HealthStream Regulatory Script
[Medication Terminology: Use of Abbreviations & Symbols]
Version: [09.15.2005]
Lesson 1: Introduction
Lesson 2: Recommendations
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on medication
terminology.
IMAGE: 1001.GIF
This course covers the safe use of medication terms.
As your partner, HealthStream strives to provide its customers with excellence in
regulatory learning solutions. As new guidelines are continually issued by regulatory
agencies, we work to update courses, as needed, in a timely manner. Since
responsibility for complying with new guidelines remains with your organization,
HealthStream encourages you to routinely check all relevant regulatory agencies
directly for the latest updates for clinical/organizational guidelines.
If you have concerns about any aspect of the safety or quality of patient care in your
organization, be aware that you may report these concerns directly to JCAHO.
Point 1 of 4
1002
Course Rationale
This course will help you and your facility improve patient
safety.
IMAGE: 1002.GIF
You will learn about:
• “Risky” [glossary] drug terms
• Safer terms to use instead
Point 2 of 4
1003
Course Goals
After completing this course, you should be able to:
• Identify JCAHO [glossary] recommendations related
to risky drug terms.
• Recognize risky abbreviations and symbols.
• Select safer terms to use in place of risky terms.
NO IMAGE
Point 3 of 4
1004
Course Outline
This lesson gives the course rationale, goals, and outline.
FLASH ANIMATION: 1004.SWF/FLA
Lesson 2 gives recommendations for the use of written drug
terms.
Point 4 of 4
Lesson 2: Recommendations
2001
Introduction
Welcome to the lesson on recommendations for the use of
drug terms.
FLASH ANIMATION: 2001.SWF/FLA
Point 1 of 16
2002
Objectives
After completing this lesson, you should be able to:
• Identify JCAHO recommendations related to risky
drug terms.
• Recognize risky abbreviations and symbols.
• Select safer terms to use in place of risky terms.
NO IMAGE
Point 2 of 16
2003
JCAHO Recommendations
JCAHO recognizes the importance of using safe drug terms.
IMAGE: 2003.GIF
In the 2005 National Patient Safety Goals (NPSGs), JCAHO
recommends:
• Each facility should identify and prohibit certain risky
abbreviations, acronyms [glossary], and symbols.
Point 3 of 16
2004
Risky Terms: Problems (1)
Why is it so important for facilities to prohibit risky terms?
NO IMAGE
Let’s take a look on the following screen.
Point 4 of 16
2005
Risky Terms: Problems (2)
Abbreviations and symbols can cause drug errors.
IMAGE: 2005.GIF
For example, when a doctor writes a drug order, he or she
may use the term “U” (for “unit”).
A nurse reading the order might mistake the “U” for:
o “0” (zero)
o “4” (four)
o “cc” (cubic centimeter)
This could lead to confusion. Treatment may be delayed
while the nurse checks the order.
Even worse, the nurse might not check the order. He or she
may misread the order and give the wrong dose. This could
cause serious patient injury or death.
Point 5 of 16
2006
Risky Terms: Prohibited List (1)
In short: Certain terms can lead to serious drug errors.
IMAGE: 2006.GIF
Therefore, JCAHO recommends that each healthcare facility
should:
1. Identify the abbreviations, acronyms, and symbols
that staff members use commonly.
2. Review the list of common terms.
3. Identify terms on the list that might be confusing.
4. Place confusing terms on a “risky” list.
Point 6 of 16
2007
Risky Terms: Prohibited List (2)
Finally, each facility must prohibit [glossary] the use of
certain terms from the risky list.
IMAGE: 2007.GIF
These terms must not be used on any type of written record.
This includes:
• Any type of written order
• Progress notes
• Consultation reports
• Operative reports
Point 7 of 16
2008
Risky Terms: Which Terms? (1)
Which terms must be prohibited?
NO IMAGE
Let’s take a look on the following screen.
Point 8 of16
2009
Risky Terms: Which Terms? (2)
Facilities may prohibit any terms from their risky list.
IMAGE: 2009.GIF
However, certain terms must be prohibited.
A table of these terms appears on the following screen.
Note: In the following table, terms appear in one form (upper
case, with periods between letters). Be aware that any
prohibited term is prohibited in all forms:
• Upper case
• Lower case
• With periods
• Without periods
Point 9 of16
2010
Risky Terms: Minimum List of Prohibited Terms
This prohibited
term…
Is used to mean…
But could be
mistaken for…
Therefore, this term
should be written
instead:
U
Unit
- 0 (zero)
- 4 (four)
- cc (cubic centimeter)
Unit
I.U.
