SDS Accreditation Update

You’re writing more as abbreviations disappear

No more d/c, u, Q.D., or Q.O.D., according to Joint Commission list

Old habits are hard to break, and the Joint Commission on Accreditation of Healthcare Organizations is asking same-day surgery staff members to break some habits they’ve had since nursing and medical school. National Patient Safety Goal No. 2 requires health care organizations to standardize abbreviations, acronyms, and symbols and to develop a list of do-not-use abbreviations.

The list includes abbreviations that are most commonly misinterpreted and most likely to cause an adverse outcome. All Joint Commission-accredited organizations were required to have a minimum list of do-not-use abbreviations in place by Jan. 1, 2004, and they were to have added at least three other abbreviations pertinent to the organization to the list by April 1, 2004. (See list of abbreviations.)

The requirement that every organization accredited by the Joint Commission develop a do-not-use abbreviation list was in place throughout all of 2003, but the requirements needed to comply with the patient safety goal addressed by the list become more specific in 2004.

The list is designed to clarify communications and avoid interpretation mistakes as different people read the patient’s chart, explains Richard J. Croteau, MD, executive director for strategic initiatives for the Joint Commission. "Although we don’t believe the list should be lengthy, our surveyors found that some organizations’ lists were so short that they didn’t address abbreviations that have been proven to cause confusion," he says. "Some organizations had only one item identified, and one item does not make a list."

The do-not-use minimum requirements and the additional abbreviations to consider were identified after review of root-cause analyses of adverse events included in a variety of databases, including the Joint Commission’s database of sentinel events, Croteau says.

Because several of the abbreviations are medication-related, the Joint Commission worked with the Institute for Safe Medication Practice (ISMP) in Huntingdon Valley, PA. In addition to the lists recommended by the Joint Commission, organizations also are encouraged to review a list developed by ISMP to see if your same-day surgery program is using risky abbreviations related to medication, he suggests. (For information on how to access that list, see resources at the end of this article.)

Another way that the staff at Nacogdoches (TX) Medical Center Surgery Center identifies abbreviations that might cause problems is through chart audits, says Janice S. Williams, RN, BSN, regulatory manager for the surgery center. "We were surveyed in 2003 and had our do-not-use list in place, but we have added some abbreviations to meet the minimum requirements for 2004," she says.

In addition to using chart audits to identify which of the additional abbreviations are used most often and present the greatest risk for misinterpretation, the audit tool also is used to measure compliance with the do-not-use standard, Williams explains.

Compliance with this requirement is not as high as compliance with other Joint Commission standards, Croteau admits. "In 2003, we saw an overall compliance rate of 70% for the do-not-use abbreviation list as compared to a compliance rate of 90% or better for other patient safety goal requirements and standards," he says. "This is a tough standard to meet because we are not just changing processes, we are changing behavior."

Introduction of the list required inservice education, posters in all areas of the same-day surgery program, fliers in the physician’s in-house mailboxes, and presentations to the medical staff, Williams explains. The posters and fliers, which listed the banned abbreviations, were created in-house and reminded everyone not to use the abbreviations in order to increase patient safety, she says.

Don’t forget to include the physicians’ office staffs in your education efforts, Williams notes. "Any handwritten paperwork that relates to patient care must comply with the standard, even if it is generated by the physician’s own staff," she says.

Repetition throughout the year was necessary because staff members and physicians are being asked to stop using abbreviations they’ve used since nursing or medical school, Williams adds. "With some of us, we are changing 30 years of learned behavior. We are adding d/c’ to our list, but we’ve all been accustomed to using it for discharge."

She obtained medical staff buy-in by having the medical staff review and approve each variation of the do-not-use list as it is introduced. The approval process not only gave Williams a chance to explain the reasons for including different abbreviations, but also gave her an opportunity to point out how elimination of confusing abbreviations will increase patient safety, she adds.

William’s organization still has an "approved abbreviations" list that staff members use, but Croteau points out that this list is not required. "We require that organizations standardize their terminology so that the chart can be easily read and understood by others, and many organizations do this with an approved abbreviation list," he explains. "We would prefer that no abbreviations be used, but if there is a list, we will check to make sure it is used consistently."

The Wilmette, IL-based Accreditation Association for Ambulatory Health Care (AAAHC) does not take the same approach to clear communications as the Joint Commission, says Barbara Ann Harmer, RN, MS, a health care consultant and AAAHC surveyor. "AAAHC is not a prescriptive as Joint Commission," she explains.

"In our standards, we require that the clinical record be kept in a consistent and standard format that is predetermined. Also, throughout all of the standards that relate to records, AAAHC emphasizes the need for legibility and accurate communication, Harmer adds.

If a same-day surgery program chooses to meet the standard with a list of abbreviations that are approved or that cannot be used, be sure that all staff members use the list consistently, she explains. "One of the biggest problems is a cumbersome list that no one uses." For this reason, review any list you use on a regular basis to make sure it is appropriate for your organization, Harmer says. "If you state that a list is how you are meeting a standard, the surveyor will be looking in your charts for proof that staff members use the list," she notes.

Resources

For more on use of abbreviations, contact:

Richard J. Croteau, MD, Executive Director for Strategic Initiatives, Joint Commission on the Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5000. Fax: (630) 792-5005. E-mail: rcroteau@jcaho.org.

Barbara Ann Harmer, RN, MS, Senior Consultant, Healthcare Consultants International. Phone: (407) 709-7209. E-mail: HCIhelp@aol.com.

Janice S. Williams, RN, BSN, Regulatory Manager, Nacogdoches Medical Center Surgery Center, 4948 N.E. Stallings Drive, Nacogdoches, TX 75965. Phone: (936) 568-3595. E-mail: Janice-NMC.Williams@tenethealth.com.