Goodbye to U: Safety campaign nixes abbreviations

Improved patient safety is the goal of efforts to rid the medical world of truncated terms that are often misunderstood.

By Susan J. Landers — Posted July 17, 2006

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The Food and Drug Administration is taking aim at "U." Actually, the agency is targeting this often-misread abbreviation as well as a long list of others.

It's all part of a nationwide education campaign launched June 14 by the FDA in conjunction with the Institute for Safe Medication Practices.

The initiative is directed at physicians, pharmacists, pharmaceutical companies, FDA staff and medical journals with the intent of pointing out the error of their ways. The message: Don't abbreviate crucial medical terms -- spell them out in their entirety. The reason: The use of shorthand terms is a common and preventable source of medication mix-ups and mistakes.

"Some abbreviations, symbols and dose designations are frequently misinterpreted and lead to mistakes that result in patient harm," said FDA Acting Commissioner Andrew C. von Eschenbach, MD.

In its 1999 review, To Err is Human, the Institute of Medicine reported that more than 7,000 deaths a year are due to medication errors. Mistakes can occur anywhere in the system, beginning with a name that is too similar to that of an existing drug and ending with prescribing and administration blunders, said Carol Holquist, director of the division of medication errors and technical support at the FDA Center for Drug Evaluation and Research. "Everyone has a role in preventing errors," she said.

The AMA also has taken up the cause of patient safety. It has adopted policy encouraging accuracy and clarity in all prescriptions and has discouraged the use of abbreviations.

The intent of the current effort is to cut through a thicket of mishap-prone abbreviations in all forms of medical communication, including written medication orders, computer-generated labels, medication administration records, pharmacy or prescriber computer order entry screens and commercial medication labeling, packaging and advertising.

Additional shortcuts the campaign is trying to abolish include the trailing zero -- written as X.0 mg. Since the decimal point is easy to miss and could lead to the administration of 10 times the amount of medication intended, the wiser choice would be to write X mg. Likewise, rather than .X mg, write 0.X mg, the groups advise. Plus, MSO4 and MgSO4 can be confused too easily with one another, so instead write out morphine sulfate or magnesium sulfate.

Lists available

The ISMP, a nonprofit organization based in Huntingdon Valley, Pa., has developed a list of more than 60 error-prone abbreviations it would like never to see used again. "We recommend that the ISMP's list of abbreviations, symbols and dose designations most often associated with medication errors be considered whenever medical information is communicated," said ISMP President and founder Michael Cohen, ScD, RPh.

The FDA provides a link to the list of ISMP abbreviations on its Web site (link).

A lengthy retraining effort might be required to abolish the unwanted terms, Dr. Cohen said, as they have been around for some time. The troublesome "U" was recognized as dangerously confusing in 1975 when the ISMP first published a column in a publication that was geared toward the education of health care professionals. Yet it's still used today.

"Old habits die hard," Dr. Cohen said. Physicians and pharmacists may first encounter these shortcuts while attending school, said Dr. Cohen, who would like to see the practice abolished there as well.

Journals also continue to use the abbreviations, he said, and the campaign targets the elimination of such terms in publications as well.

The Joint Commission on Accreditation of Healthcare Organizations has a list of "Do Not Use" abbreviations in its patient safety goals. That list includes "QD" and directs "daily" be used instead. Likewise, "every other day" should replace "QOD."

The accrediting organization is considering adding the wedge-shaped symbols for "greater than" and "less than" to the list, favoring the words instead.

Another patient safety measure recently took effect in Washington state. Starting June 7, no prescriptions written in cursive were acceptable at pharmacies. Specifically, the law requires that prescriptions be hand-printed, typewritten or electronically generated. The Washington State Medical Assn. supported this provision, which was part of a larger bill.

AMA policy also calls for legible prescriptions, including signatures.

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FYI on med abbrevs

The Institute for Safe Medication Practices would like doctors to avoid the use of confusing abbreviations in all communication forms, including:

  • Written orders
  • Internal communications
  • Telephone/verbal prescriptions
  • Computer-generated labels
  • Drug storage bin labels
  • Medication administration records
  • Preprinted protocols
  • Pharmacy and prescriber computer order entry screens

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Write it out, for clarity and safety

Drug names, dosage units and use directions should be written out to avoid confusion. Below are notations that, according to the Institute for Safe Medication Practices and the Food and Drug Administration, should never be used. These terms are also on the "do not use list" required by the Joint Commission on Accreditation of Healthcare Organizations.

Instead of Write Because
U unit Can be mistaken for 0, 4, or cc
IU international unit Can be mistaken for IV or 10
QD daily Can be mistaken for QID
QOD every other day Can be mistaken for QID or QD
X.0 mg (with trailing zero) X mg Decimal point can be missed
.X mg (without leading zero) 0.X mg Decimal point can be missed
MSO4 or MgSO4 morphine sulfate or magnesium sulfate Can be confused with one another

Sources: Institute for Safe Medication Practices and the Food and Drug Administration

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External links

Food and Drug Administration and Institute for Safe Medication Practices campaign to eliminate unclear medical abbreviations (link)

Institute for Safe Medication Practices on unclear medical abbreviations (link)

AMA on patient safety (link)

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