International unit
- IV (intravenous)
- 10 (ten)
International unit
Q.D.
Once a day
- Q.O.D. (every other
day)
- Q.I.D. (four times a
day)
Daily
Q.O.D.
Every other day
- Q.D. (once a day)
- Q.I.D. (four times a
day)
Every other day
MgSO4
Magnesium sulfate
MS or MSO4
(morphine sulfate)
Magnesium sulfate
MS or MSO4
Morphine sulfate
MgSO4 (magnesium
sulfate)
Morphine sulfate
Using a trailing zero
after a decimal point
(e.g., “1.0”)
“1” (in the example
given)
Ten-fold higher
dosage (e.g., “1.0”
could be mistaken for
“10”)
Value without a
trailing zero (e.g., “1”)
Leaving out a leading
zero before a decimal
point (e.g., “.1”)
“0.1” (in the example
given)
Ten-fold higher
dosage (e.g., “.1”
could be mistaken for
“1”)
Value with leading
zero included (e.g.,
“0.1”)
[table only screen]
Point 10 of 16
2011
Suggested Risky Terms: Which Terms? (2)
NO IMAGE
Facilities are only required to prohibit the terms on the
minimum list.
However, many other terms can be risky, as well.
A table of other possible terms to avoid or prohibit appears
on the following screen.
Point 11 of16
2012
Risky Terms: Suggested List of Prohibited Terms
This term…
Is used to mean…
But could be
mistaken for…
Therefore, this term
is suggested
instead:
ug
Microgram
mg (milligram),
resulting in a 1000fold overdose
- mcg
- microgram
H.S.
Half-strength
H.S. (bedtime)
Half-strength
H.S. or q.H.S.
Bedtime
- H.S. (half-strength)
- Q.H. (every hour)
At bedtime
T.I.W.
Three times a week
-T.I.D. (three times a
day)
- T.W. (twice weekly)
- 3 times weekly
- Three times weekly
S.C. or S.Q.
Subcutaneous
- S.L. (sublingual)
- Five every
- Sub-Q
- SubQ
- Subcutaneously
D/C
Discharge
Discontinue
Discharge
c.c.
Cubic centimeter
U (units)
ml (for “milliliters”)
A.S.
Left ear
O.S. (left eye)
Left ear
A.D.
Right ear
- O.D. (right eye)
- O.D. (once daily)
Right ear
A.U.
Both ears
- O.U. (both eyes)
Both ears
[table only
screen]
Point 12 of 16
2013
Risky Terms: Other Suggestions
Other dangerous terms may be found at the Institute for Safe
Medication Practices (ISMP) website.
IMAGE: 2013.GIF
Try not to use any of the terms on the ISMP list.
Point 13 of 16
2014
Risky Terms: Exceptions
Remember: A trailing zero should not be used when writing
out drug dosages.
NO IMAGE
However, the trailing zero is acceptable for:
• Lab values (i.e., test results)
• Equipment sizes
Point 14 of 16
2015
Review
FLASH INTERACTION: 2015.SWF/FLA
Drag and drop terms from the word bank to complete the following chart.
Terms that
healthcare facilities
must prohibit
U
MSO4
2.0
Q.D.
Acceptable terms
ml
mg
0.4
dl
NOTE TO BV: Please edit existing 2015.SWF/FLA files to be consistent with
the current version above. There were some last minute changes required
for this interaction after it had already been created.
Point 15 of 16
2016
Summary
You have completed the lesson on recommendations.
NO IMAGE
Remember:
• On written documents, abbreviations, acronyms, and
symbols can lead to drug errors.
• Drug terms prohibited by your facility should not be used.
Point 16 of 16
Course Glossary
#
Term
acronym
prohibit
risky
JCAHO
Definition
abbreviation formed from the initial letters of a series of words
forbid, veto, command against
in the context of medication terminology: a medication term that could lead to a
medication error
Joint Commission on the Accreditation of Healthcare Organizations
[Medication Terminology: Use of Abbreviations & Symbols]
Pre-Assessment
1. When reporting lab values, which of the following is (are) a prohibited written form?
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
10 mg/dl
10.0 mg/ml
10 milligrams/deciliter
Both 10 mg/dl and 10.0 mg/dl
None of these answers
Correct Answer: None of these answers
Answer Rationale: Use of a trailing zero is prohibited when documenting drug dosage. However, trailing zeroes are acceptable for
lab values. Neither “mg” nor “dl” is a prohibited term. Therefore, “6 mg/dl,” “6.0 mg/dl,” and “6 milligrams/deciliter” all are acceptable
forms for reporting lab results.
