Error-prone Abbreviations Research Articles

Impact of 'Never Use' Abbreviations (Error-Prone Abbreviations-EPA's) List on the Incidence of EPAs in Inpatient Medical Prescriptions in Apex Tertiary Care Public Hospital in India.

The aim of the study was to assess the impact of never-use list and standardized abbreviations on error prone abbreviations. Abbreviations are commonly used in medical records to save time and space but use in prescriptions, which can lead to communication failures and preventable harm. Prescriptions need to be clear for correct interpretation. Hospitals should implement uniform use of approved abbreviations, such as an approved list or never-use list of abbreviations and symbols. In the hospital under study, there was no system of avoiding error prone abbreviations while prescribing any medication. Hence, an interventional study was performed to quantify and reduce the incidence of error prone abbreviations. The main objectives were to determine the incidence of error prone abbreviations, development and implementation of 'Never-use' list and standardized abbreviations and finally determine its effectiveness in reducing the error prone abbreviations in the prescriptions. The study design was pre-post interventional / quasi-experimental design. The settings were inpatient wards of broad specialties of a tertiary care hospital. 'Never-use' list and standardized abbreviations were developed by review of relevant literature, existing lists by Institute for Safe Medication Practices and Australian Commission on Safety and Quality in Health Care compared against findings of the pilot study of prescriptions for error prone abbreviations and experts' input. Poster copies of the lists were affixed in inpatient wards, doctors were educated, and poster pamphlets were distributed. Pre-intervention data was collected by a retrospective closed in-patient medical record review. Post-interventional incidence of error prone abbreviations was determined, and the effectiveness of the same was assessed by using statistical analysis. The incidence of error abbreviations in inpatient prescriptions was 47.5%, and the 'Never Use' list of abbreviations led to a statistically significant reduction of error prone abbreviations by 8.2% from 47.5% to 43.6% (P\0.006). 'Never Use' lists are effective in reducing the incidence of common error-prone abbreviations, and discipline-wise variation is observed.

Prescription audit study from a tertiary care private hospital in Kolkata, India

Introduction: Prescription writing is an important aspect of safe medication practices. Prescriptions should adhere to best practices mentioned in the World Health Organization guidelines and the National Accreditation Board for Hospitals and Healthcare Providers guidelines. Aim: Evidence about prescription audit study conducted in developing countries like India is scarce, especially from the Eastern part of the country. Hence, the current prescription audit study was conducted in a tertiary care private hospital in Eastern India in the city of Kolkata. Materials and Methods: This study presents an assessment of the quality of prescribing practice in a tertiary care private hospital in Kolkata. Six thousand four hundred and six medicine cards (6406) of inpatients were prospectively analyzed for the duration of 6 months. Results: The audit revealed that only 69.24% of medicine cards had captured drug allergy, 99.53% had mentioned the route of administration, 99.85% had dose strength, 99.89% had mentioned the frequency of dose, and only 75.35% had mentioned the indication/diagnosis of patients. Surprisingly, 90.75% of medicine cards had an error-prone abbreviation which was an issue of major concern. Conclusions: The audit report was shared with the clinicians every month along with regular training of good prescribing practices, which improved the quality of prescribing practice. Regular prescription audit followed by dedicated clinical pharmacology team along with constant communication with clinicians can improve the quality of prescriptions in long run.

Paediatric antimicrobial stewardship and safe prescribing: an assessment of medical staff knowledge and behaviour.

Objective:Determine baseline knowledge of antimicrobial stewardship, and safe prescribing among junior medical officers, monitor their level of participation in interactive education during protected teaching time and assess day-to-day prescribing behaviours over the subsequent 3-month period.Methods:A voluntary and anonymous survey of all non-consultant level medical officers was conducted with the use of an audience response system during mandatory face-to-face orientation sessions at a tertiary paediatric hospital. Routine prescribing audits monitored compliance with national and locally derived quality use of medicines indicators.Results:Eighty-six percent of medical officers participated by responding to at least one question (171/200). Response rate for individual questions ranged between 31% and 78%. Questions that addressed adverse drug reactions, documentation and monitoring for empiric antibiotics and the error-prone abbreviations IU and U were correctly answered by over 90% of participants. Other non-standard and error-prone abbreviations were less consistently identified. In practice, 68% of patients had complete adverse drug reaction documentation (113/166). Error-prone abbreviations were identified on 5% of audited medication orders (47/976), approximately half included a documented indication and intended dose.Conclusions:Participants demonstrated a good understanding of safe prescribing and antimicrobial stewardship. Audits of prescribing identified potential discrepancies between prescribing knowledge and behaviours.

