Are nurses still using do-not-use’ abbreviations?

A recent report from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) revealed that hospitals were almost 100% in compliance with all the National Patient Safety Goals, with one exception: the requirement to avoid use of unauthorized abbreviations, which fell to 85% compliance.

The goal requires you to standardize abbreviations, acronyms, and symbols used and develop a list of which not to use. (For JCAHO’s minimum "do-not-use" list, go to www.jcaho.org. Click on "National Patient Safety Goals and FAQs," "Implementation Tips to Eliminate Dangerous Abbreviations," "Prohibited Abbreviations," and scroll down to the list.)

This is one of the most difficult of the safety goals for EDs to comply with, says Karol Edwards, RN, nursing director of the ED at Upper Chesapeake Medical Center in Bel Air, MD. "This was a big challenge for ED nurses," Edwards says. "We are creatures of habit, and this was a change in practice that some of us have been doing for many years."

5 steps to compliance

To reduce use of unauthorized abbreviations in your ED, do the following:

  • Use pocket cards.

Small pocket cards were given to each ED nurse with a list of accepted abbreviations, says Barb Baughman, RN, director of emergency services at Harford Memorial Hospital in Havre de Grace, MD.

  • Use fliers to address current trouble spots.

Bulletin boards are updated continually to remind nurses of specific abbreviations currently being watched, she says.

  • Audit charts.

At Upper Chesapeake, two ED nurses review five sets of admission orders per month, says Edwards. "It is easy to accomplish this on any day, as we have so many admissions through the ED," she adds.

The inpatient floor secretaries do a second check when they are taking off the orders for admitted patients. "They are always double-checking the abbreviations as they know what is approved and what is unacceptable," says Edwards.

If the secretaries find any unapproved abbreviation, they immediately notify the ED nurse and send the order sheet back to the ED to be corrected by the nurse who wrote the orders. "This helps us make sure that we are in compliance as close to 100% of the time as possible," she explains. "It is a good system and keeps us all on our toes."

The information from the audit tools are submitted monthly to a designated person who puts them into a departmental and hospitalwide report, and monthly, quarterly, and yearly reports are generated, says Edward.

Although unauthorized abbreviations are rarely found, charts still are monitored regularly so that Joint Commission surveyors can see that compliance is continually tracked, she notes.

  • Make sure agency nurses are informed.

Agency nurses working in Upper Chesapeake’s ED are given the same list of unauthorized abbreviations used by ED nurses, and the list was sent out in a mailer with paychecks, says Edwards.

"It is the expectation that agency nurses function under the same guidelines, protocols, and policies as the staff or pool nurses," she says. "It is truly a patient safety issue."

  • Start with a small list of abbreviations.

At Northeast Medical Center in Concord, NC, a list of 25 unauthorized abbreviations was developed, but nurses felt overwhelmed because the list was too long, says Sherry Walter, RN, MSN, CCRN, clinical director of the emergency care center. After the list was cut down to the 10 most frequently misused abbreviations, staff showed dramatic improvements, she reports.

Bright yellow cards were posted at every workstation and in bathrooms as a reminder, says Walter. "The more people saw the unapproved abbreviations, the more they remembered not to use them."

Also, ED coders reviewed every record for unapproved abbreviations until staff consistently showed compliance, she adds. "Now that we have mastered these, we will soon begin to tackle some more."

The coders monitored 100% of charts, paying particular attention to handwritten medication orders since that is what the Joint Commission goal originally required, says Walter. "We did not do a baseline study prior to implementation of unapproved abbreviations, but we did a three-month review of ED charts for our 10 identified abbreviations, and we were consistently between 99%-100% compliant," she reports.

The JCAHO’s modified 2005 requirements for standardizing medical abbreviations now apply to pre-printed forms as well as handwritten documentation, but apply only to orders and medication-related documents. "As far as pre-printed forms being in compliance, this step has already been taken, so this will not be an issue for our organization," says Edward. n

Sources

For more information about the "do-not-use" abbreviations, contact:

  • Barb Baughman, Director of Emergency Services, Harford Memorial Hospital, 501 S. Union Ave., Havre de Grace, MD 21078. Telephone: (443) 843-5544. Fax: (443) 843-7954. E-mail: blb.01@ex.uchs.org.
  • Karol Edwards, Emergency Department, Upper Chesapeake Medical Center. 500 Upper Chesapeake Drive, Bel Air, MD 21014. Telephone: (443) 643-2120. E-mail: kle.01@ex.uchs.org.
  • Sherry Walter, RN, MSN, CCRN, Clinical Director, Emergency Care Center, Northeast Medical Center, 920 Church St. N., Concord, NC 28025. Telephone: (704) 783-1648. Fax: (704) 783-2384. E-mail: slwalter@northeastmedical.org.