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JCAHO releases new guidance on its 'abbreviations' patient safety goal

Patient Safety Monitor Alert, September 15, 2004

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The JCAHO's prohibited abbreviations requirement applies only to handwritten orders and other handwritten, patient-specific documentation, according to a clarification from the accreditor regarding its 2004 National Patient Safety Goals.

"As a long-term objective, ambiguous and otherwise dangerous forms of notation should be eliminated from all heathcare documentation. However, through the end of 2004, the survey and scoring of this requirement will be limited to all handwritten, patient-specific documentation, not just orders," the JCAHO clarified on its Web site August 30.

The requirement is Goal 2b under the JCAHO's 2004 National Patient Safety Goals. It requires healthcare providers and administrators to standardize the abbreviations, acronyms, and symbols that are used throughout their organization, including by creating a list of prohibited abbreviations, acronyms, and symbols. This requirement will continue as part of the JCAHO's 2005 National Patient Safety Goals.

One of the toughest goals to meet: Historically, this goal requirement is among the most difficult for hospitals to meet. Surveyors found that less than 77% of hospitals complied with the requirement during announced surveys in 2003. Even worse, surveyors noted that less than 65% of hospitals met the goal requirement during random unannounced surveys in 2003, according to information obtained from the JCAHO.

In addition, organizations that have not achieved 100% compliance with this goal will get a slight break on scoring during their 2004 surveys, the JCAHO says.

"The long-term objective of this requirement continues to be 100% compliance, in all forms of clinical documentation, with a reasonably comprehensive list of prohibited 'dangerous' abbreviations, acronyms and symbols," according to clarification. "However, recognizing that this type of change will take time, the survey and scoring of this requirement has been modified."

Thus, effective immediately for all surveys conducted through the end of 2004, organizations that cannot show 100% compliance with the goal during an open and closed medical record review will receive a score of "in compliance" if ALL of the following conditions are met:

• Use of any item on the organization's prohibited list is "sporadic" (i.e., less than 10% of the instances include the prohibited abbreviation, acronym, or symbol);
  
• Orders that include a prohibited item also include written evidence that someone confirmed the intended meaning before carrying out the order; and
  
• The organization has implemented a plan for continued improvement to achieve 100% compliance by the end of 2004.

New clarification about Goal 2b and lab reports: The JCAHO has also clarified that printed and electronic lab reports are exempt from the requirement of Goal 2b, although handwritten lab reports aren't. The JCAHO plans to reexamine this issue in November.

In addition, laboratories are "permanently exempt" from the JCAHO's prohibition against using trailing zeros, "because they often must indicate the precision of their test results," according to information that the JCAHO also added to its Web site August 30.

-- Wendy Johnson
wjohnson@hcpro.com

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