August 20, 2004

VUMC cracks down on problem- prone medical abbreviations

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Shelley Moore, M.S.N., R.N.

VUMC cracks down on problem- prone medical abbreviations

by Paul Govern

In the interest of patient safety, VUMC will no longer tolerate any use of prohibited, problem-prone medical abbreviations.

Used in medication orders and clinical notes, the troublesome abbreviations have been targeted for elimination by both the Joint Commission for Accreditation of Healthcare Organizations and the National Coordinating Council for Medication Error Reporting and Prevention. The abbreviations were first banned at VUMC in late 2002.

Last week, a new program of staff and faculty education about the restrictions was started, and VUMC pharmacies began rejecting as illegible any prescriptions that include banned abbreviations.

The Medical Records Committee is sponsoring the effort to rid the abbreviations from VUMC.

“These abbreviations can cause confusion, misreading, and ultimately, medical errors,” said Jim N. Jirjis, M.D., assistant chief medical officer and chair of the Medical Records Committee. “We’ve organized a multi-faceted campaign to root out these abbreviations once and for all, whether in handwriting, on care plans, in order sets, progress notes, nursing notes — anywhere.”

• VUMC pharmacies are no longer accepting prescriptions containing the abbreviations.

• Hospital coders will flag improper abbreviations in the patient chart, requesting clarification.

• Doctors and nurses will be required to view a brief Web-delivered presentation outlining the VUMC policy regarding proper use of medical abbreviations.

• The compliance office will expand chart audits to include assessment and feedback about use of abbreviations.

• Nursing reviews will include assessing proper use of abbreviations.

• To help get out the word, thousands of pens are being distributed at VUMC with the “Do not use” list printed on them.

• The screen saver on VUMC clinical workstations will feature reminders about the “Do not use” list.

• The electronic prescription writer will not use any abbreviations.

The decision to prohibit the abbreviations was approved by the Pharmacy and Therapeutics Committee, the Clinical Practice Committee and the Medical Records Committee. The VUMC Medical Record Handbook has been updated to include the list of prohibited abbreviations.

Below is a list of banned abbreviations. The explanation of common misunderstandings is from the National Coordinating Council for Medication Error Reporting and Prevention.