Medication Safety in Two Intensive Care Units of a Community Teaching Hospital After Electronic Health Record Implementation: Sociotechnical and Human Factors Engineering Considerations.

The aim of the study was to assess the impact of Electronic Health Record (EHR) implementation on medication safety in two intensive care units (ICUs). Using a prospective pre-post design, we assessed 1254 consecutive admissions to two ICUs before and after an EHR implementation. Each medication event was evaluated with regard to medication error (error type, medication-management stage) and impact on patient (severity of potential or actual harm). We identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). Although the overall potential for harm due to medication errors decreased post-implementation only 2 of the 3 error rates were significantly lower post-implementation. After EHR implementation, we observed reductions in rates of medication errors per admission at the stages of transcription (0.13-0, P < 0.001), dispensing (0.49-0.16, P < 0.001), and administration (0.83-0.56, P = 0.011). Within the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information). Within the administration stage, we observed a reduction of late administrations and increases in omitted administrations and incorrect documentation. Electronic Health Record implementation in two ICUs was associated with both improvement and worsening in rates of specific error types. Further safety improvements require a nuanced understanding of how various error types are influenced by the technology and the sociotechnical work system of the technology implementation. Recommendations based on human factors engineering principles are provided for reducing medication errors.

Medication Safety in Hospital

The World Health Organization has recommended the adoption of basic applications in healthcare facilities to enhance medication safety over the years, but it remains unclear if these recommendations are adhered to by hospitals. We assessed the availability of primary medication safety practices in Saudi Arabian hospitals. Survey were carried out in 70 hospitals to identify the presence of core medication safety practices in Saudi Arabian hospitals and revealed that there were room and opportunity for improvement, even for cheap interventions. According to the study, only about 29% of the Saudi Arabian hospitals had a proper functioning drug safety committee, and 10% had a designated medication safety officer. It was also revealed that only 32% of the hospitals had the list of LASA authorized drugs, and 51% had a list of error-prone abbreviations and medical terms. Saturated electrolytes were also found as floor stock in 60% of all hospitals.Alreshidi, International Current Pharmaceutical Journal, December 2016, 6(1): 6-8http://www.icpjonline.com/documents/Vol6Issue1/02.pdf

An assessment of the basic medication safety practices in Khartoum State hospitals

PurposeTo assess the presence of medication safety practices in Khartoum State hospitals.MethodsA previously used questionnaire was used to evaluate medication safety practices. The main practices evaluated were the presence of...

Medication Safety

Medication Safety

The Pattern of Abbreviation Use in Prescriptions: A Way Forward in Eliminating Error-Prone Abbreviations and Standardisation of Prescriptions

Inappropriate abbreviations used in prescriptions have led to medication errors. We investigated the use of error-prone and other unapproved abbreviations in prescriptions, and assessed the attitudes of pharmacists on this issue. A reference list of error-prone abbreviations was developed. Prescriptions of outpatients and specialty clinic patients in a teaching hospital in Sri Lanka were reviewed during one month. An interviewer administered questionnaire was used to assess attitudes of pharmacists. 3370 drug items (989 prescriptions) were reviewed. The mean (standard deviation) number of abbreviations per prescription was 5.9 (3.5). The error-prone abbreviations used in the hospital were, μg (microgram), mcg (microgram), u (units), cc (cubic centimeter), OD (once a day), @ sign, d (days/daily), m (morning) and n (night), and among all prescriptions reviewed, they were used at a rate of 17.4%, 0.1%, 1.9%, 0.2%, 0.2%, 4.9%, 23.5%, 4.4% and 15.8% respectively. Among the 103 types of abbreviations observed, 71 were not standard acceptable abbreviations. Multiple abbreviations were used to indicate a single drug item/ instruction (N = 7). The abbreviation 'd' was used to denote 'daily' as well as 'days'. All pharmacists believed that using error-prone abbreviations will always (5.3%) or sometimes (94.7%) lead to medication errors. Error-prone abbreviations and many other unapproved abbreviations are frequently used in hospitals. There is a need to educating health care professionals on this issue and introduce an in-house error-prone abbreviation list for their guidance.

