P.O. Box 1200
16 Garfield St.
Charlottetown PE
C1B 1K8
www.healthpei.ca
C.P. 1200
16 rue Garfield
Charlottetown I.-P.-E.
C1B 1K8
www.healthpei.ca
Medication Management Quality Improvement Team
Memorandum
To:
From:
Date:
Re:
Health PEI Physicians, Nursing Staff and Pharmacists
Medication Management Quality Improvement Team (MMQIT)
September 3, 2015
Abbreviation Use Within Medication Orders
The use of certain abbreviations, symbols, and dose designations has been identified as an underlying cause of serious,
even fatal medication errors. As a result of this type of error, Accreditation Canada introduced a Required
Organizational Practice (ROP) with the goal of eliminating the use of dangerous abbreviations and improving
communication among health care providers.
The MMQIT conducted a spot-audit of abbreviation use within medication orders in February 2015. The 2-day audit
included all electronic orders in an unverified state each morning, paper orders received in all hospital pharmacies, and
paper orders received at Provincial Pharmacy from long term care facilities. All medication orders were reviewed for use
of “Do Not Use” abbreviations as identified in Appendix A of the Health PEI Chart Documentation Standard (see attached
or access at http://iis.peigov/dept/health/manual/pdf/Chart%20Documentation%20Standard_2015-0618_Approved_Final.pdf).
The most commonly seen abbreviations in the audit of the electronic
orders were: “+”, the degree symbol,”&”, “cc”, and “> or <”.
The most commonly seen abbreviations in the audit of the paper
orders were: “OD”, “HS”, “sc, s/c, sq”, “qhs”, and “d/c”.
Despite the limitations of this type of audit, it is obvious from the
results that CPOE has dramatically decreased the use of
abbreviations within medication orders.
The use of abbreviations carries risk of misinterpretation, and that risk becomes even greater if a hand-written
medication order is illegible. Illegible handwriting on medication orders is widely recognized as a cause of errors and can
lead to misunderstanding of the intended drug, dosage, route of administration, or frequency. Poorly written orders can
delay the administration of the medication while clarification is sought.
All healthcare professionals involved in the writing and transcription of medication orders are reminded to avoid the
use of abbreviations and when orders are handwritten, ensure that the orders are legible.
Detailed results of the abbreviation audit will be shared with Local Medication Management Committees and Quality
teams in the coming months.
References:
•
Accreditation Canada. Required Organizational Practices Handbook 2016. www.accreditation.ca/sites/default/files/rop-handbook-2016en.pdf (accessed June 11, 2015).
nd
•
Cohen M.R. (Ed). (2007). Medication Errors (2 Ed). Washington DC: American Pharmacists Association.
•
Health PEI Clinical Standard. Chart Documentation Standard. Effective Date: November 28, 2011.
http://iis.peigov/dept/health/manual/pdf/Chart%20Documentation%20Standard%20FINAL%20Jan%2012-2012.pdf (accessed July 20, 2015)
From Health PEI – Chart Documentation Policy
DO NOT USE
Unacceptable Abbreviations
Abbreviation / Dose
Expression
U or u
Intended Meaning
Unit
“Unit” has no acceptable
abbreviation. Use “unit”
1 mg
Mistaken as 10 mg if the decimal point is not
seen
Do not use trailing/terminal zeros for
doses expressed in whole numbers
Microgram
Mistaken for “mg” (resulting in a thousand-fold
overdose) when handwritten
May be confused with one another or with AS,
AD, AU
May be confused with one another or with OS,
OD, OU
Mistaken as “BID” (twice daily)
Misread as “U” (units)
Premature discontinuation of medication when
D/C (intended to mean “discharge”) has been
misinterpreted as “discontinued” when
followed by a list of drugs
Mistaken as “IV” or “intrajugular”
Mistaken as “IM” or “IV”
Mistaken as bedtime
Mistaken as half-strength
Use “mcg”
Mistaken as OD or OS (right or left eye); drugs
meant to be diluted in orange juice may be
given in the eye
The “os” can be mistaken as “left eye”
Mistaken as “qhr” or every hour
Mistaken as “qh” (every hour)
Mistaken for q.i.d. (four times daily)
Mistaken as every six hours
Use “orange juice”
SC mistaken as SL (sublingual)
SQ mistaken as “5Q” or “5 every”
“sub q” has been mistaken as “every” (e.g. a
heparin dose orders “sub q 2 hours before
surgery” misunderstood as every 2 hours
before surgery
Mistaken as “55”, “one-half” or use “1/2”
Use “subcut” or “subcutaneous”
International unit
Every day
o.d or od
O.D or OD
Every other day
q.o.d. or qod
Q.O.D. or QOD
“Naked” decimal point or
Lack of leading zeros
(e.g. .5 mg)
Trailing zeros or terminal
zeros after the decimal
point (e.g. 1.0 mg)
µg
Every other day
AS, AD, AU
BT
cc
D/C
IJ
IN
HS
hs
OJ
Per os
qhs
qn
q1d
q6pm, etc
SC, SQ, sub q, s/c
ss
Correction
Read as zero (0) or a four (4), causing a 10-fold
overdose or greater. 4U seen as “40” or 4u
seen as “44”
Misread as IV (intravenous) or 10
Mistaken as q.i.d., especially if the period after
the “q” or the tail of the “q” is misunderstood
as “I”
Misinterpreted as “right eye” (OD – oculus
dexter) and administration of oral medications
in the eye
Misinterpreted as “q.d” (daily) or “q.i.d.” (four
times daily) if the “o” is poorly written
Mistaken as 5 mg if the decimal point is not
seen
IU
q.d. or qd
Q.D or QD
OS, OD, OU
Misinterpretation
0.5 mg
Left eye, right eye,
both eyes
Left ear, right ear,
both ears
Bedtime
Cubic centimeters
Discharge
Discontinue
Injection
Intranasal
Half-strength
At bedtime, hours of
sleep
Orange juice
By mouth, orally
Nightly at bedtime
Nightly or at bedtime
Daily
Every evening at 6
p.m.
