Abstract
Background The use of error-prone abbreviations has led to medication errors. Many safety organisations have introduced ‘Do Not Use’ lists (lists of error-prone abbreviations that should be avoided by prescribers), but the effectiveness of these lists have not been studied. Objective We assessed the effectiveness of the ‘Do Not Use’ list introduced to the study hospital, and sought the attitudes of healthcare professionals on other potentially dangerous abbreviations (not included in the ‘Do Not Use’ list) used in prescriptions. Setting The study was conducted in a university affiliated tertiary hospital in Hong Kong. Methods An uncontrolled observational study was conducted. In-patient prescriptions were reviewed to assess the use of error-prone abbreviations included in the ‘Do Not Use’ list before, after its introduction, and following the first reinforcement. An on-line survey was also conducted among prescribers, pharmacists and nurses. Main outcome measure Rate of using error-prone abbreviations and other unapproved abbreviations among reviewed prescriptions. Results 3,238 prescriptions (23,398 drug items) were reviewed. The use of abbreviations in the ‘Do Not Use’ list decreased from 7.8 to 3.3 % after its introduction (P < 0.001) and to 1.3 % after the first reinforcement (P < 0.001). However, unapproved abbreviations were used to denote prescribing instructions in 19.2 % of the drugs prescribed. 49 different types of unapproved abbreviations were used for drug names. Conclusions A ‘Do Not Use’ list is effective in reducing error-prone abbreviations. Reinforcements of the ‘Do Not Use’ list further improves prescriber adherence. However, many other unapproved abbreviations (not included in current ‘Do Not Use’ lists) are used when prescribing. Periodic reminders on error-prone abbreviations and education of prescribers on associated risks may help to reduce the use of error-prone abbreviations in hospitals.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brunetti L, Santell JP, Hicks RW. The impact of abbreviations on patient safety. Jt Comm J Qual Patient Saf. 2007;33:576–83.
Parvaiz MA, Subramanian A. The use of abbreviations in medical records in a multidisciplinary world-an imminent disaster. Commun Med. 2008;5:25–33.
Das-Purkayastha P, McLeod K, Canter R. Specialist medical abbreviations as a foreign language. J R Soc Med. 2004;97:456.
Traynor K. Enforcement outdoes education at eliminating unsafe abbreviations. Am J Health Syst Pharm. 2004;6:1314–5.
Benjamin DM. Reducing medication errors and increasing patient safety: case studies in clinical pharmacology. J Clin Pharmacol. 2003;43:768.
Lilley LL, Guanci R. Look-alike abbreviations: prescriptions for confusion. Am J Nurs. 1997;97:12.
Institute of Safe Medication Practices. Please don’t sleep through this wake up call. Medication Safety Alert! http://www.ismp.org/Newsletters/acutecare/archives.asp (2011). Accessed Mar 2011.
National Coordinating Council for Medication Error Reporting and Prevention. Recommendations to correct error-prone aspects of prescription writing. http://www.nccmerp.org/pdf/reportFinal2005-11-29.pdf (2013). Accessed Feb 2013.
Institute of Safe Medication Practices. ISMP’s list of error-prone abbreviations, symbols and dose designations. http://www.ismp.org/tools/errorproneabbreviations.pdf (2012). Accessed Aug 2012.
The Joint Commission. Official ‘Do Not Use’ list of abbreviations. https://www.hnfs.com/content/dam/hnfs/tn/prov/news/pdf/Prov_News_10_2010_V6_I10.pdf (2013). Accessed Feb 2013.
Australian Commission on Safety and Quality in Healthcare. National terminology, abbreviations and symbols to be used in the prescribing and administering of medicines in Australian hospitals. http://www.countryhealthsa.sa.gov.au/LinkClick.aspx?fileticket=MrTKXCi7fEY (2013). Accessed Feb 2013.
Dooley MJ, Wiseman M, Gu G. Prevalence of error-prone abbreviations used in medication prescribing for hospitalised patients: multi-hospital evaluation. Intern Med J. 2012;42:19–22.
Abushaiqa ME, Zaran FK, Bach DS, et al. Educational interventions to reduce use of unsafe abbreviations. Am J Health Syst Pharm. 2007;64:1170–3.
Whyte M. Computerised versus handwritten records. Paediatr Nurs. 2005;17:15–8.
Sheppard JE, Weidner LCE, Zakai S, et al. Ambiguous abbreviations: an audit of abbreviations in paediatric note keeping. Arch Dis Child. 2008;93:204–6.
Garbutt J, McNaughton C, Highstein G, et al. Reducing medication prescribing errors in a teaching hospital. Jt Comm J Qual Saf. 2008;34:528–36.
Flanigan TS, McFarlane E, Cook S. Conducting survey research among physicians and other medical professionals: a review of current literature. Proceedings of the Section on Survey Research Methods of the American Statistical Association. American Statistical Association: Alexandria, VA; 2008.
Viera AJ, Edwards T. Does an offer for a free on-line continuing medical education (CME) activity increase physician survey response rate? A randomized trial. BMC Res Notes. 2012;5:129.
Acknowledgments
The authors wish to thank Dr. J. M Johnston, Associate Professor, School of Public Health, for her advice on conducting the survey.
Funding
This work was supported by the Faculty Research Fund, Li Ka Shing Faculty of Medicine University of Hong Kong received by BMYC; University Postgraduate Fellowship, Postgraduate Scholarship from the University of Hong Kong and the Wong Ching Yee Medical Scholarship for 2012 received by NRS.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Samaranayake, N.R., Cheung, D.S.T., Lam, M.P.S. et al. The effectiveness of a ‘Do Not Use’ list and perceptions of healthcare professionals on error-prone abbreviations. Int J Clin Pharm 36, 1000–1006 (2014). https://doi.org/10.1007/s11096-014-9987-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-014-9987-9