Medication Errors: Medication Orders with Error-Prone Abbreviations

Introduction: Ambiguous abbreviations are one the most common and preventable causes of medication errors. Clinicians use many abbreviations as a timesaving convenience; however they can be prone to misinterpretation. Aim: The aim of this practice review evaluation is to identify the top six error-prone abbreviations at a local Hospital and compare those results to previous review conducted at the same facility to detect any improvement in practice. Method: Copies of inpatient medication charts were randomly selected from each ward over a one-week period. A sample size of 100 patients’ charts was included in the audit. Only regular orders on all current medication charts were included in the review (excluding ceased orders). The audit tool used is based on indicator 3.3, “Percentage of medication orders that include error-prone abbreviations” published by the New South Wales, Australia; Therapeutic Advisory Group. Findings: A total of 47 error-prone abbreviations were detected which equates to an overall incidence of 6% (n=784 medication orders) which is higher than the results of the audits of 2008 (5.1%) and 2012 (5.3%). The most common error-prone abbreviation were ‘mcg or ug’ (57.4%), ‘od or OD’ (23.4%) and ‘U or IU’ (19.1%). There were no ‘leading zeros’, ‘trailing zeros’ or ‘qd or QD’ abbreviation in the sample audited. Conclusion: The audit suggests that the possible reasons for the increase in use of unapproved abbreviations may include: 1) junior medical officers were not instructed to use the New South Wales, Australia, Therapeutic Advisory Group guidelines or 2) some medical staff are in the habit of using varying abbreviations due to their previous work experience and practice standards. If these doctors had never received timely or direct feedback on their prescribing practices then they may not be aware that they are utilising error-prone abbreviations.

Medication Safety in Hospitals: Avoiding Medication Errors in the Medication use Process

Medication errors have a large impact on patient safety and on healthcare costs. Although errors happen at every stage of the medication use process, the ones that occur in the latter part of the process are frequently undetected. Therefore, while all medication errors need to be eliminated, the ones that frequently reach the patient should be stopped first. Errors occur due to a combination of human and system-related failures. However, improving the system seems to be the prudent approach to avoiding medication errors, as human failures are inevitable. Efforts to improve systems include two broad areas. One is the automation of systems and the other is to improve the quality of prescription writing. Technologies have improved the safety of the medication use process to a large extent but this success depends on user acceptance. If technologies are difficult to use, users may work around standard procedures resulting in new and unanticipated errors. Bar-code assisted medication administration is one such useful technology which is commonly associated with implementation problems and workarounds. Therefore adequate preplanning, user attitude assessments and post-implementation assessments are three vital aspects of implementing new technology. Improving the quality of prescriptions is also a very useful strategy to improve medication safety, because a large percentage of hospitals still use hand-written prescriptions. The use of error-prone abbreviations has been shown to be very dangerous as pharmacists and nurses may misinterprit them, especially if the prescriptions are illegible. A popular approach to discourage error-prone abbreviations in prescriptions is through a ‘Do Not Use’ list; a list showing error-prone abbreviations that should be avoided by prescribers. However, its effectiveness and adherence by healthcare professionals has not been established. In conclusion, medication errors have a large impact on patient safety and interventions aimed at minimising them need careful planning and implementation.

