Abbreviations Toolkit
Section 4: Making it Happen
Research – Effectiveness of
Abbreviation Intervention Strategies
Focus
Education
Multifaceted
approach
Intervention
Findings
Reference
Single education program for
residents to decrease the use
of nine error-prone
abbreviations
Significant reduction in
abbreviation use from 25.8
per cent to 18.3 per cent.
Overall rate remained high
suggesting a single
intervention was not effective;
a system wide approach was
recommended.
35
Educational interventions with
leadership support
Decreased the use of six
unsafe abbreviations and
dose designations (TIW, µg,
trailing zero, U, degree
symbol and leading zero) from
19.7 per cent to 3.3 per cent
after eight months.
36
Extensive education program
for medical students,
physicians and nursing
targeting abbreviations for
insulin units.
Reduction in the use of
incorrect abbreviations for
insulin units from 37.5 per
cent to 15.5 per cent.
34
Letters, posters and pharmacy
issued reminders to prescribers
using unapproved
abbreviations in medication
orders at three acute and
continuing care facilities.
Use of seven abbreviations
(U, IU, qd, od, trailing zeros,
lack of leading zeros and ug)
declined from 20 per cent to 9
per cent over one year.
75
Use of medication order
standards, prescriber education
and audit and feedback to
decrease prescribing errors in
trainee medical staff in ICU.
For three groups of trainees,
the percentage of
prescriptions with prescribing
errors fell from 19 to 25 per
cent in the pre-training audit to
3 to 7 per cent in the six week
post-intervention follow-up.
27
Research – Effectiveness of Abbreviation Intervention Strategies
Focus
Multifaceted
approach
Intervention
Findings
Reference
Two phase intervention
strategy with education and
reminders in the first phase and
introduction of an unsafe
abbreviations policy and further
education in the second phase.
Prescriptions containing errorprone abbreviations fell from
28.3 per cent to 21.3 per cent
after the first phase, and
leveled out at 10 per cent after
the second phase.
26
Group and one-on-one
education sessions, pocket
cards and posters used to
communicate expectations
regarding abbreviation use to
emergency room staff.
The incidence of error-prone
abbreviation use declined
from 31.8 to 18.7 per 100
prescriptions in the four-month
follow-up period.
38
Evaluated compliance with a
medication order writing policy
in a health region after
education alone and then
audits with prescriber feedback.
Before intervention 26.3 per
cent of medication orders did
not comply with the policy.
Education alone reduced
noncompliance to 24.9 per
cent of orders; audit and
feedback further reduced
noncompliance to 19.1 per
cent of orders.
28
Education alone was neither
effective nor sustainable. In
one hospital, improvement
occurred only with a rewrite
policy requiring for orders with
unacceptable abbreviations.
Another hospital had success
when medical staff leaders
followed-up with their
colleagues who were using
unapproved abbreviations in
addition to pharmacist followup on orders with unapproved
abbreviations.
11
Enforcement Multiple strategies were tried
and
including prescriber feedback
leadership
letters, one-on-one educational
sessions, newsletters, chart
notices, information about
approved abbreviations on
charts, posters, positive
reinforcement. Greatest
success was achieved with a
policy requiring orders with
unapproved abbreviations to be
rewritten, and with medical staff
leaders reinforcing
expectations.
abbreviations.hqca.ca
Research – Effectiveness of Abbreviation Intervention Strategies
Focus
Findings
Reference
Enforcement Collaborative improvement
and
process used with hospital and
leadership
clinic-based physicians to
reduce the use of high-risk
abbreviations.
Strategies included educational
program and printed materials
for medical staff, posters, wallet
cards. The hospital but not
clinics introduced a policy
prohibiting use of target
abbreviations with feedback to
noncompliant physicians.
Compliance with
abbreviations standards
improved from 62.6 per cent
to 81.4 per cent in the
hospital, but in the community
only improved from 69.1 per
cent to 72.9 per cent. The
difference was attributed to
the policy and feedback
strategies used in the
hospitals. The collaborative
process was successful.
88
Education with reminders was
followed by implementation of a
policy in which prescriptions
with error-prone abbreviations
were not accepted.
Education with reminders was
not successful. Enforcement
through policy was required.
29
Pre- and post-intervention
prescribing error rate in
prescribers who converted to a
stand-alone e-prescribing
system with embedded clinical
decision support in an
ambulatory care setting.
