New Joint Commission “Do Not Use” List: Abbreviations, Acronyms, and Symbols
In Brief: The Joint Commission’s list of dangerous abbreviations,
acronyms, and symbols not to be used became effective on January 1, 2004.
To help reduce the numbers of medical errors related to incorrect use of
terminology, the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) recently issued a list of abbreviations, acronyms, and symbols that
should no longer be used.
Since the first Institute of Medicine (IOM) report was published in 1999,
which stated that between 44,000 and 96,000 deaths each year may be attributed
to medical errors, efforts have increased exponentially throughout the health
care system to systematically address the issues and better protect patient
safety. JCAHO's National Patient Safety Goals, which include the “Do Not Use”
list, are one example.
A "minimum list" of dangerous abbreviations, acronyms and symbols has been
approved by JCAHO. Beginning January 1, 2004, the following items must be
included on each accredited organization’s “Do not use” list:
A "minimum list" of dangerous abbreviations,
acronyms, and symbols
|
|
Set
|
Item |
Abbreviation |
Potential Problem |
Preferred Term |
|
1. |
1. |
U (for unit) |
Mistaken as
zero, four or cc. |
Write "unit" |
|
2. |
2. |
IU (for
international unit) |
Mistaken as
IV (intravenous) or 10 (ten) |
Write
"international unit" |
|
3. |
3.
4. |
Q.D.,
Q.O.D.
(Latin abbreviation for once daily and every other day) |
Mistaken for
each other. The period after the Q can be mistaken for an "I" and the "O"
can be mistaken for "I" |
Write
"daily" and "every other day" |
|
4. |
5.
6. |
Trailing
zero
(X.0 mg),
Lack of leading zero (.X mg) |
Decimal
point is missed |
Never write
a zero by itself after a decimal point (X mg), and always use a zero
before a decimal point (0.X mg) |
|
5. |
7.
8.
9. |
MS
MSO4
MgSO4 |
Confused for
one another
Can mean morphine sulfate or magnesium sulfate |
Write
"morphine sulfate" or "magnesium sulfate" |
Medication orders are subject to the initiative, but
so is all clinical documentation, including orders, progress notes,
consultation reports, and operative reports, as well as educational materials
and protocols/pathways.
In January 2004 as JCAHO conducts its facility surveys, it will check to see
that any terms on the "list of dangerous abbreviations are not found in
handwritten clinical documentation." Organizations found not to be in
compliance will be required to submit a plan for continued improvement.
Effective April 1, 2004, (if your organization does not already have
additional "do not use" items in place), each organization must identify and
apply at least another three "do not use" abbreviations, acronyms, or symbols
of its own choosing. The following items can be considered when expanding the
"Do not use" list to include the additional three or more items:
In addition to the
"minimum required list"
|
|
Abbreviation |
Potential Problem |
Preferred Term |
|
µg
(for microgram) |
Mistaken for
mg (milligrams) resulting in one thousand-fold dosing overdose |
Write "mcg" |
|
H.S.
(for half-strength or Latin abbreviation for bedtime) |
Mistaken for
either half-strength or hour of sleep (at bedtime) q.H.S. mistaken for
every hour. All can result in a dosing error. |
Write out
"half-strength" or "at bedtime" |
|
T.I.W.
(for three times a week) |
Mistaken for
three times a day or twice weekly resulting in an overdose |
Write "3
times weekly" or "three times weekly" |
|
S.C. or S.Q.
(for subcutaneous) |
Mistaken as
SL for sublingual, or "5 every" |
Write
"Sub-Q", "subQ", or "subcutaneously" |
|
D/C
(for discharge) |
Interpreted
as discontinue whatever medications follow (typically discharge meds).
|
Write
"discharge" |
|
c.c.
(for cubic centimeter) |
Mistaken for
U (units) when poorly written. |
Write "ml"
for milliliters |
|
A.S., A.D.,
A.U.
(Latin abbreviation for left, right, or both ears) O.S., O.D., O.U. (Latin
abbreviation for left, right, or both eyes) |
Mistaken for
each other
(e.g., AS for OS, AD for OD, AU for OU, etc.) |
Write: "left
ear," "right ear" or "both ears;" "left eye," "right eye," or "both eyes |
By the end of 2004, JCAHO expects full compliance in
all handwritten, print, and electronic media documents related to these
dangerous abbreviations. Further details are available on the JCAHO Web site:
www.jcaho.org.
In addition, the Institute for Safe Medication Practices (ISMP) has published
a list of dangerous abbreviations relating to medication use that it
recommends should be explicitly prohibited. It is available on the ISMP Web
site: www.ismp.org.
If you have questions regarding the content of this
article or JCAHO in general, contact Lisa Kaplan, at the Academy office: (312) 464-9700 or
lkaplan@aapmr.org.
