Van Wert County Hospital
Policy/Procedure: Hospital
Issue Date:
6/02
No.: PH-02
By: Pharmacy
Reviewed: 4/12, 03/11, 10/06
Distribution List:
SUBJECT:
No. of Pages: 5
Revised: 10/06
All Departments
Approved/Unapproved Abbreviations/Dose Designations
PURPOSE:
Abbreviations may increase the risk of a medication error. Certain abbreviations and dose
designations pose significant risk and should not be used.
POLICY
1.
The Pharmacy and Therapeutics Committee should develop and annually review a “Do Not
Use Abbreviations List” (may also be referred to as a “Dangerous Abbreviations List” or
“Error Prone Abbreviations List”). This list should include abbreviations, symbols,
acronyms, and dose designations that are considered dangerous (Appendix A). The
following are required:
U,u
IU
Q.D., QD, q.d., qd
Q.O.D., QOD, q.o.d., qod
MS
MSO4
MgSO4
Terminal (trailing) zeros after a decimal should not be used (i.e., 1.0 mg should be 1
mg).
Lack of a leading zero (.5). Leading zeros before a decimal point should always be used
(i.e., 0.5 mg instead of .5 mg).
Additional abbreviations, symbols, acronyms, and dose designation may be included. The
Institute for Safe Medication Practice (ISMP) maintains a “List of Error-Prone
Abbreviations, Symbols, and Dose Designations” (Appendix B) that may be used as a
reference and may be incorporated into the annual review and update for the facility.
2.
3.
5.
The “Do Not Use Abbreviations List” applies to all medication related orders and
documentation that is handwritten or that appears on preprinted forms.
Medication error reports should be reviewed to determine if a medication error was due to
the use of an abbreviation. Any abbreviation medication error should be reviewed by the
Pharmacy and Therapeutics Committee.
If a prescriber uses an abbreviation or dose designation on the “Do Not Use Abbreviations
List” as part of a medication related order, and there is any doubt about the exact intent, the
order should be verified by nursing and/or pharmacy prior to the medication being
dispensed.
6.
Terminal (trailing) zeros after a decimal should not be used ( i.e., 1.0mg should be 1mg).
Computer-generated lab reports are EXEMPT, however, and may utilize a trailing zero
to express the necessary number of significant digits.
7.
Leading zeros before a decimal point should always be used (i.e., 0.5mg instead of .5mg).
Computer-generated lab reports are EXEMPT, however, and may omit a leading zero
due to software constraints.
APPENDIX A
“DO NOT USE” ABBREVIATIONS
JCAHO MANDATED
(100% COMPLIANCE IN ALL DOCUMENTATION PER JCAHO)
Set
Item
Abbreviation
Potential Problem
1.
1.
2.
2.
IU
Mistaken as IV or 10
3.
3.
4.
QD/Q.D.
QOD/Q.O.D.
Mistaken for each
other
4.
5.
6.
X.0 (trailing zero)
__.X (no leading
zero)
Decimal point can be
overlooked.
5.
7.
8.
9.
U
Preferred
Term(s)
“Unit”
Mistaken as 0, 4 or cc
Confused for one
another.
MS
MSO4
“International
Unit”
“Daily”/”Qday”
“Q24hr”
“Every other day”
Never write a zero
by itself after a
decimal, and
always use a zero
before a decimal.
“Morphine”
“Magnesium”
MGSO4
VWCH Chosen (June 2002)
(Per Van Wert County Hospital Policy PH-02)
Abbreviation
Potential Problem
Preferred Term
g
Mistaken for mg
“mcg”
SS
Could mean ½ or sliding scale or
Social Services
Write out “½”or
“one-half” or
“social services”
QHR
Mistaken for Bedtime
“every hour”
Form #6220-015
reviewed 3/12
APPENDIX B
ISMP Dangerous Abbreviations or Dose Designations
Abbreviation/
Dose Expression
Intended Meaning
Correction
Misinterpretation
Apothecary symbols
dram
minim
Misunderstood or misread (symbol for
Use the metric system.
AU
aurio uterque (each ear)
D/C
discharge
discontinue
Mistaken for OU (oculo uterque each
eye).
abbreviation.
