Nursing

Taking the hard-line approach against dangerous abbreviations

Nurse Leader Weekly, February 9, 2004

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Take a firm stand against staff who continue to use unapproved
abbreviations, or you'll face complications during your next survey by the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
That was the lesson learned by San Antonio's University Health System
(UHS) during its December 2003 survey.

Like all JCAHO surveys in recent months, the surveyors scrutinized how
well the hospital implemented the JCAHO's National Patient Safety Goals.
Specifically, surveyors wanted to know how the central Texas organization prevents physicians and nurses from using abbreviations that are on the hospital's do-not-use list (Goal #2b).

Reminder: On January 1, the JCAHO made effective its own list of nine
dangerous abbreviations, acronyms, and symbols that hospitals can no
longer use. In April, the JCAHO will require all hospitals to adopt three
additional do-not-use abbreviations from a list of seven that it has
identified as dangerous and confusing.

UHS includes 12 abbreviations on its do-not-use list. Surveyors combed
through a year's worth of medical records and written orders to verify
whether physicians and others adhered to it.

Surveyor investigation: When they found several instances in which a
physician had used one of the dangerous abbreviations, the surveyors
looked for evidence that the pharmacist, nurse, or other person who caught the error contacted the physician to clarify the order verbally or in
writing.

TIP: You can help physicians understand the value of writing out
abbreviations longhand by showing them examples of errors that have
occurred within your own hospital due to misinterpretation of an
abbreviation. Once they see the possible consequences, they will be apt to try harder.

Surveyors were impressed with several of UHS's patient safety initiatives,
including one that requires unit nurses to scan all written orders and
file the image in the hospital's network system. This allows pharmacists
and pharmacy techs to view the physician's original order.

Other initiatives that received praise from the surveyors included the
following:

Medication safety: A medication focus safety group within UHS has worked to find ways to help nurses feel comfortable telling their peers not to disturb them while they dispense medications.

One solution developed by Tess Pape, PhD, RN, quality and process
improvement coordinator, is for nurses to wear a red safety vest while
dispensing medications. The vests alert other staff members that they are
not to be disturbed. The back of the vest clearly reads, "MEDSAFE-Do not
disturb."

Good documentation: In another safety initiative, the hospital posts signs
and reminders that nurses should not only verify that they have the right
patient, drug, dose, time, and route, but that they should also document
in the medical record everything that they do for the patient.

Positive feedback: Supervisors try to encourage behavior that promotes
patient safety by giving positive feedback to staff as often as possible.
Quality improvement staff encourage managers to leave "Post-It" notes that compliment staff on their efforts.

A note left for a nurse on the medical surgical floor, for example, might
say, "I noticed that you locked your medication cart. You did a good job.
Thank you!" Other notes are gently constructive, such as "You left your
computer screen on. In the future, please make sure you shut it down when you leave."



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