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Check your unacceptable abbreviations against the JCAHO's new list

Hospital Pharmacy Regulation Report, December 10, 2003

Check your unacceptable abbreviations against the JCAHO’s new list

If you’ve already given a list of unacceptable abbreviations to your pharmacy staff, you’ll have to create a new one.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) on November 3 released a list of nine unacceptable drug abbreviations, acronyms, and symbols that will go into effect January 1, 2004. Hospitals must also choose three additional prohibited abbreviations by April 1, 2004.

The JCAHO will give facilities an “in compliance” score if they present a plan to comply fully by the end of 2004. Read the full story at www.jcaho.org under the National Patient Safety Goals frequently asked questions.

For creative ways to educate your staff about the required list of unacceptable abbreviations, HPRR turned to two of your colleagues who shared their ideas.

Get those laminates back
The pharmacy and quality improvement coordinator at Warren Hospital in Phillipsburg, NJ, created laminated cards containing the hospital’s list of unaccepted abbreviations, says clinical pharmacy coordinator Priti Merchant, PharmD. The medication use evaluation committee selected candidates for the hospital’s list based on the Institute for Safe Medication Practices (ISMP) list at www.ismp.org and some of the commonly used abbreviations that can lead to medication errors. The pharmacy and therapeutics (P&T) committee then created the final list.

In its original list however, the pharmacy did not cite three abbreviations that are on the JCAHO list, including “Q.D.,” an abbreviation of the Latin for “once daily” (see the box on p. 3 of the PDF of this issue for a complete list of the JCAHO’s unacceptable abbreviations). The pharmacy must now add the three unacceptable abbreviations to its list, Merchant says.

Organizing a committee to research the lists of unacceptable abbreviations is the best way to achieve compliance, says Ben Muoghalu, PharmD, pharmacy director at Provena St. Joseph Medical Center in Joliet, IL.

At a minimum, pharmacists and nursing educators should sit on the committee and research abbreviations that could lead to medication errors at the hospital, he says.
TIP: Solicit physician opinions when selecting your hospital’s unaccepted abbreviations. Physicians will understand what they can and cannot use if they have a part in choosing the unacceptable abbreviations, instead of just reading about them in a memo.

Educate hospital staff
Pharmacy staff must help educate physicians, nurses, and other staff about the unacceptable abbreviations. Merchant says that Warren Hospital’s pharmacy did the following in order to comply:
• Sent staff laminated cards with the abbreviations and posted signs at nursing stations and in the pharmacy to tell people what they can and cannot use when writing a medication order
• Hung posters in the physicians’ lounge to educate staff about the abbreviations

The pharmacy at Provena St. Joseph Medical Center printed a list of unacceptable abbreviations in its pharmacy newsletter, Muoghalu says.

TIP: Speak with physicians and nurses one-on-one to tell them which abbreviations are prohibited. This will help them understand what they cannot use. Provena has made a point of holding these one-on-one sessions between pharmacists and physicians. “Doctors are creatures of habit,” Muoghalu says. “They’re going to keep doing what they’ve done for the last 20 years.”

Enforce the rules
Call the physician if the pharmacy receives a medication order with an unacceptable abbreviation, Muoghalu says. Provena’s pharmacy staff will not fill the order until physicians clarify what they meant by the abbreviation, he says.

At Warren Hospital, the pharmacy takes a similar approach. Pharmacy staff at your facility may want to adapt the following tactics that have proven to be effective at Warren:
• Enter any order with an unapproved abbreviation into your hospital’s error tracking database, Merchant says.
• Contact the physician. If a pharmacist cannot confirm the order, he or she will fill it to prevent a delay in patient care, Merchant says.
• Keep calling physicians until they stop using unacceptable abbreviations.

“Over time, I think they’ll get tired of us calling them,” Merchant says.