E-prescribing group reduced
errors from 42.5 to 6.6 errors
per 100 prescriptions
compared to no change in the
handwritten order group. Use
of inappropriate abbreviations
decreased from 12.7 per cent
to 0.04 per cent and illegibility
issues were eliminated.
42
Effectiveness of computerized
alerts to reduce the use of
error-prone abbreviations in
electronic progress notes by
physicians. Participants
received either no alert, an alert
with a forced correction, or an
auto-corrected alert.
Forced correction of errors
resulted in a significantly
lower rate of abbreviations in
handwritten notes compared
to auto-correction. There was
no change in knowledge
about unapproved
abbreviations.
46
Technology
Intervention
abbreviations.hqca.ca
Research – Effectiveness of Abbreviation Intervention Strategies
Focus
Intervention
Findings
Reference
Technology
Effectiveness of a screening
tool for abbreviations within an
electronic medical record
coupled with continued
education and feedback to
reduce the use of error-prone
abbreviations.
The use of error-prone
abbreviations decreased by 8
per cent each month for a
37.3 per cent decrease in a
six month period.
89
References
Note: Taken from the reference list for the Abbreviations Toolkit.
11. Traynor K. Enforcement outdoes education at eliminating unsafe abbreviations. American
Journal of Health-Systems Pharmacy. 2004; 61:1314, 1317, 1322.
26. Alshaikh M, Mayet A, Adam M, Ahmed Y, Aljadhey H. Intervention to reduce the use of
unsafe abbreviations in a teaching hospital. Saudi Pharmaceutical Journal [Internet]. 2013
[cited 2015 Oct 1]; 21(3):277-80. Available from
http://www.sciencedirect.com/science/article/pii/S1319016412000965
27. Thomas, AN, Boxall EM, Laha SK, Day AJ, Grundy D. An educational and audit tool to
reduce prescribing errors in intensive care. Quality and Safety in Health Care. 2008; 17:360363.
28. Raymond CB, Sproll B, Coates J, Woloschuk D. Evaluation of a medication order writing
standards policy in a regional health authority. Canadian Pharmacists Journal/Revue des
Pharmaciens du Canada [Internet]. 2013 [cited 2015 Oct 1]; 146(5):276-283. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785189
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.
34. Lewis AW, Bolton N, McNulty S. Reducing inappropriate abbreviations and insulin
prescribing errors through education. Diabetic Medicine; 27(1):125-126.
35. Burkiewicz J and Hassenplug K. Educational interventions to reduce frequency of use of
restricted abbreviations in a community health center. Journal of Pharmacy Technology.
2006; 22:332-335.
36. Abushaiqa M, Zaran F, Bach D. Education interventions to reduce the use of unsafe
abbreviations. American Journal of Health-System Pharmacy. 2007; 64:1170-1173.
abbreviations.hqca.ca
Research – Effectiveness of Abbreviation Intervention Strategies
38. Taylor S, Chu M, Haack L et al. An intervention to reduce the use of error-prone prescribing
abbreviations in the emergency department. Journal of Pharmacy Practice and Research.
2007; 37(3):214-216.
42. Kaushal R, Kern L, Barron Y, et al. Electronic prescribing improves medication safety in
community-based office practices. Journal of General Internal Medicine. 2010; 25(6):530536.
46. Myers JS, Gojraty S, Yang W, et al. A randomized-controlled trial of computerized alerts to
reduce unapproved medication abbreviation use. Journal of the American Medical
Informatics Association [Internet]. 2011 [cited 2015 Oct 1]; 18(1):17-23. Available from:
http://jamia.oxfordjournals.org/content/18/1/17
75. Poloway L, Greenall J. Medication safety alerts – Taking action on error-prone
abbreviations. Canadian Journal of Hospital Pharmacy. 2006; 59(4):206-209.
88. Leonhardt KK, Botticelli J. Effectiveness of a community collaborative for eliminating the use
of high-risk abbreviations written by physicians. Journal of Patient Safety. 2006; 2(3):147153.
89. Capraro A, Stack A, Harper B et al. Detecting unapproved abbreviations in the electronic
medical record. Joint Commission Journal on Quality and Patient Safety. 2012; 38(4): 178183.
abbreviations.hqca.ca