Abbreviation Pharmacology

Lecture by Dr.Ayman Alromih
Meeqat General Hospital,Madina

1. Eliminating Error-prone Eliminating Error-prone
Abbreviations, Symbols, and Abbreviations, Symbols, and
Dose DesignationsDose Designations

2. 2
The ProblemThe Problem
Ambiguous medical notations are one of the Ambiguous medical notations are one of the
most common and preventable causes of most common and preventable causes of
medication errors.medication errors.
Drug names, dosage units, and directions for use Drug names, dosage units, and directions for use
should be written clearly to minimize confusion.should be written clearly to minimize confusion.

3. 3
Consequences of Consequences of
Using Error-Prone AbbreviationsUsing Error-Prone Abbreviations
Misinterpretation may lead to mistakes that Misinterpretation may lead to mistakes that
result in patient harm result in patient harm
Delay start of therapy due to time spent for Delay start of therapy due to time spent for
clarificationclarification

4. 4
Implement “Do Not Use” ListImplement “Do Not Use” List
The Institute for Safe Medication Practices The Institute for Safe Medication Practices
(ISMP) and the Food and Drug Administration (ISMP) and the Food and Drug Administration
recommend that ISMP’s list of error-prone recommend that ISMP’s list of error-prone
abbreviations be considered whenever medical abbreviations be considered whenever medical
information is communicated.information is communicated.
Complete list is located at:Complete list is located at:
www.ismp.org/Tools/errorproneabbreviations.pdfwww.ismp.org/Tools/errorproneabbreviations.pdf

5. 5
Consider All Communication FormsConsider All Communication Forms
Written ordersWritten orders
Internal communicationsInternal communications
Telephone/verbal prescriptionsTelephone/verbal prescriptions
Computer-generated labelsComputer-generated labels
Labels for drug storage binsLabels for drug storage bins
Medication administration recordsMedication administration records
Preprinted protocolsPreprinted protocols
Pharmacy and prescriber computer order Pharmacy and prescriber computer order
entry screensentry screens

6. 6
Short List of Error-Prone NotationsShort List of Error-Prone Notations**
The following notations should NEVER be used.The following notations should NEVER be used.
NotationNotation ReasonReason Instead UseInstead Use
U U Mistaken for 0, 4, ccMistaken for 0, 4, cc “unit”“unit”
IU IU Mistaken for IV or 10Mistaken for IV or 10 “unit”“unit”
QDQD Mistaken for QIDMistaken for QID “daily”“daily”
*Comprises “do not use” list required for JCAHO accreditation*Comprises “do not use” list required for JCAHO accreditation

7. 7
Short List of Error-Prone Notations Short List of Error-Prone Notations
ContinuedContinued
NotationNotation ReasonReason Instead UseInstead Use
QODQOD Mistaken for QID, QDMistaken for QID, QD“every “every
other day”other day”
Trailing zero Trailing zero Decimal point missedDecimal point missed“X mg”“X mg”
(X.0 mg)(X.0 mg)
Naked decimal Naked decimal Decimal point missed Decimal point missed “0.X mg” “0.X mg”
pointpoint
(.X mg)(.X mg)

8. 8
Short List of Error-Prone Notations Short List of Error-Prone Notations
ContinuedContinued
NotationNotation ReasonReason Instead UseInstead Use
MSMS Can mean morphineCan mean morphine“morphine sulfate”“morphine sulfate”
sulfate or magnesiumsulfate or magnesium
sulfatesulfate
MSOMSO
44 and and Can be confused withCan be confused with“morphine sulfate”“morphine sulfate”
MgSOMgSO
44each othereach other or “magnesium or “magnesium
sulfate” sulfate”
cccc Mistaken for UMistaken for U “mL”“mL”

9. 9
Short List of Error-Prone Notations Short List of Error-Prone Notations
ContinuedContinued
NotationNotation ReasonReason Instead UseInstead Use
Drug name Drug name Mistaken for other drugs Mistaken for other drugs Complete Complete
abbreviationsabbreviations or notationsor notations drug namedrug name
(especially those (especially those
ending in “l”)ending in “l”)
> or <> or < Mistaken as opposite Mistaken as opposite “greater than”“greater than”
of intendedof intended or “less than” or “less than”
μμ Mistaken for mgMistaken for mg “mcg”“mcg”

10. 10
@@ Mistaken for 2Mistaken for 2 “at” “at”
&& Mistaken for 2 “and”Mistaken for 2 “and”
// Mistaken for 1Mistaken for 1 “per” “per”
rather rather
than than
a slash a slash
mark mark
++ Mistaken for 4 Mistaken for 4 “and”“and”
Short List of Error-Prone Notations Short List of Error-Prone Notations
ContinuedContinued
NotationNotation ReasonReason Instead UseInstead Use

