Literature Summary

Abbreviations are a part of the culture of communication in healthcare

Historically, physicians, nurses, and pharmacists were taught to use Latin medical terms and their abbreviated forms when writing orders.5 The benefits of abbreviations seem obvious in today’s fast paced therapeutic environment – they are convenient, easy and quick to use, space saving, and hard to misspell.5

Abbreviations and acronyms are not universally understood

Some commonly understood abbreviations are a useful part of practice (e.g., ‘a.m.’ for morning or ‘AIDS’ for acquired immunodeficiency syndrome). Other abbreviations lead to misinterpretation of instructions if they have multiple meanings or are not understood by all healthcare providers (e.g., OD can mean ‘once a day’ or ‘right eye’ or ‘overdose’).5,6,7

Use of abbreviations is widespread

Abbreviations are found in medical treatment orders, prescriptions, medication administration records, care plans, clinical notes about the patient, and instructions to patients.7,8,9 Free text entry fields in the electronic medical record are open to short forms of communication.8 Texting abbreviations and acronyms are increasingly being found in audits of health records.10

Students learn to use abbreviations early

Classroom and clinical educators need to be aware of how abbreviation use is being modeled to students and new healthcare providers. Discourage students from using abbreviations and texting acronyms in their assignments and in all forms of professional communication including documenting in the patient health record.

Poor handwriting compounds the problem

Poor handwriting increases the risk associated with abbreviation use.11-14 In one study, 20 per cent of orders with error-prone abbreviations were deemed illegible.11 When illegible handwriting was a contributing factor to a medication error, the order often included an abbreviation.12, 13 Error-prone abbreviations can also be introduced when a verbal order is recorded or orders are copied onto a medication administration record.

Some abbreviations are more likely to result in errors

A small number of abbreviations were implicated in the majority of abbreviation-related errors reported to a national reporting system (Table 1).12

Table 1. Top five abbreviations associated with errors
Abbreviation Percentage of abbreviation-related errors
QD 43%
U 13%
cc 13%
MS04 or MS 10%
Leading or trailing zeros 4%

Adapted from Brunetti et al., 200712

Research documents the issue and impact of abbreviation use

Evidence from research on the impact of abbreviations will be useful in building a case for an abbreviation initiative. A summary of some of the research documenting the issues with abbreviation use is provided in the Resources at the bottom of this page.

Patient safety organizations urge limiting abbreviation use

Many patient safety organizations (Table 2) have identified specific error-prone abbreviations and recommend that steps be taken to limit or prohibit their use. Accreditation Canada has a Required Organizational Practice related to dangerous abbreviations.4 Most of these resources refer to the use of abbreviations in medication orders. However, there is a much broader scope of situations and types of documentation where the use of error-prone abbreviations should be eliminated.6 (Table 3)

Table 2. Patient safety organization resources
Organization Resource
Accreditation Canada Dangerous Abbreviations Required Organizational Practice4
Institute for Safe Medication Practices Canada (ISMP Canada) Do Not Use Dangerous Abbreviations, Symbols and Dose Designations15
Institute for Safe Medication Practices (ISMP) List of Error-Prone Abbreviations, Symbols and Dose Designations16
The Joint Commission Facts about the Official ‘Do Not Use’ List17
National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) Dangerous Abbreviations15
Australian Commission on Safety and Quality in Healthcare Recommendations for Terminology, Abbreviations and Symbols Used in the Prescribing and Administration of Medicines19



Table 3. Types of Communication where error-prone abbreviations should be eliminated20

Communication Type Examples
Prescriptions Handwritten
Electronic
Pre-printed prescriber order sets
Standing orders
Prescription labels
Transcribed orders Verbal orders
Medication administration records
Medication reconciliation – best possible medication history form
Clinical communication Progress notes
Multi-disciplinary notes
Emergency department visit records
Discharge and transfer summaries
Operative notes
Protocols and care maps
Electronic medical or health records E-prescribing or computerized prescriber order entry
Free text entries in encounter notes or prescription notes
Published medical information Style guidelines include abbreviations not to be used
Research articles
Journals
Manuals
Pharmaceutical industry communications Promotional advertising including graphics and text
Training materials, presentations
Packaging and labelling
Education institutions/continuing education programs Instructional materials
Textbooks
Computer systems used in laboratories or practice settings
Publications
Communications with or instructions to students in small teaching groups