Subcutaneous
Sliding scale (insulin)
or ½ (apothecary)
Use “units”
Use “daily” or “every day”
Use “daily”
Use “every other day”
Use zero before a decimal when the
dose is less than a whole unit.
Use “left eye”, “right eye” or “both
eyes”
Use “left ear”, “right ear” or “both
ears”
Use “bedtime”
Use “mL”
Use “discharge or discontinue)
Use “injection”
Use “intranasal”
Use “half-strength” and “bedtime”
Use “PO”, “by mouth” or “orally”
Use “nightly” or “at bedtime”
Use “nightly” or “at bedtime”
Use “daily”
Use “6 pm nightly” or “6 pm daily”
Spell out “sliding scale”; or Use “onehalf” or use “1/2 ”
Abbreviation / Dose
Expression
SSRI
SSI
i/d or t/d
TIW or tiw
Drug name and dose run
together (especially
problematic for drug
names that end in “l”
such as Inderal40mg and
Tegretol300mg)
Numerical dose and unit
of measure run together
(e.g. 10mg, 100mL)
Large doses without
properly place commas
(e.g. 100000 units;
1000000 units)
Drug Name
Drug names should be
written out (*)
Symbols
Apothecary symbols
x3d
> or <
/ (slash mark)
@
&
+
°
Intended Meaning
Sliding scale regular
insulin
Sliding scale insulin
Once daily
Three times a week
Misinterpretation
Correction
Inderal 40 mg
Mistaken as Selective-serotonin reuptake
inhibitor
Mistaken as strong solution of Iodine (Lugol’s)
Mistaken as “tid”
Mistaken as “three times a day” or “twice in a
week”
Mistaken as Inderal 140 mg
Tegretol 300 mg
Mistaken as Tegretol 1300 mg
10 mg
100 mL
The “m” is sometimes mistaken as a zero or
two zeros, risking a 10- to -100 –fold overdose
Place adequate space between the
dose and unit of measure.
100,000 units
1,000,000 units
100000 has been mistaken as 10,000 or
1000000 has been mistaken as 100,000
Use commas for dosing units at or
above 1,000 or use the words such as
100 “thousand” or 1 “million”, to
improve readability
Intended Meaning
Specific drug
Intended meaning
Dram
Minim
For three days
Greater than or less
than
Separate two doses or
indicated “per”
At
And
Plus or and
Hour
Spell out “Sliding scale (insulin)”
Use “1 daily”
Use “three times weekly” or “3 times
weekly”
Place adequate space between the
drug name, dose and unit of measure
Misinterpretation
Abbreviations of drug names can lead to
misinterpretation as another drug
Correction
Use complete drug names
Misinterpretation
Misunderstood or misread (symbol for dram
mistaken as “3”; symbol for minim mistaken as
“mL”
Mistaken as “3 doses”
Mistaken as opposite of intended; mistakenly
use incorrect symbol; “<10” mistaken as 40
Mistaken as the number 1 (e.g. “25 units/10
units” misread as “25 units” and “110 units”
Mistaken as “2”
Mistaken as 2”
Mistaken as “4”
Mistaken as a zero (e.g. q2 seen as 20)
Correction
Use the metric system
Use “for three days”
Use “greater than” or “less than”
Use “per” rather than a slash mark to
separate doses.
Use “at”
Use “and”
Use “and”
Use “hr”, “h” or “hour”
(*) Appendix A of the Health PEI Chart documentation standard provides several examples of abbreviated drug names.