11. 11
NotationNotation ReasonReason Instead UseInstead Use
AD, AS, AUAD, AS, AU Mistaken for OD, OS, OUMistaken for OD, OS, OU“right ear,” “right ear,”
“left ear,” “left ear,”
or “each ear”or “each ear”
OD, OS, OUOD, OS, OU Mistaken for AD, AS, AUMistaken for AD, AS, AU“right eye,” “right eye,”
“left eye,” “left eye,”
or “each eye”or “each eye”
D/C, dc, d/cD/C, dc, d/c Misinterpreted as Misinterpreted as “discharge” or “discharge” or
“discontinued” when “discontinued” when “discontinued”“discontinued”
followed by list of followed by list of
medicationsmedications
Short List of Error-Prone Notations Short List of Error-Prone Notations
ContinuedContinued

12. 12
Other Good PracticesOther Good Practices
Drug name abbreviations can easily be Drug name abbreviations can easily be
confused. Always write out complete drug confused. Always write out complete drug
name.name.
Apothecary units are unfamiliar to many Apothecary units are unfamiliar to many
practitioners. Always use metric units.practitioners. Always use metric units.

13. 13
ExamplesExamples

Intended dose of 4 units in patient history Intended dose of 4 units in patient history
interpreted as 44 units. “U” should be written interpreted as 44 units. “U” should be written
out as “unit.”out as “unit.”

14. 14
ExamplesExamples
Intended dose of “.4 mg” interpreted as 4 Intended dose of “.4 mg” interpreted as 4
mg from medication order. Should be mg from medication order. Should be
written as “0.4 mg.”written as “0.4 mg.”

15. 15
ExamplesExamples


““Potassium chloride QD” in medication order Potassium chloride QD” in medication order
interpreted as QID. Should be written as interpreted as QID. Should be written as
“daily.”“daily.”

16. 16
ExamplesExamples

Intended recommendation of “less than 10” Intended recommendation of “less than 10”
was interpreted as 4. “<” should be written out was interpreted as 4. “<” should be written out
as “less than.”as “less than.”

17. 17
ExamplesExamples

““QD” in advertisement should be written out as QD” in advertisement should be written out as
“daily.”“daily.”

18. 18
ExamplesExamples

““U” in prominent professional journal article U” in prominent professional journal article
should be written out as “unit.”should be written out as “unit.”

19. 19
Do Not Use Error-Prone Do Not Use Error-Prone
Abbreviations Even in PrintAbbreviations Even in Print
May still be confused May still be confused
Perpetuates the impression that they are Perpetuates the impression that they are
acceptableacceptable
May be copied into written ordersMay be copied into written orders

20. 20
Recommendations for Recommendations for
Healthcare ProfessionalsHealthcare Professionals
Avoid ambiguous abbreviations in written orders, computer-Avoid ambiguous abbreviations in written orders, computer-
generated labels, medication administration records, storage generated labels, medication administration records, storage
bins/shelf labels, and preprinted protocols.bins/shelf labels, and preprinted protocols.
Work with computer software vendors to make changes in Work with computer software vendors to make changes in
electronic order entry programs.electronic order entry programs.
Provide examples when educating staff on how using error-prone Provide examples when educating staff on how using error-prone
abbreviations have led to serious patient harm.abbreviations have led to serious patient harm.
Provide staff with ISMP’s list of error-prone abbreviations.Provide staff with ISMP’s list of error-prone abbreviations.
Introduce healthcare students to the list of error-prone Introduce healthcare students to the list of error-prone
abbreviationsabbreviations..

21. 21
Recommendations for Recommendations for
Pharmaceutical IndustryPharmaceutical Industry
Review existing drug labeling and packaging as well as new Review existing drug labeling and packaging as well as new
drug applications for use of error-prone abbreviations.drug applications for use of error-prone abbreviations.
Eradicate use of ambiguous abbreviations in product Eradicate use of ambiguous abbreviations in product
advertising (both in graphics and text).advertising (both in graphics and text).
Check for error-prone abbreviations in all communications Check for error-prone abbreviations in all communications
vehicles, including slides, promotional kits, and sales staff vehicles, including slides, promotional kits, and sales staff
training materials.training materials.
Include ISMP’s list in corporate editorial style guidelines.Include ISMP’s list in corporate editorial style guidelines.
Incorporate list into software and medical device design.Incorporate list into software and medical device design.

22. 22
Recommendations for Medical Recommendations for Medical
Communications/Publishing ProfessionalsCommunications/Publishing Professionals
Make “do not use list” of notations as part of Make “do not use list” of notations as part of
publishing style manuals and internal style guides for publishing style manuals and internal style guides for
clinical writing.clinical writing.
Add the list of error-prone abbreviations to Add the list of error-prone abbreviations to
instructions for journal authors.instructions for journal authors.
Review all internal and external communications Review all internal and external communications
products for ambiguous abbreviations.products for ambiguous abbreviations.
Eliminate error-prone abbreviations in company-wide Eliminate error-prone abbreviations in company-wide
educational and training sessions.educational and training sessions.

23. 23
Other ResourcesOther Resources
For more information and tools to help For more information and tools to help
promote safe practices, visit:promote safe practices, visit:
www.ismp.org/tools/abbreviationswww.ismp.org/tools/abbreviations
oror
www.fda.gov/cder/drug/MedErrorswww.fda.gov/cder/drug/MedErrors