Premature discontinuation of medications
when followed by a list of drugs.
Drug names
ARA-A
AZT
CPZ
DPT
vidarabine
zidovudine (RETROVIR)
COMPAZINE
(prochlorperazine)
DEMEROLPHENERGANTHORAZINE
cytarabine (ARA-C)
azathioprine
chlorpromazine
Use the complete
spelling for drug
names.
diphtheria-pertussis-tetanus (vaccine)
HCl
hydrochloric acid
HCT
HCTZ
MgSO4
MSO4
MTX
TAC
ZnSO4
hydrocortisone
hydrochlorothiazide
magnesium sulfate
morphine sulfate
methotrexate
triamcinolone
zinc sulfate
hydrochlorothiazide
hydrocortisone (seen as HCT250 mg)
morphine sulfate
magnesium sulfate
mitoxantrone
tetracaine, ADRENALIN, cocaine
morphine sulfate
sodium nitroprusside infusion
NORFLEX (orphenadrine)
g
nitroglycerin infusion
norfloxacin
microgram
o.d. or OD
once daily
Stemmed names
oculus dexter) and administration of oral
medications in the eye.
TIW or tiw
three times a week.
abbreviation.
per os
orally
q.d. or QD
every day
qn
nightly or at bedtime
Qhs
nightly at bedtime
Mistaken as q.i.d., especially if the period
misunderstood as an
Misread as every hour.
APPENDIX B
ISMP Dangerous Abbreviations or Dose Designations (cont’d)
Abbreviation/
Dose Expression
q6PM, etc.
q.o.d. or QOD
Intended Meaning
every evening at 6 PM
every other day
Misinterpretation
Correction
Misread as every six hours.
is poorly
written.
sub q
subcutaneous
SC
subcutaneous
U or u
unit
IU
cc
international unit
cubic centimeters
x3d
BT
for three days
bedtime
ss
sliding scale (insulin)
or ½ (apothecary)
> and <
greater than and less than
/ (slash mark)
separates two doses or
every 2 hours before surgery).
Mistaken for SL (sublingual).
Read as a zero (0) or a four (4), causing a
10-fold overdose or greater (4U seen as
acceptable abbreviation.
Misread as IV (intravenous).
Mistakenly used opposite of intended.
Do not use a slash mark
to separate doses.
Name letters and dose Inderal 40 mg
numbers run together
(e.g., Inderal40 mg)
Misread as Inderal 140 mg.
Zero after decimal
point (1.0)
1 mg
Misread as 10 mg if the decimal point is
not seen.
No zero before
decimal dose
(.5 mg)
0.5 mg
Misread as 5 mg.
Always use space
between drug name,
dose and unit of
measure.
Do not use terminal
zeros for doses
expressed in whole
numbers.
Always use zero before
a decimal when the dose
is less than a
whole unit.
©2001 Institute for Safe Medication Practices. Permission is granted to subscribers to use material from ISMP Medication Safety Alert! for in-house newsletters or other
internal communications only. Reproduction by any other process prohibited without permission from ISMP in writing. ISMP® is an FDA MEDWATCH partner. Report
medication errors to the USP Medication Errors Reporting Program (USP MERP). Call 1-800-23 ERROR (233 7767). Unless otherwise indicated, error reports
referenced in this publication were received through the USP MERP, operated in cooperation with ISMP. Editors: Judy Smetzer, RN, BSN, Michael R. Cohen, MS,
FASHP; Contributing Editors: Thomas Burnakis, PharmD, Bob Cisneros, MS, RPh, Hedy Cohen, RN, BSN, George Di Domizio, Joanne Falcone, RN, CCRN, Matthew
Grissinger, RPh, Russell Jenkins, MD, Marci Kropff, PharmD, Christina Marucci, RPh, Steven Meisel, PharmD, John Senders, PhD, Daniel J. Sheridan, MS, RPh, Joel
Shuster, PharmD, Lawrence A. Trissel, MS, FASHP. Institute for Safe Medication Practices, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006. Tel.
215 947 7797; Fax 215 914 1492; E-MAIL: [email protected]. www.ismp.org. HOTLINE: 1-800 FAIL SAFE (324 5723).