How can eliminating abbreviations reduce errors?
Basic tenet of patient safety is effective communication practices, and poor handwritings, use of dangerous abbreviations, symbols or notations, as well as their misinterpretations will obstruct effective communication. Working knowledge of medical terminology is a basic necessity for all members of a healthcare team, and misinterpretation of diagnosis, treatment procedure, and medication will be hazardous and lead to medication errors. In an effort to improve efficiency and saving time clinicians generally use symbols and abbreviations when writing prescriptions, completing documentation in patient charts, and issuing other orders. Abbreviations, symbols, signs, and notations are used to facilitate fast communication and failure of healthcare providers to communicate clearly with other caregivers will exacerbate medication errors.
It is well documented that misinterpretation of abbreviations, acronyms, symbols, and dose designations in prescribing and transcribing orders can lead to medication errors, such as: “administration via the wrong route; unintended discontinuation of medications; wrong strengths; wrong dosages; extra or improper doses; and administering the wrong drug” (Fry, 1). For example the intended meaning of abbreviation ‘D/C’ may be either “discharge’ or “discontinuation.”
Whereas, this abbreviation can be misinterpreted as “premature discontinuation of medications,” if D/C (intended to mean ‘discharge’) has been misinterpreted as ‘discontinue,’ when followed by a list of discharge medications” (ISMP, 2009). By using the word ‘discharge’ and ‘discontinuation’ specifically according to the prerequisite, rather than the abbreviation ‘D/C’ any unnecessary complication in medical error and discomforting situations can be eliminated. By universal standardization of abbreviations that are specific to clinical use the chances of multiple interpretations, or misinterpretations of medical terms could be eliminated.
Should written policies be developed for abbreviation usage? If yes, what should the policies contain? If not, explain.
Documentation errors have always been part of the healthcare profession. Some people in the medical field believe that errors are the result of using abbreviations in handwritten documentation related to patients. The Institute of Medicine (IOM) report of 2006 revealed that there were at least 1.5 million preventable medication errors each year in the United States, and the estimated annual cost for these preventable medical errors is at $3.5 billion in hospitals alone. (Fry). “Although no single recommendation or activity offers a full solution to medical error, error prevention experts agree that successful error reduction strategies depend heavily on responsible detection and open reporting of errors.” (Discussion Paper on adverse Event and Error Reporting in Health Care).
Current healthcare scenario is more demanding, because of escalating aged patient population, reduced health care providers, more stress on quality of care, and greater expectations from healthcare receivers. Writing and maintaining large volumes of records as part of assuring quality of care consume precious time of all the healthcare providers. Under such circumstances symbols, abbreviations, and notations become handy and time saving. Uniform abbreviations, free from misinterpretation will assist health care providers to reduce medical errors emanating from abbreviations, and eliminate litigations associated with error of judgment. Therefore, accreditation agencies are now composing lists of terms that should not be abbreviated. Development of written policies and educating health care providers to strictly adhere to these policies will reduce medication errors resulting from abbreviations.
When are abbreviations acceptable? Who should use them and why?
Studies indicate that majority of abbreviation errors originate from medical staff, because of “poor prescription writing habits and use of error-prone medical notations” by medical staff, as well as the abbreviations have “more than one meaning or can be easily misread” (Fry, 2). The National Coordinating Council on Medication Error Reporting and Prevention recommends that “eliminating organizational tolerance of at-risk behavior, determining system-based reasons for at-risk behavior, increasing awareness of at-risk behaviors, eliminating system-wide incentives for at-risk behavior, and motivating through feedback and rewards”are fundamental components for reducing medication errors. (Council Recommendations). Abbreviations that are consolidated by national accreditation agencies in consultation with various stakeholders and participating agencies in healthcare shall be more authentic and acceptable to maintain uniform standards.
Unexplained abbreviations are found to cause frustration and confusion, particularly when the case notes are from an unfamiliar specialty. Medical abbreviations are often used to “facilitate and shorten written narratives,” which is an acceptable practice, as long as universally recognized and understood abbreviations are used. (Emergency Treatment Guidelines: Medical Abbreviations, 1). Hence, the Joint Commission established its National Patient Safety Goals (NPSGs) program in 2002, with an objective to “help accredited organizations address specific areas of concern in regards to patient safety” in the U.S. (The Joint Commission. 2009). The Joint Commission is an independent not-for-profit organization with a mission to “continuously improve the safety and quality of care provided to the pubic through the provision of health care accreditation and related services that support performance improvement in health care organizations.” (About the Joint Commission). The ‘do not use’ list of abbreviations developed by the Joint Commission as part of the requirement for meeting National Patient Safety Goal Requirement 2B is an important document in assisting healthcare providers to reduce medication errors. This list could be adopted by all the healthcare providers and clinicians to improve their performance. Distributing a list of universally acceptable abbreviations, with explanations, among frontline healthcare providers like physicians, nurses, and pharmacists by accreditation agencies is indispensable for performance improvement in health care organizations.
