Abbreviations are used everyday by almost everyone connected to the medical industry. And yet it is this very customary usage that has been facing some serious criticism in the past few years. The reason is quite simple; while abbreviations are no doubt a method to simplify prescriptions and thereby save time they are also, often, the sole reason behind medication errors. Medication mistakes are serious business and can affect a patient’s health severely and even prove to be fatal! A fact most medical practitioners seemed to have missed till a few years ago until when abbreviations where standing protocols.
However recurring cases of medication errors soon urged the medical community to give a serious thought to the use of abbreviations, which often tend to be misinterpreted, both by pharmacy owners and nurses apart from of course the patients themselves. While such a misreading sounds innocuous enough it can have devastating results. Imagine how a seriously ill typhoid patient can be affected due to taking a dose of antibiotic only twice a week after having interpreted TTW (a commonly used abbreviation for three times a week) as two times a week. Most medication errors occur due to miscommunications of this very kind.
While many think that abbreviations, being common amongst medical practitioners, are quite all right to be scribbled onto medical prescriptions they seem to forget that patients (who are usually disconnected with the medical world otherwise) may not understand these short forms and end up misinterpreting them. And why just patients’ even nurses, medical storeowners and even doctors themselves have been known to misread medical short forms. This is only obvious given that there are hundreds of different abbreviations making the rounds in medical circles. The US ISMP and FDA themselves recognize over 200 commonly used medical contractions.
Of course this official figure captures only a fraction of the abbreviations used by doctors today. Also, every medical circle has its own set of contractions, which are usually understood by people belonging to that particular circle only. Given the sheer number of contractions prevalent in the medical world today it is only expected that medical practitioners, of all kind, will be making mistakes interpreting them. Reducing (if not completely eliminating) the use of abbreviations will force doctors to spell out all instructions, doses and the names of medicines in full on all prescriptions, thereby allowing greater ease of understanding.
This in itself will go a long way in reducing medical errors. (Lamb, 2004) Developing a written policy regarding the usage of abbreviations is perhaps one of the best ways to control the use of medical contractions. These policies should be common for all hospitals, clinics and individual practitioners all over the country. The contents of the policy should definitely be directed towards the following necessities, a) The formulation of a facility specifically devoted to reporting the various abbreviation-specific errors being made in the above-mentioned establishments.
b) The suggested facility should first and foremost engage nursing managers, staff leaders, pharmacy staff and others who regularly encounter medical abbreviations through prescriptions to identify some of the most commonly used contractions. These short forms should immediately be used to develop a “DO NOT USE” list, which has now become a requirement of the JCAHO National Safety Goals. Such a list should be used to govern the prescribing phase. c) Not just manual prescriptions computer entry systems too often use abbreviations. To rid the medical system of the contraction crisis all computer data systems should also be updated.
d) Complete awareness, ensured by regular seminars for the medical and the pharmacy staff as well as the doctors is the key to ensuring the reduction of errors due to the use of abbreviations. The policy should thus ensure that such campaigns are a regular phenomenon in all medical institutions. (King, 2006) Following the awareness within the medical community regarding the possible disadvantages of the use of abbreviations the community itself has taken a number of steps to help eliminate medication errors caused by uncertain medical contractions.
A number of these programs have proved to be thoroughly successful, having managed to bring down the use of medical contractions phenomenally. The Institute for Safe Medication Practices (ISMP) along with the Food and Drug Administration (FDA) department for instance has initiated a special nation-wide education campaign specifically directed at reducing the use of abbreviations by doctors and other medical practitioners.
The ISMP-FDA drive intends to educate the medical community about safe practices and thereby thwart serious errors that occur primarily due to ambiguous medication orders, such as abbreviations. For the purpose it has introduced a ‘List of Error-Prone Abbreviations, Symbols and Dose Designations’, (ISMP, 2003) which may be referred to whenever medical information, of any kind, is being communicated.
The ISMP-FDA has also provided an Online Abbreviation Toolkit, which furthers the cause. Apart from such national endeavors there have also been a number of attempts to do away with ‘dangerous abbreviations’ on the part of various individual medical establishments. A case in point would be SSM Health Care who introduced various methods to cut down on the use of abbreviations in 2002 as ‘the part of a broader effort to improve patient safety’. (IHI, 2002)
Similarly, a number of other institutions, such as the Detroit Receiving Hospital relied on educational intervention methods to learn about, strategize against and finally reduce the use of medical contractions and dosage designations regarded hazardous by the medical community. While all these efforts are commendable they are only but the first step towards eliminating medical abbreviations once and for all.
References:
IHI. org; 2002; Cutting the Use of Dangerous Abbreviations: SSM Health Care; Institute for Healthcare Improvement; retrieved on 04. 09.
2007 from http://www. ihi. org/IHI/Topics/PatientSafety/MedicationSystems/ImprovementStories/CuttingtheUseofDangerousAbbreviations. htm ISMP MedicationSafetyAlert; November 27, 2003; ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations; JCAHO; Volume 8 Issue 24; retrieved on 04. 09. 2007 from http://www. usp. org/pdf/EN/patientSafety/ismpAbbreviations. pdf King, H; 2006; Medical Ethics Today; Dunedin: HBT & Brooks Ltd Lamb, D; 2004; Cult to Culture: The Development of Civilization on the Strategic Strata; Wellington: National Book Trust