The Use of Abbreviations in Clinical Practice

The use of abbreviations in routine practice and by medical personnel has been in practice since time immemorial. The term abbreviation literally means ‘a shortened form of a written word or phrase used in place of the whole’ (Merriam-Webster, 2009). Evidence of the use of abbreviations in Latin manuscripts dating back to medieval times has been found, and it has been postulated that the use of these abbreviations came into practice due to the scarcity of writing materials such as parchment, marble, stone, etc (Bloom, 2000 cited in Kuhn, 2007).

In today’s world, the reasons quoted for the use of abbreviations are quite similar to those in ancient times; however, the writing materials used nowadays are in stark contrast to those used previously. In the modern era of computer technology, with the ever increasing use of emails and devices such as cell phones, Personal Digital Assistants (PDAs) and the lack of time, the use of abbreviations is becoming increasingly prevalent.

In the field of medicine, abbreviations first came into use when different classification systems were devised, such as the Periodic Table for the classification of metals (Kuhn, 2007) and ever since, the use of abbreviations has become a norm. Although abbreviations have the advantages of being convenient to use, short and thus less space consuming and time saving, they carry with them several concomitant disadvantages, including being ambiguous in nature and prone to being misinterpreted (Kuhn, 2007).

The use of abbreviations can be potentially dangerous as it can lead to medication errors due several factors such as untidy or illegible handwriting of health care professionals, and incomplete or improper instructions employing the use of abbreviations, leading to a communication gap (Alert, 2001). This has serious implications, especially in professions such as medicine, which carry with them the enormous responsibility of ensuring patient safety at all times. Moreover, this problem is not only confined to the use of handwritten formats but is also commonly experienced while using print and electronic media (Alert M.

S. , 2002). The magnitude of the problem can be judged from the fact that each year, more than 7000 deaths can be attributed to medication errors, as estimated by the Institute of Medicine of the National Academies (Nagy, 2006). Eliminating abbreviation related morbidity and mortality is crucial in medical practice. Examples of problems associated with the use of abbreviations include: (a) ambiguous abbreviations such as CP which can be interpreted in several different ways including cerebral palsy, cleft palate, creatinine phosphate etc (Kuhn, 2007).

Similarly, a very commonly misinterpreted abbreviation is MS, which can be used to mean morphine sulfate or magnesium sulfate and substituting one for the other can lead to potentially serious hazardous consequences, (b) unfamiliar abbreviations and (c) look alike abbreviations, the most famous and widely used example of which is the ‘naked decimal point’. It is common practice to avoid the use of the zero preceding a decimal and thus can lead to the common error of dosages being misinterpreted.

For instance, . 5mg can be misinterpreted as 5mg and can lead to catastrophic accidents. Other commonly used look-alike abbreviations include µ (for micrograms) and U (for units) which are often misinterpreted for a zero (Kuhn, 2007). Such errors can occur in everyday clinical practice when orders written by one doctor or health care professional are misinterpreted by other health care professionals involved in patient care such as nurses, pharmacists, etc.

These examples reflect and emphasize the importance of clarity and precisions in the written instructions and of effective communication between different key players involved providing health care in medical practice. All these errors and accidents can be avoided by limiting the use of abbreviations in clinical practice. Keeping the above mentioned examples and the magnitude of this problem in view, it is imperative that written policies should be devised to minimalise the inadvertent morbidity and mortality which is associated with abbreviation use.

These policies should mention clear instructions on which abbreviations to avoid and methods to ensure proper implementation of these policies and compliance amongst all health care professionals should be devised. A list of potentially dangerous abbreviations should be identified and circulated amongst all health care professionals. These policies should not be limited to targeting only medical professions (e. g. doctors and nurses) but also other individuals involved in heath care such as personnel belonging to pharmaceutical companies and information system vendors.

In order to maximize the effectiveness of policies prohibiting or limiting the use of abbreviations, policies targeting pharmaceutical companies should also be devised. Such policies should dictate proper standards to be used by these companies while publishing product labels, drug manuals, advertisements and packages. This would be an effective intervention as once published manuals minimize abbreviation use and start using proper documentation, health care professionals using the products from these companies would adapt similar styles of dosage documentation in prescriptions.

