Determine Interventions

The team will need to generate ideas for strategies that can be used to influence how abbreviations are used. Consider ideas from other initiatives or from the literature, adapt current processes or technologies, or devise a completely new change idea.

The most important learning from the experience of others is that using a combination of intervention strategies is required in order to change ingrained practice habits like the use of abbreviations. Different interventions and strategies that have been used to curtail abbreviation use are described in Section 4: Making it Happen. The main categories of intervention strategies are summarized below in the order from least to most effective according to the hierarchy of effectiveness:31

  • Policies and guidelines – While policies and guidelines need to be in place for any type of enforcement strategy to be effective, they will be ineffective when used alone.
  • Education and awareness – In order to be effective, educational interventions should be tailored to the needs of the group expected to change their practice.
  • Reminders – Most initiatives use some form of reminder or prompt to reinforce what people learn from educational interventions.
  • Audit and feedback – Measuring how abbreviations are being used and providing feedback to individuals about their performance can be an effective strategy.
  • Standardization of orders – The use of protocols or pre-printed clinical order sets (paper or electronic) that do not use abbreviations can help structure medication ordering and support clear communication.40
  • Computerization – Computerized prescriber order entry (CPOE) and electronic prescribing help to standardize medication prescribing, eliminate illegible orders, and curtail the use of error-prone abbreviations.
  • Forcing functions – A forcing function or constraint is a process or equipment design feature that makes it easy to do the right thing. For example, in an electronic health record system, free text data entry fields can be designed to not accept certain abbreviations (forced correction) or to automatically convert a short form of communication into an acceptable format (auto-correction).

U for Units: Choosing Interventions

The project team determined that the primary change strategy would be education combined with feedback to individual prescribers about their use of units and U. A phased approach to education was proposed beginning with a letter from the chief of medicine and the chief of surgery to their colleagues setting expectations for performance. This would be accompanied by a personalized report for each prescriber showing how their prescribing compares to that of their unnamed colleagues. This would be followed by an inservice education program presented in person and accessible as a podcast through the internal website. Posters were designed for the nursing station to raise awareness of the issue and reinforce key messages from the inservice.
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U for Units: Choosing Interventions

The project team determined that the primary change strategy would be education accompanied by prescriber feedback. The medical advisor sent a letter to all physicians caring for residents of the facility setting expectations for insulin ordering. For prescribers who had ordered insulin during the baseline period, the letter included a bar graph showing how that prescriber’s use of units and U compared to that of their anonymous colleagues. Posters were designed for the nursing stations to raise awareness of the issue and reinforce key messages. A 10 minute inservice suitable for presentation at shift change was developed for nursing and pharmacy staff. It highlighted the problems encountered when U is used as the dose designation for insulin and how this had contributed to medication incidents at the site. It also included information on the use of U in transcribed orders. Expectations for using units instead of U in transcribing orders were established.

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