Abbreviations Toolkit
Section 4: Making it Happen
Challenges to Reducing Abbreviation
Use and Possible Strategies
Challenges and Barriers
Possible Strategies
Limited reporting of abbreviation-related errors
Organizations rely on reports of
errors or close calls to identify
hazards in the system that need to
be addressed.
Staff may not recognize when new
technology contributes to an error.
Organizations and facilities
 Assess the culture of safety and address concerns.30,50
 Provide patient safety training to leaders and staff.
 Encourage reporting of abbreviation-related close calls
and adverse events.
 Address gaps and share the learning to prevent similar
errors.
 Make error reporting less labour intensive.
Individuals
 Actively participate in safety initiatives.
 Accept that errors will occur and be vigilant to the
possibility of error when abbreviations are used.
 Report close calls and errors involving abbreviations.
 Consider how technology can contribute to errors.
Today’s culture reinforces use of abbreviations and other communication short-cuts
Abbreviations, acronyms, and
other short forms of
communication are increasingly
used outside the workplace.
Due to time constraints, staff may
be under pressure to take
shortcuts.
Professional journals,
pharmaceutical industry
communications, and educational
materials contain error-prone
abbreviations.
Organizations/facilities
 Monitor the use of abbreviations in documentation and
provide feedback to individuals who regularly use
nonstandard or error-prone abbreviations.
 Design pre-printed forms that minimize handwriting.
Technology
 Look for technology solutions to streamline processes.
 Place alerts in the electronic medical record to warn
when error-prone abbreviations are used.
 Use autocorrect features to prevent abbreviation use.
 Assess whether there is a potential for an abbreviation
to be interpreted incorrectly by the software.
Industry
 Revise publishing guidelines to prohibit use of errorprone abbreviations.
 Remove error-prone abbreviations from
pharmaceutical labelling, packaging, and advertising.
Challenges to Reducing Abbreviation Use and Possible Strategies
Challenges and Barriers
Possible Strategies
Today’s culture reinforces use of abbreviations and other communication short-cuts
Individuals
 Take time to write out medication orders completely.
 Avoid use of error-prone abbreviations and other
shortcuts when documenting or transcribing orders.
 Examine your personal habits to identify and change
‘at risk’ behaviour.51
 Encourage others to write out rather than abbreviate.
Colleges and universities
 Eliminate the use of error-prone abbreviations from
teaching materials.
 Establish expectations for student performance that
discourages the use of error-prone abbreviations in
presentations and reports.
Limited knowledge of patient safety concerns related to abbreviations
Healthcare workers are unaware of
the safety concerns with using
certain abbreviations, symbols,
dose designations, and shortened
medication names. This includes
individuals involved in prescribing,
dispensing, and administering
medications as well as those that
document in the medical record:
 physicians
 nurses
 pharmacists and pharmacy
technicians
 other healthcare professionals
(e.g., dentists,
physiotherapists, respiratory
therapists)
 health care aides/attendants
 medical records technicians
Organizations/Facilities
 Include expectations for abbreviation use in
medication ordering and other documentation in
orientation of new staff and students.
 Develop an e-learning module with a self-assessment
and post-test for self-directed education.
 Develop a dangerous abbreviation policy.
 Provide frequent reminders for all staff using posters,
chart stickers, or reminders in the electronic medical
record.
Professional Organizations
 Develop continuing education programs to address
this safety concern.
 Update practice standards to discourage the use of
abbreviations.
Individuals
 Know the abbreviations that cause errors and
eliminate them from your practice.
abbreviations.hqca.ca
Challenges to Reducing Abbreviation Use and Possible Strategies
Challenges and Barriers
Possible Strategies
Limited knowledge of patient safety concerns related to abbreviations
Colleges and universities
 Include information about safety concerns with
abbreviations in the curriculum.52
 Stop using abbreviations in teaching and discourage
the use of abbreviations by students.5
 Remove abbreviations from manuals and teaching
material.
 Ensure that clinical practice sites and preceptors are
aware of the safety concern and have resources to
discourage the use of abbreviations.
Variable prescribing practices
There is a lack of guidelines and
training on safe prescribing
practices and medication order
writing standards.
Prescribers are not informed when
their orders do not meet expected
order writing standards.53
Some prescribers are not
concerned about the quality or
completeness of their prescriptions
and expect the system to catch
any errors.29
Poor handwriting contributes to the
misinterpretation of medication
orders. Illegible orders often
contain abbreviations.12
Organizations and facilities
 Establish standards and guidelines for medication
order writing.
 Redesign order forms to provide guidance or
reminders about expected standards for order writing.
 Develop pre-printed protocols for high alert
medications.
 Train new prescribers in safe prescribing practices.
 Encourage staff to contact prescribers when
prescriptions are unclear and contain an error-prone
abbreviation.
 Provide a variety of reminders about expected
standards for order writing.
 Monitor prescriptions for unapproved abbreviations
and provide targeted feedback to prescribers
Technology
 Implement electronic prescribing, either stand alone or
integrated, within the electronic health record.
 Provide adequate training to prescribers about
electronic prescribing.
abbreviations.hqca.ca
Challenges to Reducing Abbreviation Use and Possible Strategies
Challenges and Barriers
Possible Strategies
Variable prescribing practices
Prescribers54
 Use a standardized prescription format (e.g., the five
‘Rs’ – right patient, medication, dose, route, and
frequency) when writing medication orders.
 Print if handwriting is illegible and include name and
contact number.
Colleges and universities
 Incorporate education on safe prescribing practices
into programs.