According to the information in the online articles, do you think enough steps have been taken to reduce errors? Explain why you agree or disagree.
Compliance with the NPSGs is a critical and demanding part of the accreditation process, and it is expected that healthcare providers will adhere to adopting obligatory medical error elimination parameters. Since the development and updating of the NPSGs is overseen by an expert panel of professionals in healthcare delivery, and the goals highlight serious patient safety issues that need to be addressed by health care organizations, it has to be construed that adequate steps are being taken to reduce errors. In addition, the recommendations to the Joint Commission are made by the advisory group “following a solicitation of input from practitioners, provider organizations, purchasers, consumer groups, and other parties of interest.” (Facts about the National Patient Safety Goals). Hence, in the general perspective it seems that by involving all the stakeholders in the advisory group of Joint Commission adequate steps have been taken to reduce errors.
Institute of Safe Medication Practices (ISMP) assert that its list of error-prone abbreviations, symbols, and dose designations have been “frequently misinterpreted and involved in harmful medication errors” and “they should NEVER be used when communicating medication information.” (ISMPs List of Error Prone Abbreviations, Symbols and Dose Designations, 1). The IOM report of 2006 recommends that access to comprehensive risk-benefit information, clinical outcome data, and effectiveness data by health care providers like physicians, nurses, and pharmacists, including community pharmacists will “not only promote clinical understanding, but also to populate automated decision support systems.” (ISMP comments on IOM Report, Preventing Medication Errors). It also recommended a national taxonomy with standard terminology for error reporting so that data sharing on a national level will be useful. However, it is criticized that National Patient Safety Goals (NPSGs) have become more specific and detailed in some cases, which challenge the time and resources of healthcare organizations to meet these goals.
Study by Din et al (2001) opine that “medical abbreviations are a common problem in understanding operating notes,” and that poor operation notes make it difficult for medical and nursing staff to understand what type of procedure has been performed on the patient (319-320). They suggested the use of an aide-memoire attached to the front of an operation sheet can dramatically improve the quality of operation notes. In another study by Das-Pukayastha and colleagues (2004) found that “6 of 11 commonly used abbreviations in ENT were unclear to more than 90% of junior doctors from other specialties,” and if abbreviations are used in the traditional manner, medical notes may be incompletely understood by the doctor on call (Purkayastha, McLeod and Canter, 456). These findings suggest that written policies are necessary to eliminate abbreviation errors. Literature reviews based on online article information reveal that enough steps taken so far have not fructified in eliminating medical errors.
About the Joint Commission. The Joint Commission. 2009. Web.
Council Recommendations. National Coordinating Council for Medication Error Reporting and Prevention. 2007. Web.
Din, R., et al. The Use of an Aide-Memoire to Improve the Quality of Operation Notes in an Orthopaedic Unit. Ann R Coll Surg Engl. 83.5. 2001. Web.
Discussion Paper on adverse Event and Error Reporting in Health Care: Introduction. The Institute for Safe Medication Practices. 2000. Web.
Emergency Treatment Guidelines: Medical Abbreviations. Manitoba Health. 2006. Web.
Facts about the National Patient Safety Goals. The Joint Commission. 2008. Web.
Fry, Helen, M. Do-Not-Use Abbreviations: Toolkit for Implementing National Patient Safety Goal 2B. Joint Commssion Resources. 2008. Web.
ISMPs List of Error Prone Abbreviations, Symbols and Dose Designations. Institute for Safe Medication Practices. 2007. Web.
ISMP comments on IOM Report, Preventing Medication Errors. Institute for Safe Medication Practices. 2009. Web.
Purkayastha, Prodip Das., McLeod, Katie., and Canter, Richard. Specialist Medical Abbreviations as a Foreign Language. Journal of the Royal Society of Medicine. 97.9. 2004. Web.
The Joint Commission. National Patient Safety Goals: Facts about the National Patient Safety. 2009. Web.