have any beneficial effect on patient care and often cause delays in patient care due to all the requirements for extraneous information. If the chart reviewers instead were able to use their time to provide care to the patients, hospitals would be safer places.
Enough ranting.

My chart review error was heinous. I wrote “cc” instead of “ml” in one of my notes. It wasn’t even an order or a prescription. It was a notation of how much medicine a child was taking prior to coming to the emergency department.
“Dr. WhiteCoat, you’re going to need to change this in your note. It says “cc” and should say “ml.”
“I can’t change it in my note. The note has been finalized and can’t be edited.”
“You’ll need to put an addendum clarifying the notation, then.”
“What?”
“It is on the Joint Commission’s ‘unapproved abbreviation’ list. The notations can be confused. In this case, the ‘cc’ could be confused with ’00.’”
“You’re kidding me.”
“No. It has to be changed.”

Then that little gremlin whispered something in my ear.
“I’m not sure what the problem is. The notation says ‘ml.’”
She stopped and read through the chart.
“No. Right there. It says ’15 cc’. See it?”
“Yes. I see where you’re pointing. It says ’15ml.’”
She started getting frustrated and raised her voice.
“No, Dr. WhiteCoat. It clearly says ’15 cc.’”
“OK. If it clearly says ’15 cc’ then there’s no chance of people confusing it with ’1500′ – which by the way would mean that the child was taking a liter and a half of medicine every day. So remind me again what the problem is.”
She gathered her papers and left in a huff.
The nurse who had been chastised earlier gave me a thumbs up sign.
Fifteen minutes later I get a phone call from the head of the medical staff.
“Will you just make the change, please?”
“OK. Fine.”

All in the name of patient safety.

7 Responses to “Still Don’t Use These Abbreviations”

  1. maura says:

    according to the dictionary the definition of the word moot is open to discussion or debate. most people use it incorrectly. they assume it means that a point is no longer debatable.

  2. throckmorton says:

    Don’t you hate how they make us reconcile their home medications? When a patient is discharged, we have to “reconcile their home meds” which we never put them on nor are we treating that problem. Further, we have to reconcile their “herbals” and “homeopathic” stuff. I just gave up and when the chart Nazi calls I say that she will have to call all the doctors who prescribed that stuff and get confirmation that they really are on it and then get that doctor or “herbalist” to sign off on the meds and take full responsibility for them.

  3. Obviously Sarcastic says:

    You’re right. If only everyone else could overcome their human shortcomings and just do everything perfectly, you wouldn’t have to stop using confusing abbreviations and write out all those extra characters. Sure, these recommendations were made *because* people have made these errors, but those were the “other people,” and no one you work with (or heavens forbid, you yourself) would make a mistake.

    It’s so annoying when patients complain that they were wrongly told to continue using a treatment after discharge and end up with duplicate therapies, or that they weren’t told to discontinue the drug that they *obviously* should have discontinued. I mean, seriously, what are you supposed to do? Gather a medication history and then explicitly tell your patients which drugs they should continue and which drugs they discontinue to prevent a simple error that could lead to serious consequences? Naw. I’ll spend my time being a dick to the chart review team instead.

    Honestly, those abbreviations, it’s just so damn difficult to remember to use “mL” instead of “cc.” They’re totally just as bad as people who commit genocide and murder for trying to get you to consistently use two characters instead of two other characters. You bravely stood up to the chart review team and should receive a medal or a pin or something.

    /end sarcasm

    • Ryan Persaud says:

      On a more serious note, in community pharmacy there are handwritten prescriptions that are totally illegible. It would save me a phone call, and your time, if these things were just written out clearly to begin with. Not to mention the time it would save if a serious problem did occur, and above all it would spare the patient from the ill effects of a completely avoidable mistake.

  4. TH says:

    I think a reasonably OK idea has (once again) taken on a life of its own. With the advent of EHRs, most of the abbreviations/shortcuts are now easily readable.

    And making an addendum 1, 2, or (in my favorite case of the extreme) 14 months later does not change the fact that AT THE TIME I WROTE THE ORDER, IT WAS CLEAR AND EXECUTED PROPERLY.

    If we’re going to start being paid for results… how about starting with documentation?

  5. markps2 says:

    From 10,000 trivial errors to one fatal error in paperwork.
    Where was this type of employee when Brian Sinclair was in the emergency department waiting room? http://www.cbc.ca/news/canada/manitoba/er-video-released-at-brian-sinclair-inquest-1.1391894

  6. ardosa says:

    The sad thing is this. You know it is idiotic, we know it is idiotic but the Joint will make our lives hell over it.
    I can see the issue with “u” when dosing insulin in a correction scale (even typed in the order there are mistakes when nursing is going too quick or doesn’t read closely), but in a note where you are saying the pt recieved 2u of prbc, does anyone really think you gave 20?

    The problem is that if the joint sees it, then they mandate a correction plan, then everyone has to meet and ENSURE the correction plan is written correct, filed and followed up… and staff will be mandated to ‘education’ over it.

    you’re right. it’s stupid. but as long as the hospital has to have accreditation by Joint, DNV, CMS and all the other entities, we’re all stuck.

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