Variable documentation and transcription skills
Abbreviations are often introduced
during transcription or
documentation. For example:
 updating medication records
 transcribing verbal orders
 completing medication
reconciliation forms
Poor practices may be introduced
during practical training and
reinforced on the job.
Electronic medical records do not
eliminate the use of abbreviations
in clinical notes or other free-text
entry fields.
Poor handwriting compounds the
problem of abbreviation use in
transcription and documentation.
Organizations and facilities
 Develop a documentation and transcription policy.
 Discourage verbal orders.
 Create a list of approved abbreviations and their
intended meaning.
 Adopt ISMP Canada’s ‘Do Not Use’ list and add
additional abbreviations, as appropriate to the site.
 Monitor orders and health records for unapproved
abbreviations and provide feedback to individuals on
their use of abbreviations.
Technology
 Ensure error-prone abbreviations are not used or
allowed by the system.
 Include alerts that warn when an unapproved
abbreviation is used or use an autocorrect feature.
 Provide a definition when the user hovers over an
abbreviation.
 Implement a computerized prescriber order entry
system (CPOE).
 Integrate the CPOE system with a pharmacy
information system to reduce transcription errors.
 Use an electronic medication administration record (eMAR) to decrease transcription.
abbreviations.hqca.ca
Challenges to Reducing Abbreviation Use and Possible Strategies
Challenges and Barriers
Possible Strategies
Variable documentation and transcription skills
Individual
 Avoid the use of prohibited abbreviations when
transcribing orders or documenting care.
 Print out orders if you have poor handwriting and
include your name and contact number.
 Use an electronic method or dictation to transcribe or
document.
 Do not use abbreviations or communication shortcuts
during free-text entry or dictation.
Poorly designed technology
Design flaws in the system, such
as the on-screen display, can
introduce errors.
Electronic health record or
pharmacy systems may contain
error-prone abbreviations in drop
down lists.
The computer program does not
prompt for correction of
abbreviations, or display or print
full words when abbreviations are
entered into the system.
Technology may be difficult to use.
The system does not include a
clinical decision support
component that provides alerts
when an error-prone abbreviation
is used.
Organizations/Facilities
 Review computer programs for the use of
abbreviations and confusing screen displays.44
 Provide adequate technology training for employees,
prescribers, and contracted service providers (e.g.,
outside pharmacists who provide medications to a
continuing care facility).
 Pharmacy providers remove abbreviations from
computer generated reports and labels.55
 Ensure a prescriber’s ‘favourite’ prescriptions or
protocols are free of abbreviations. Write out in full the
name of each medication in a protocol rather than
using an acronym to designate the protocol.
 Place alerts on the electronic medical record to warn
when abbreviations are used.
Individuals
 Avoid the use of abbreviations in free-text fields.
 Avoid workarounds (e.g., turning off alert features) or
reverting to a paper system to avoid safety features of
the technology.
abbreviations.hqca.ca
Challenges to Reducing Abbreviation Use and Possible Strategies
References
Note: Take from the reference list for the Abbreviations Toolkit.
5. Kuhn IF. Abbreviations and acronyms in healthcare: When shorter isn’t sweeter. Pediatric
Nursing. 2007; 33(5):392-398.
12. Brunetti L, Santell J, Hicks, R. The impact of abbreviations on patient safety. The Joint
Commission Journal on Quality and Patient Safety. 2007; 33(9): 576-583.
29. Garbutt J, Milligan P, McNaughton C, Highstein G, Waterman B. Dunagan W. et al.
Reducing medication prescribing errors in a teaching hospital. The Joint Commission
Journal on Quality and Patient Safety. 2008; 34(9):528-536.
30. Wachter RM, Pronovost PJ, Shekelle, PG. Strategies to improve patient safety: the evidence
base matures. Annals of Internal Medicine. 2013; 158(5 part 1):350-352.
44. National Patient Safety Agency National Reporting and Learning Service. Design for patient
safety: Guidelines for safe on-screen display of medication information [Internet]. 2010 [cited
2015 Oct 1]. Available from: http://www.nrls.npsa.nhs.uk/resources/collections/design-forpatient-safety/?entryid45=66713
50. Weaver SJ, Lubomksi LH, Wilson RF, et al. Promoting a culture of safety as a patient safety
strategy: Systematic review. Annals of Internal Medicine. 2013; 158(5):369-374.
51. National Coordinating Council for Medication Error Reporting and Prevention. Reducing
medication errors associated with at-risk behaviors by healthcare professionals [Internet].
2007 [cited 2015 Oct 1] Available from: http://www.nccmerp.org/reducing-medication-errorsassociated-risk-behaviors-healthcare-professionals
52. World Health Organization. Multi-professional patient safety curriculum guide[Internet].
2011[cited 2015 Oct 1]. Available from:
http://whqlibdoc.who.int/publications/2011/9789241501958_eng.pdf?ua=1
53. Brennan N, Mattick K. A systematic review of educational interventions to change behaviour
of prescribers in hospital settings, with a particular emphasis on new prescribers. British
Journal of Clinical Pharmacology. 2012; 75(2):359-372.
54. National Coordinating Council for Medication Error Reporting and Prevention.
Recommendations to enhance accuracy of prescription writing [Internet]. 2005 [cited 2015
Oct 1]. Available from: http://www.nccmerp.org/recommendations-enhance-accuracyprescription-writing
55. Institute of Safe Medication Practices. Principles of designing a medication label for
community and mail order pharmacy prescription packages [Internet]. 2010 [cited 2015 Oct
1]. Available from:
http://www.ismp.org/tools/guidelines/labelFormats/comments/printerVersion.pdf
abbreviations.hqca.ca