The Joint Commission upon Accredita...

The Joint Commission upon Accreditation of Healthcare Organizations (JCAHO) has established a safety goal for 2004 related to the use of dangerous abbreviations, acronyms, and types Abbreviations contribute to medical errors when clinicians misinterpret a literal meaning or symbol and, because of this misinterpretation, administer a unfair medication or dose or give medication at the unfit time or with the unfit frequency. The Joint Commission approves that facilities limit their use of certain abbreviations and has required facilities to stop using five specific establishs of abbreviations as of Jan 1 2004 They also require that facilities expand their "do-not-use" lists to include three or more additional abbreviations of the facilities' choosing by means of April 1, 2004. (1)

commonly these requirements relate to all handwritten, patient-specific documents, including orders, progres notes, surgical acquiescences and reports, and consultation reports. Beginning Jan 1 2005 compliance with these guidelines will be wait fored for all types of documentation media, including printed and electronic clinical and laboratory records. (1)

THE FIVE DO-NOT-USE ABBREVIATIONS

The five abbreviations that must not be used are abbreviations that can be ambiguous or confusing to clinicians, as well as an that have led to serious medication errors. The first abbreviation forward the do-not-use list is the abbreviation "U" (ie, units). This abbreviation has been mistaken for a naught a four, or even cc (ie, cubic centimeter). Consider a situation in which an order for insulin is written or transcribed as, "give 80 regular insulin." as it was an order easily could be interpreted as "give 80 regular insulin," and the patient could be given a dose that is 10 times the dose intended. The Joint Commission commits that "U" be written without as units to minimize the risk of misinterpretation errors. (1)

The next to the first do-not-use abbreviation is "IU" (ie, international traits). This abbreviation can be misread as IV or 10 in the same state [i]or[/i] condition a misinterpretation could result in a patient inadvertently receiving a medication intravenously instead of at the intended route or receiving the immoral dose. (1) To avoid confusion, the abbreviation should be written without as international units.

The third settle of abbreviations on the JCAHO do-not-use list includes "QD" (ie, each day) and "QOD" (ie, each other day). These abbreviations are commonly confused with each other and, in the case of QOD the "O" can be mistaken for an "I," indicating four times daily. If periods are used (ie, QD) the period may be mistaken for an i. like errors can result in administration of an overdose or inadequate dose of a medication; therefore, JCAHO commends writing out the words daily or each other day. (1)

A public medication error relates to the use of a trailing naught (eg, 1.0) or lack of leading naught (eg, .1) when a decimal point is used, because the decimal point may not be seen To impede an error when using decimal points, JCAHO commits never writing a zero by dint of itself after a decimal point (eg 1 mg) and always using a naught before a decimal point (eg 01 mg)

The final establish of do-not-use abbreviations are "MS" "MS[Osub4]" and "MgS[Osub4]" The Joint Commission attract favor tos writing out morphine sulfate or magnesium sulfate to minimize the confusion related to abbreviations for these couple medications.

THREE MORE OF THE FACILITY'S CHOOSING

In addition to these abbreviations, JCAHO requires each facility to include three additional abbreviations forward their do-not-use list. In perioperative settings, a number of abbreviations may contribute to the potential for error. For example, use of the abbreviations "AS," "AD," and "AU"--left ear, right ear, the two ears, respectively--and "OS," "OD," and "OU"--left estimate right eye, both eyes, respectively--in perioperative settings may lead to confusion about the laterality of inspection or ear surgery or where to administer estimate or ear drops. The Joint Commission commends that clinicians write left ear, right ear, or the two ears when referring to ears and left sight right eye, or both inspections when referring to eyes. (1)

Another put of inconsistently used abbreviations are used to indicate "subcutaneous." The abbreviation "SC" can be mistaken for "SL" (ie, sublingual) and "SQ" can be mistaken as "5 every" Clinicians should write sub-Q subQ or subcutaneous instead.

Another abbreviation that can contribute to confusion is "cc" which can be mistaken for "U" if it is poorly written. The Joint Commission prompts using "mL" or "milliliters" instead. (1) These three examples of potentially confusing abbreviations, figures or dose designations are an that facilities may want to consider eliminating. (1)

The standard does not require hospitals to expand an approved list of abbreviations, unless they must develop a do-not-use list. (1) Abbreviations upon the do-not-use list should not be used in any format, including upper or lower case epistles or with or without periods. The Joint Commission intends to assess compliance with this safety goal and related standards through reviewing patient care records and determining the rank of adherence to these recommendations.