Abbreviations in the Health Sectors Essay
Common sources of errors that have led to the compromising of patients’ health and recovery have been blamed on the lack of understanding of the original message which in general can be classified as communication breach.Abbreviations in the Health Sectors Essay. In depth analysis has shown that most of these breaches occur in prescription and other written communication, not because some people are incompetent and do not understand English but do to the use of non-standard abbreviations that are misinterpreted for other things (ISMP, 2012). The purpose of this article is to delve into matters regarding abbreviation in the medical field and the steps being taken to ensure that indeed unnecessary errors are avoided at all costs.
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Abbreviations can be loosely termed as a number of letters that have been used to represent or shorten a long word. As the description suggests, we are prone to shortening words commonly used for the purpose of fast writing convenience and sometimes due to social groupings. In the medical fraternity, abbreviations can be used to represent processes, operations and medication or other prescriptions that may be used by a patient. As stated, these abbreviations can be limited to a particular group of people in a hospital or a lowers still, a particular department in the hospital. It can therefore lack meaning or mean another thing altogether in another department, area or region. Avoiding abbreviation means that whatever needs to be communicated is communicated without distorting the information or bringing about any sort of ambiguity to the issue.
As a result of the impact the distortion may have on the delivery of useful information that may at times be the lifeline of someone. Strict rules regarding the use of non-standard abbreviations should be made. The policies can be either nationwide, regional or in particular institutions. Policies made should be two-fold. One policy should advice against such doings and prescribes disciplinary actions that may be bestowed upon those who default from the system. Secondly, there should be a policy that checks any prescription that is made within the institutions for such errors and more so the ones that go out of the institutions should be verified as checked and approved to avoid wrong interpretation that may be made by other people outside the institutions. Also a list of the standard abbreviations should be included in notification to the practitioners (Joint commission, 2008) as per agreements that have been made in the industry as a whole. Abbreviations in the Health Sectors Essay.
That notwithstanding, the abolishment of abbreviations can translate to more tedious work for persons who are either reading or writing the material to be communicated. Thus abbreviations should ONLY be accepted when they coincide with the standard abbreviations in that particular industry for purposes of uniformity and deleting the possible ambiguity that may exist. In that case, they can be used by every practitioner in the place of work to mean the same thing. That way ease of communication will be ensured and it should be limited only to ones that have been approved as having traceability to the standards put in place.
According to the data mining that have been achieved in preparation of this article, significant efforts have been put in place to ensure that the errors that are propagated through abbreviations are reduced if not extinguished permanently. However, more should be done in terms of more education to the practitioners on the need to use only standard abbreviations that will not elicit any confusion in the implementation of any health action plan designed to help the customer overcome impending illnesses. Moreover, preaching of work ethics and the invoking of conscience is a major avenue that has not been indulged in and it would bring more fruit that imposing policies on a rebellious and unreasonable group. Start with reason then initiate policies (ISMP, 2012).
Even though the caregivers have her best interests at heart and are doing what they can to help, Jane believes they are the ones keeping her from going home. There were a few abbreviation mistakes that I noticed. There were no ICD-9-CM codes on the admission summary sheet. These codes are used for billing and the absence of these codes would cause her provider not to approve of her billing. The second mistake noticed was that all diagnosis were principle diagnosis and no secondary diagnosis. Which was the main reason for admitting Jane Dare, Congestive Heart Failure, left pleural effusion, or pneumonia? There should almost always be a secondary diagnosis with a primary. Another mistake noticed is the kind of antibiotic used when Jane was pit on an IV. Was there sulfa in it, considering Jane is allergic? Why was a blood culture not collected? If Jane was not able to sleep in her room because it is too hot or cold and the staff has found her sleeping on the floor, how do they know that she did not fall during the night? In RAP #8 it says that Jane needs the assistance of 1 to ambulate, however, the next statement reads that in a wheelchair she must be pushed to and from all locations because she gets SOB when doing it on her own. If she is able to ambulate, why is it she is having trouble in a wheelchair? Also, if psychotropic drugs are causing problems, why hasn’t the
Use of medical abbreviations in medicine is not new. Since the development of mainstream medicine nearly 200 years ago, abbreviations have been used. While initially, the abbreviations were limited to the writing of prescriptions, today, abbreviations have become very common in all aspects of medical documentation. Medical abbreviations are used in all medical and surgical departments, during surgery, the emergency room, and at discharge.Abbreviations in the Health Sectors Essay. One area where medical abbreviations are used most often and are a cause for concern is when writing drug orders. Until recently, the use of abbreviations has never been regulated, and there is no universal rule as to which abbreviations can be used and which ones cannot. In fact, over the past 3 decades, some healthcare workers have been making up abbreviations. The long-standing practice of writing medical abbreviation has become so entrenched in healthcare that even the most junior medical and nursing school graduates are very accustomed to writing them. In fact, many healthcare institutions have specialized lists of abbreviations that can be used. The use of medical abbreviations is not only an American phenomenon but a global problem.