2. Which of the following terms should not be used in an operative report?
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
5.0 Units
0.5 I.U.
.25 mcg
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: The term “I.U.,” the use of trailing zeroes (for example, 5.0 instead of 5), and the omission of leading zeroes (for
example, .25 instead of 0.25) all are prohibited in clinical documentation. They should not be used when documenting drug dosage,
including on operative reports.
3. Which of the following terms is (are) acceptable on a drug order?
Answer 1: MSO4
Answer 2: 0.5 mg
Answer 3: 10.0 micrograms
Answer 4: All of these answers
Answer 5: None of these answers
Correct Answer: 0.5 Units
Answer Rationale: The term “MSO4” and the use of trailing zeroes (for example, 10.0 instead of 10) are prohibited on drug orders.
“0.5 mg” is acceptable because it uses a leading zero, and the abbreviation “mg” for “milligram” is acceptable.
4. Of the following, which is most likely to result in a drug dosage 1000 times greater than it should be?
Answer 1:
Answer 3:
Answer 4:
Answer 2:
Using the term “ug” on a drug order
Using the term “A.U.” on a drug order
Using the term “MSO4” on a drug order
Leaving out a “leading zero” on a drug order
Correct Answer: Using the term “ug” on a medication order
Answer Rationale: The term “ug” (microgram) could be mistaken for “mg” (milligram), resulting in a 1000-fold overdose. The other
terms listed could cause drug errors, but are unlikely to cause the error of a 1000-fold overdose.
5. Prohibited terms may be used on drug orders if written:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
In block letters
In all capital letters
With periods between letters
Without periods between letters
None of these answers
Correct Answer: None of these answers
Answer Rationale: Prohibited abbreviations may not be written on drug orders in any form: upper case, lower case, with periods,
without periods, in cursive handwriting, or in print.
Final Exam
Question Title: Question 1
Question: When reporting lab values, it is prohibited to write:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
6 mg/ml
6.0 mg/ml
6 milligrams/milliliter
Both 6 mg/ml and 6.0 mg/ml
None of these answers
Correct Answer: None of these answers
Answer Rationale: The trailing zero is prohibited for documenting drug dosage. However, trailing zeroes may be used with lab
values. Neither “mg” nor “ml” is a prohibited term. Therefore, “6 mg/ml,” “6.0 mg/ml,” and “6 milligrams/milliliter” all are acceptable for
lab results.
Question Title: Question 2
Question: In an operative report, do not use the term:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
5 I.U.
MSO4
0.25 U
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: “I.U.,” MSO4,” and “U” all are prohibited terms. They should not be used in any written order or record of drug
dosage. This includes operative reports.
Question Title: Question 3
Question: On a drug order, it is okay to use the term:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Q.O.D.
0.5 Units
5.0 International Units
All of these answers
Answer 5: None of these answers
Correct Answer: 0.5 Units
Answer Rationale: “Q.O.D.” and the trailing zero are prohibited on drug orders. “0.5 Units” may be used because it uses a leading
zero and spells out the term “Units.”
Question Title: Question 4
Question: A nurse misreads an order and gives a patient a ten-fold drug overdose. This is most likely if the order used:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
The term “D/C”
A “trailing zero”
The term “Q.D.”
The term “q.H.S.”
Correct Answer: A “trailing zero”
Answer Rationale: If a trailing zero is used on an order (for example, 5.0 instead of 5), the person reading the order may miss the
decimal point. He or she may give the patient 50 units instead of five: a ten-fold overdose. The other terms listed could cause drug
errors. However, they are unlikely to cause the error of a ten-fold overdose.
Question Title: Question 5
Question: Clinical staff frequently use a certain abbreviation to mean “half-strength.” This abbreviation also means:
Answer 1:
Answer 4:
Answer 2:
Answer 3:
Every hour
Sublingual
At bedtime
Three times a week
Correct Answer: At bedtime
Answer Rationale: “H.S.” is commonly used for “half-strength.” “H.S.” is also used for “at bedtime.” Therefore, this term can lead to
errors.