Medication safety practices in hospitals: A national survey in Saudi Arabia

BackgroundMedication errors in hospitals are a worldwide concern. The World Health Organization has recommended the implementation of basic applications in healthcare systems to improve medication safety, but it is largely unknown whether these recommendations are adhered to by hospitals. We assessed the presence of core medication safety practices in Saudi Arabian hospitals. MethodsWe developed and validated a survey to assess medication safety practices in hospitals. Major headings included Look-Alike Sound-Alike (LASA) medications, control of concentrated electrolyte solutions, transitions in care, information technology, drug information and other medication safety practices. Trained pharmacists visited samples of hospitals from all regions of Saudi Arabia. ResultsSeventy-eight hospitals were surveyed. Only 30% of the hospitals had a medication safety committee and 9% of hospitals had a medication safety officer. Only 33% of hospitals had a list of LASA medications and 50% had a list of error-prone abbreviations. Concentrated electrolytes were available in floor stock in 60% of the hospitals. No hospital involved pharmacists in obtaining medication histories and only 37% of the hospitals provided a medication list to the patients at discharge. While 61% of hospitals used a computer system in their pharmacy to enter prescriptions, only 29% of these hospitals required entry of patient’s allergies before entering a drug order. ConclusionsCore practices to improve medication safety were not implemented in many hospitals in Saudi Arabia. In developing countries, an effort must be made at the national level to increase the adoption of such practices.

Prevalence of error‐prone abbreviations used in medication prescribing for hospitalised patients: multi‐hospital evaluation

The use of error-prone abbreviations in prescribing is a potential cause of misinterpretation that may lead to medication error. This study determined frequency and type of error-prone abbreviations in inpatient medication prescribing across three Australian hospitals. Three hundred and sixty-nine (76.9%) patients had one or more error-prone abbreviations used in prescribing, with 8.4% of orders containing at least one error-prone abbreviation and 29.6% of these considered to be high risk for causing significant harm.

Assessing Controlled Substance Prescribing Errors in a Pediatric Teaching Hospital: An Analysis of the Safety of Analgesic Prescription Practice in the Transition From the Hospital to Home

Iatrogenic errors producing serious and often preventable injury occur frequently in hospitalized patients, particularly in children. Little is known about the epidemiology of analgesic medication errors in patients being discharged from the hospital. The goal of this study was to describe the epidemiology of controlled substance prescription errors by physicians-in-training for children being discharged from the hospital. We conducted a prospective, observational study of the analgesic prescriptions and discharge forms of 241 pediatric patients discharged from a Children's Center of a major urban teaching hospital from November 2003 to April 2004. All patients who were actively followed by the Pediatric Pain Service at the time of their discharge and were discharged with an analgesic prescription were included in the study. Primary outcome variables were the percentage of prescriptions that contained at least 1 medication error or potential adverse drug event. Errors were defined using the Institute for Safe Medication Practices' (ISMP) List of Error-Prone Abbreviations, Symbols, and Dose Designations, literature review, expert panel consensus, and the Johns Hopkins Department of Pharmacy hospital formulary. Two hundred forty-one patients who received 314 prescriptions were included in this study. Prescription errors were common; 257 of 314 (82%) of the prescriptions examined contained 1 or more errors. The most common errors were missing or wrong patient weight (n = 127, 77%), incomplete dispensing information (n = 167, 53%), and no or wrong date on prescription (n = 19, 6%). Nine prescriptions (2.9%) had the potential for significant medical injury and were considered potential adverse drug events. Discharge prescription errors for children requiring potent, opioid analgesic drugs in the management of pain are common, and nearly 3% could cause significant harm. The high rate of prescribing errors highlights the importance of developing, testing and implementing effective error-prevention strategies, especially in high-risk medications such as narcotics. Narcotic prescriptions written by trainees at discharge from a pediatric hospital are error prone and nearly 3% have the potential to cause significant harm. With a low therapeutic profile, the hospital may consider a review/verification process to reduce the risk of patient harm.

