The pharmacist can play a key role in ensuring that healthcare practitioners avoid using medical abbreviations that have been deemed "off-limits" by The Joint Commission (TJC), according to a new study. In the study, the researchers sent monthly e-mail reminders to individual practitioners who they had identified as being repeat violators. The e-mails detailed their unapproved abbreviations and the reason(s) why the abbreviations were prohibited.
"We found that the pharmacist-led e-mail strategy led to a rapid, significant decrease in the number of practitioners using unapproved abbreviations as well as the total number of unapproved abbreviations," said Juliana Chan, PharmD, assistant director of pharmacy clinical services at the University of Illinois Medical Center (UIMC) in Chicago.
As a condition for accreditation by TJC, all healthcare organizations are required to comply with a mandate by the organization prohibiting them from using selected abbreviations for all medication-related documentation. The abbreviations must be avoided whether the documentation is handwritten or entered as free-text on a computer or on preprinted forms. The list was "implemented" in 2005 with the intention of standardizing abbreviations, acronyms, and symbols as part of the TJC's requirements for meeting National Patient Safety Goals.
The official "Do Not Use" list includes, for example, "U," which refers to "unit." "U" should not be used because it can be mistaken for "0" (zero), the number "4" (four) or "cc." Instead, healthcare practitioners should write the word "unit."
"IU," which refers to "international unit," is also included in the list of banned abbreviations because "IU" can be mistaken for "IV" (intravenous) or the number "10" (ten). Instead, healthcare practitioners should write "international unit."
The list also includes "QD" (every day), "QOD" (every other day), "MS" or "MSO4" (morphine sulphate), "MgSO4" (magnesium sulphate), decimal doses without leading zeros, and trailing zeros after a decimal point.
Several additional abbreviations, acronyms, and symbols are being considered for inclusion in the official "Do Not Use" list. These include the symbol "@," which may be mistaken for the number "2" (two), and the abbreviation "μg," which may be mistaken for "mg" (milligrams) resulting in a one thousand-fold overdose.
Chan and colleagues reviewed electronic medical records at UIMC over a recent 9-month period to identify noncompliant practitioners and then to test the usefulness of personal follow-up emails from a pharmacist in improving compliance. E-mails were only sent to practitioners who had used at least six banned abbreviations in a single month.
During the study period, 1663 practitioners used a total of 13,663 unapproved abbreviations. Of the 1663 practitioners, 37.3% were resident physicians, 21.4% were nurses, 15.3% were attending physicians, 8.4% were medical students, and the rest were a mix of pharmacists, social workers, and dietitians. Notably, medical residents and attending physicians accounted for more than three quarters of the total number of abbreviations.
Since the implementation of follow-up e-mails, the total number of practitioners using an unapproved abbreviation has decreased 13.7% from 1317 to 1136. The total number of unapproved abbreviations was reduced by 32.3% from 8147 to 5517.
"We were surprised at how effective e-mails were in making our institution more TJC-compliant," Chan said. "We knew that it would be time-consuming, but it paid off."
She also noted that her group is considering using e-mails for other TJC initiatives, such as medication reconciliation.