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How to eliminate dangerous abbreviations

Accreditation Connection, July 30, 2004

Hospitals in the Madison (WI) Patient Safety Collaborative share seven of their most successful strategies for eliminating four dangerous abbreviations, acronyms, and symbols from 90% of all inpatient-medication orders:

1. Medical leaders and other influential physicians send reminder letters to physicians and nurses who used error-prone abbreviations. The medical-affairs vice president (VP) followed up personally with frequent offenders.

2. Unit clerks fill out an audit form each time they receive an order that contains an inappropriate abbreviation. The medical-affairs VP collects the forms daily and immediately contacts prescribers who used the targeted abbreviations.

3. Staff place educational journal articles, posters, and signs around the organization, including in staff restrooms and on computer screens as screensavers.

4. Hospitals employ a "hard stop" on orders with error-prone abbreviations. Pharmacists who receive a medication order that includes any of the targeted abbreviations require the prescriber to either rewrite it or clarify the order verbally.

5. Hospitals include education about error-prone abbreviations and medication ordering requirements in new-employee orientation programs for pharmacists, nurses, and physicians.

6. Nurses and others place fluorescent warning stickers on charts that contain orders with error-prone abbreviations.

7. Hospitals created pocket cards that list the four error-prone abbreviations and the preferred alternative. They distribute them to house staff, attending physicians, new residents, and third-year medical students.

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