Ban abbreviations

Colorado Springs, Colo. Send comments to Letters Editor, Nursing2008, 323 Norristown Road, Suite 200, Ambler, PA 19002-2758. Or send e-mails (no attachments, please) to [email protected]. Please include your name, credentials, complete mailing address, e-mail address (if applicable), and daytime phone number. Letters are edited for content, length, and grammar. Editor's note: We stand corrected, but D/C, sq, and HS are on the Institute of Safe Medication Practices' List of Error-Prone Abbreviations, Symbols, and Dose Designations. See http://www.ismp.org for more information.

How to Eliminate “Do Not Use” Abbreviations

Our facilities are aware of and have tried to eliminate the use of ambiguous, error-prone abbreviations, symbols, and dose designations identified by The Joint Commission (formerly the Joint Commission for the Accreditation of Healthcare Organizations) and the Institute for Safe Medication Practices (ISMP)1,2 because using them is dangerous. Errors caused by ambiguous abbreviations also were discussed extensively in an Institute of Medicine (IOM) report.3 However, these abbreviations still crop up with alarming frequency. How can we put an end to them? Americans love abbreviations-you'll find them everywhere, from their license plates to their e-mails. In medicine, abbreviations are in part necessary to compensate for heavy workloads, and in part used because of powerful tradition and the unique dialect of medical culture. In fact, some abbreviations are so ingrained that health care professionals use them in notes to themselves, casual correspondence, and personal to-do lists. Much of the medical shorthand used in prescribing dates back to the 1400s, when Latin was used as a universal language. As a dead language (a language with no native speakers), it was exact in its meaning and unlikely to be misinterpreted. Many health care providers, having used these abbreviations for decades, are unwilling or reluctant to change.

Campaign to Eliminate Use of Error-Prone Abbreviations

The FDA and the Institute for Safe Medication Practices (ISMP) announced a new campaign focused on the elimination of the use of error-prone abbreviations in medicine. It has long been recognized that the use of abbreviations in prescriptions and drug orders has been a root cause of a number of medication errors. The Joint Commission on Accreditation of Health Care Organizations (JCAHO) has even specified that certain abbreviations must appear on an accredited organization’s do-not-use list since this type of error is easily preventable by avoiding the use of those abbreviations for drug names, dosage forms, dosage units, and within the SIG of a medication order. Despite this knowledge and previous efforts, medication errors still occur because the use of errorprone abbreviations in medical communications has not been eliminated. The new campaign includes a national education effort to eliminate the use of ambiguous medical abbreviations that are frequently misinterpreted and can lead to mistakes that result in patient harm. The target audience for the campaign is everyone involved with medical communication, including written medication orders, computer-generated labels, medication administration records, pharmacy or prescriber computer order entry screens, and commercial medication labeling, packaging, and advertising. These groups will include health care professionals, health care students, medical writers, the pharmaceutical industry, and FDA staff. The message will be delivered with targeted educational materials, articles for professional journals, and presentations at various conferences and meetings. By broadening the scope of this type of campaign, we can only hope that its impact will be greater than previous efforts targeted at only health care professionals. Components of this campaign include a brochure to be distributed to medical professionals, the pharmaceutical industry, and medical publishing professionals; a print public service ad that will be sent to professional trade publications; posters with reminders about commonly used error-prone abbreviations for health care facilities; an online tool kit of materials, including PowerPoint slides for presentations at conferences and meetings; and a patient safety video. All of these components can be accessed at www.fda.gov/cder/ drug/MedErrors and www.ismp. org/tools/abbreviations. Another useful tool is the list of error-prone abbreviations, symbols, and dose designations developed by ISMP. This list is easily accessible on the ISMP Web site (www.ismp.org) and makes a great reference piece near work stations and office computers. The success of this program in reducing medication errors is dependent on practitioner acceptance and implementation of these recommendations. We all need to do our part to ensure that this is a successful program, so we can decrease the risk of avoidable error from causing harm to our patients. So the next time you see one of these abbreviations, let the person that used it know about the problem and share some of these wonderful resources (brochure, posters, or Web sites) with them. You may also want to consider adding a section on or reference to this topic to your educational presentations (eg, inservices, continuing education, public forums). Each of these is an important step in decreasing the risk of a medication error and should be implemented whenever possible.