For the past 3 decades, leaders in healthcare have been encouraging less use or even eliminating the use of medical abbreviations in medicine. The US Institute of Safe Medication Practices (ISMP) has regularly received a continual stream of reported errors, some of which have resulted in adverse events, due to misinterpretation of some dangerous medical abbreviations. The Joint Commission has regularly issued updates and regulations on the safe use of medical abbreviations and in fact, has also published a short list of dangerous medical abbreviations and dose expressions that should never be used. However, despite many key organizations condemning the use of medical abbreviations, they continue to be used at an alarming rate. In any medical chart or a drug prescription, medical abbreviations are almost routine. This can often place junior healthcare staff who are supposed to decipher the drug orders at great risk because often the healthcare provider who writes the medical abbreviations may not be around and the junior staff or nurse may use his or her limited knowledge to determine what the abbreviations exactly means. The other alternative is to refuse to carry out any order where the abbreviations do not make sense, but this refusal can also jeopardize a patient’s healthcare. Abbreviations in the Health Sectors Essay.
Now, with a more formalized practice of medicine, there is a concern that rampant use of medical abbreviations may pose a danger to the patient. While there are anecdotal examples of medical abbreviations that have caused harm to a few patients, good clinical evidence to support the belief that medical abbreviation use is dangerous or is causing problems in the delivery of standard of care is lacking. In any case, the potential for harm to the patient from improper communication as a result of medical abbreviations cannot be understated.
Issues of Concern
Who writes the most medical abbreviations?
From the limited publications, it appears that physicians are responsible for writing the vast majority of medical abbreviations. In private practice, it is usually the physician who writes medical abbreviations, but in large teaching hospitals, the medical and surgical residents write the most medical abbreviations, since they are the ones tasked with the writing of orders. However, other healthcare professionals who also regularly write medical abbreviations include dietitians, nurses, occupational and physical therapists, and social workers, albeit not in great numbers.
One of the biggest problems leading to medical errors is the failure to communicate, and this is made worse with the use of medical abbreviations which can have multiple meanings. Further communication lapses are often the result of using medical abbreviations, especially when writing medication orders for junior staff. The staff responsible for reading, interpreting and processing the medication order may misconstrue the abbreviation or may not even recognize it, leading to an erroneous meaning. For example, one very commonly reported misinterpretation of dosing is the use of a decimal point after a dose. For example. 5.0 is often mistaken for 50 and, if the dot is not seen-this can result in ten times the dose.
How common is medical abbreviation usage?
The exact number of healthcare professionals who use medical abbreviations or the frequency of usage is not known but the numbers are numerous. Abbreviations in the Health Sectors Essay. Pick up any medical chart or a drug prescription in any healthcare institution and one will see at least one abbreviation per page in the patient’s medical chart. But is the use of medical abbreviation really dangerous and how many patients have actually suffered an adverse event because of it?
The National Medication Error Reporting program is run by the US pharmacopeia MedMarx. This program permits subscribing healthcare institutions to report and track medication errors in a standard format. From 2004 through 2006, there were 643,151 medication errors reported to MedMarx from 682 facilities of which 4.7% (29,974) were attributed to use of medical abbreviations.
From these data, the most common medical abbreviation error was the use of QD (once daily) accounting for 43.1% of all errors followed by U for units, cc for ml and other decimal errors. The most common drug abbreviation name that led to an error was the use of MS or MS04 for morphine sulfate. At least 81% of the errors were noted to occur at the time of ordering the medication, while errors at the transcribing and dispensing area occurred at a lower frequency. The administration, procurement, and monitoring process were associated with less than 2% of the total errors. Overall, it appears that the three most common types of errors due to the use of medical abbreviations were errors in prescribing, improper dose/quantity and incorrect preparation of the medication. However, the consequences of the use of these medical abbreviations were not completely reported.
But irrespective of whether medical abbreviations are causing harm, no one argues that they can result in miscommunication because the other healthcare staff who are responsible for reading and processing orders may not be familiar or even recognize these abbreviations, which can result in gross errors in dispensing or administration of a medication or a test. Several studies have looked at critical incidents and adverse events in hospitals and in many cases it was observed that some medical abbreviations were dangerous, resulting in inappropriate dose administration or frequency.
Within the past 2 decades, there have been many reports about medication errors and patient safety remains a concern. It is estimated that medication errors alone account anywhere from 7000 to 10,000 deaths each year in the United States. While medication errors have many causes, one of the ways to reduce these errors is by improving written communication, whether it be electronic or written. In 2004, the Joint Commision developed the “Do Not Use” list of medical abbreviations as part of the requirements for meeting the National Patient Safety Goal, which primarily addresses the effectiveness of communication between healthcare workers. Abbreviations in the Health Sectors Essay. The Joint Commission has also recommended that all healthcare institutions create a standard list of acronyms, abbreviations, and symbols that should not be used. However, despite the development of “Do Not Use” lists, compliance is not 100%.