Similarly, not only medical prescriptions and physician orders but also other documents such as ‘protocols, computer-generated medication administration records, prescription labels, care maps, in-house newsletters should be targeted to reduce the widely prevalent use of abbreviations’ (Alert M. S. , 2002). Policies and strategies can also be devised which promote the use of electronic media and computerized order entry systems.

This can help in error reduction especially those associated with illegible handwriting and studies have shown this method is effective. One study showed a 62% reduction in medical errors in a one year period at a health care facility after using a computerized system of communicating orders amongst different individuals involved in providing health care to patients (Kuhn, 2007). Improvising such policies helps in maintaining an effective system of checks and balances over the entire medical system and ensuring maximum patient safety.

This is important from a public health perspective since morbidity and mortality attributed to abbreviation use is avoidable and thus can be easily prevented if efficient strategies are devised to overcome these errors. Abbreviation use is acceptable under certain circumstances. Those abbreviations which are universally accepted and standardized can be used in everyday clinical practice such as LASER, STAT, CPR etc. Moreover, abbreviations which have a low possibility of being misinterpreted and are distinct and clear can be used. These abbreviations should be standardized and used by all medical professionals.

In order to reduce the incidence of tragic accidents associated with abbreviation use, FDA and ISMP initiated a collaborative educational campaign which was targeted at individuals belonging to the pharmaceutical industry and a variety of medical personnel in a multitude of settings (Nagy, 2006). A standardized list of ‘do not use’ abbreviations was introduced by the Joint Commission in 2004 and was integrated in the Patient Safety Goal 2b, a subset of the Communication goal (Kuhn, 2007). Moreover, they also devised a package of materials to be distributed amongst the target groups as a part of the campaign.

These materials included posters, brochures, videos, self-aid online tool kits and advertisements in industrial publications (Nagy, 2006). Similarly, a community collaborative involving seven hospitals in Milwaukee County was improvised with the aim of eliminating the use of high risk abbreviations by physicians and was found to be effective in reducing the use of abbreviations in clinical practice (Leonhardt & Botticelli, 2006). A review of the literature on the steps taken by various organizations, particularly the ISMP and JCAHO, reveals that several appropriate and adequate steps to reduce abbreviation use have been taken.

However, further efforts should be made in this regard and this issue should be widely publicized so that the adherence to the ISMP and JCAHO policies is maximized. Certain other measures which can be taken include launching educational campaigns, making the list of prohibited abbreviations widely available and easily accessible to all changing the format of preprinted order sheets and other forms by removing the prohibited abbreviations from them (Goals, 2006). References Alert, M. S.

(2002, February 20). Eliminating dangerous abbreviations and dose expressions in the print and electronic world. Retrieved April 20, 2009, from Institute for Safe Medication Practices (ISMP): http://www. ismp. org/Newsletters/acutecare/articles/20020220. asp? ptr=y Alert, S. E. (2001, September 1). Medication errors related to potentially dangerous abbreviations. Retrieved April 22, 2009, from The Joint Commission: http://www. jointcommission. org/SentinelEvents/SentinelEventAlert/sea_23. htm

Bloom, D. (2000). Acronyms, abbreviations and initialisms. British Journal of Urology, 86, 1-6. Goals, N. P. (2006, January 25). Implementation Tips for Eliminating Dangerous Abbreviations. Retrieved April 20, 2009, from The Joint Commission: http://www. jointcommission. org/PatientSafety/NationalPatientSafetyGoals/abbr_tips. htm Kuhn, I. F. (2007). Abbreviations and Acronyms in Healthcare: When Shorter Isn’t Sweeter. Pediatric Nursing , 392-399. Leonhardt, K. K. , & Botticelli, J. (2006).

Effectiveness of a Community Collaborative for Eliminating the Use of High-risk Abbreviations Written by Physicians. Journal of Patient Safety , 147-153. Merriam-Webster. (2009). abbreviation. Retrieved April 20, 2009, from Merriam-Webster Dictionary Online: http://www. merriam-webster. com/dictionary/abbreviation Nagy, B. (2006). FDA safety efforts target counterfeiting, unapproved products, and confusing abbreviations;enrollment in Medicare part D rises above 38 million. Formulary , 354-355.