Local Context

In addition to evidence from the literature, an improvement initiative is more likely to be successful if it addresses a documented problem in the local setting. For example, is there an error-prone abbreviation that is frequently used or that has been a contributing factor in patient safety incidents? How are abbreviations used in high risk situations where misinterpretation could have significant consequences for the patient? More information about specific high risk situations – high alert medications, abbreviated medication names, and pediatrics – can be found here.

To focus the abbreviation initiative, define the local problem and relate it to what is known about the impact of abbreviations from the literature. This will help build a case for an executive sponsor (Engaging the Right People). Some questions that can be used to guide collection of information to help define local practice patterns are presented in Table 4. Sources of information about abbreviation use may include:

  • Patient health records – particularly medication and treatment orders, clinical notes, and records of treatments given (e.g., medication administration records)
  • Order sets (e.g., pre-printed forms or electronic documents)
  • Reports of patient safety incidents or close calls involving abbreviations
  • Medication or treatment orders with abbreviations that require clarification with the prescriber

Gather information by reviewing records from a specific time period in the past, or by noting abbreviations as they are currently being used. Although data from the local setting will be most relevant, consider trying to find information from similar organizations or programs if possible. Comparative data may also be found in the literature.

Table 4. Questions to help define local practice patterns
  • What abbreviations are most commonly used in the setting?
  • What abbreviations are used with high alert medications (e.g., insulin, warfarin, narcotics)?
  • What abbreviations have been implicated in patient safety incidents?
  • Who is using abbreviations (e.g., doctor, nurse, pharmacist, other healthcare provider)?
  • How are abbreviations being used (e.g., to order treatments, document patient progress, transcribe treatment orders, give instructions to patients)?
  • What abbreviations are commonly used for each purpose?
  • What is the impact of abbreviation use (e.g., orders need to be clarified; abbreviation results in a close call or error, such as a transcription error or patient receiving an incorrect dose of medication)?

U for Units: Identifying a Local Problem

In preparation for accreditation, a hospital pharmacy reviewed abbreviation use in all medication orders received over a one-month period. Staff recorded any abbreviations used that did not comply with the hospital medication order writing policy, as well as the patient care area where the order originated.

The pattern of most concern was use of the abbreviation U for units. The use was particularly high on one medical and one surgical unit. Eight medication errors related to the use of U for prescribing insulin had been documented in the previous year. Further investigation into how U was being used found that it was commonly used by both nurses and doctors in documenting care in the patient health record.

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U for Units: Identifying a Local Problem

In preparation for accreditation, the Director of Care of a long term care facility asked the pharmacy service provider to review abbreviation use in all medication orders received over a six week period. Pharmacy staff recorded any abbreviations used that did not comply with the facility’s medication order writing policy.

The pattern of most concern was use of the abbreviation U for units when insulin was ordered. The Director of Care also reviewed medication errors from the past year, focusing on those that involved abbreviations. Four medication incidents related to the use of U for designating a dose of insulin had been documented in the previous year. Two of these involved misinterpretation of a physician order and two involved use of U during transcription – one concerned a verbal order transcribed into the resident’s chart/physician orders and the other occurred when a new insulin dose was transcribed onto the medication administration record by a nurse.

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