Further, the Joint Commission has banned the use of medical abbreviations in documents that pertain to patient rights, informed consent forms, discharge instructions and all other documents that a patient and the family may receive from the healthcare institution.
The Joint Commission has also recommended having a uniform and standardized list of symbols, codes, and abbreviations that can enhance communication and understanding among healthcare workers, leading to improved patient safety. Many healthcare workers have consistently reported that they have a great deal of difficulty interpreting medical abbreviations, even in their own hospital.
To prevent any misunderstanding and jeopardize patient safety, the Joint commision now required healthcare institutions to develop a list of approved and not approved medical abbreviations. In addition, there should be a system or an audit process to ensure that there is compliance
The healthcare institution must ensure that the medical abbreviation in the approved list is also not on the Do not use list or vice versa. Further if a medical abbreviation is permitted, then it can have only one universal meaning. For example, DOA can mean Date of Admission or Dead on Arrival.
The Joint Commission also recommends that healthcare institutions not use abbreviations on any patient-related documents. It is important to ensure that the patient and the family can understand the information provided to them without having to guess. Often patients have difficulty understanding discharge instructions and this can affect their ability to look after themselves or follow instructions.
The information in the discharge instructions must be clear and unambiguous, many times the patient may feel embarrassed to ask questions about abbreviations and this can impact the quality of care. Abbreviations in the Health Sectors Essay.
Sometimes laboratory results are sent to the patient but often this information does contain abbreviations. Whenever test results are provided to the patient, the healthcare provider should make a concerted effort to explain the results to the patients. While the use of imaging tests like CT scan and MRI are often abbreviated, it is important for the healthcare provider to spell out other not well-known tests, for example, instead of “BE”, the patient should be told “BE” means a barium enema.
How can healthcare institutions reduce or eliminate medical abbreviation usage?
Today some hospitals recommend that junior staff simply refuse to carry out orders that use medical abbreviations. In addition, physicians who write the medical abbreviations are reprimanded. However, instead of enforcement using authoritarian rules, the tide has now turned towards using more intensive and focused educational strategies to increase compliance with hospital rules (Abushaiqa et al., 2007). To encourage compliance the following education interventions may help reduce medical abbreviations.
Describe the abbreviation and provide a rationale why and how it can lead to an error
When an abbreviation is encountered speak to the healthcare provider
Teach junior staff and students about the dangers of using medical abbreviations
Develop a list of prohibited medical abbreviations and post them on every medical floor
If a medical abbreviation is to be used, then provide the dose designation and correct terminology
Develop a list of medication abbreviations which can pose a risk to patient safety
Develop posters and stickers on prohibited medical abbreviations that can be placed on medical charts, medicine cabinet, order sheets, and in the pharmacy
Have regular inservice education sessions for physicians, nursing staff, pharmacists and other healthcare professionals
Perform regular audits on the charts to determine who is still using medical abbreviations and what is frequency
Develop a system where nursing and other healthcare staff report use of medical abbreviations by other staff. This is not meant to be as a whistleblower, but to identify the individual and punish them but to educate them about the dangers of medical abbreviation. Abbreviations in the Health Sectors Essay.
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Formation of a Hospital Committee
Most hospitals have now developed a committee that oversees the use of medical abbreviations. The committee is in charge of implementing a list of prohibited abbreviations. The committee usually consists of a physician, nurse, pharmacist and personnel from risk management and patient safety (Traynor, 2004). This committee is also tasked with the role of performing chart audits to ensure that healthcare workers are compliant. The committee should also set policies for those who do not comply. One of the means may include ceasing order writing privileges for repeat offenders. Finally, the committee should encourage all staff to report other healthcare staff who continue to write medical abbreviations (Cowell, 2007).
The use of medication abbreviation has persisted in healthcare despite recommendations by the Joint Commission that such usage may adversely affect patient care. The majority of serious medication abbreviations are written while writing drug orders and often the junior staff are left with the responsibility of understanding and deciphering the abbreviation. With the wide adoption of electronic technology, these medical abbreviations are often repeated in the medical chart and continue to pose a threat to patient safety. Abbreviations in the Health Sectors Essay. All healthcare institutions have now started to formulate guidelines restricting the use of medical abbreviations. While few studies that have quantified the extent of medical abbreviation usage and their adverse effects, the Joint Commission feels that the problem is widespread and has the potential to cause severe patient harm. Thus, the Joint Commission has released a list of prohibited medical abbreviations for all healthcare institutions. One way to reduce the use of medical abbreviations will be from continuous reporting and education of healthcare workers. But on rare occasions, enforcement by limiting ordering privileges may be necessary. Although the risk of actual patient harm from use of medical abbreviations is low, the aim is to achieve a zero risk. Abbreviations in the Health Sectors Essay.