When the Abbreviation Becomes the Killer

The patient chart is a very important document in the facility that serves as a communication tool on the whole course of the patient's care. It is a vital document that allows us to facilitate a continuous flow of care to the patient whether he or she is stable or not. When I was a student nurse, I came to realize the danger of using acronyms and abbreviations that may post great risk to the patient's well-being when Dr. Juan V. Komiya- medical director then of Lorma Medical Center stressed the importance of rather completing the "words" specifically in making doctor's order than introducing or using the shorthand that could no be understood by other members of the health care team, like the nurses (who usually carry out doctor's order). My understanding from the good doctor's perspective roots from an application of that principle in "drug orders" wherein, if not written legibly and if acronyms could have variable meanings, chances are, the nurse may have an inaccurate assumption or interpretation of its meanings. We were trained theoretically to "verify" orders from physicians when we are not sure but there are cases when these instances are not possible. Should we resort to having another supporting physician (another resident on duty) to verify the latter's order may sound unethical and may not be the standard of the facility. More so, we don't want to take much time thinking about the meaning of that acronym or abbreviation since time is essential in health care delivery, a delay may post risk again to the patient's well being.
So, as assertive as I can, I usually "ask" doctors to write legibly and with no acronyms. Luckily, the physicians who took up nursing have in any way made adjustments in the long run when they were taught the Fundamentals in Nursing practice regarding communication and documentation. However, these instances are not always the case on some training facilities. Neither they have standards posted on the bulletin boards for "allowed" shorthands. Yet, I am taking this liberty to post examples of "dangerous shorthands"...

Do Not Use	Potential Problem	Use Instead
IU (International Unit)	Mistaken as IV (intravenous) or the number 10 (ten)	Write “International Unit”
MS MSO4 or MgSO4	Can mean morphine sulfate or magnesium sulfate and are confused or mistaken for one another	Write “morphine sulfate” Write “magnesium sulfate”
Q.D., QD, q.d, qd (daily) Q.O.D., QOD, q.o.d., qod (every other day)	Mistaken for each other Period after the q mistaken for “I” and the “Q” mistaken for “I”	Write “daily” Write “every other day”
Trailing Zero (e.g. X.0 mg)* Lack of Leading Zero (.Xmg)	Decimal point is missed leading to 10-fold dose error	Write X Write 0.X
U (for unit)	Mistaken as “0”, the number 4, or “cc”	Write “unit”

While it is true that nursing is a science and an art. We can't possibly adapt the art of "texting" in making an important documentation that involves the lives of patient, the recipient of our professional service. To add, Ivy Fenton Kuhn points in an article, "Abbreviations and acronyms in healthcare: when shorter isn't sweeter" for pediatric nursing wherein it identifies the struggle to limit the use of abbreviations and acronyms in the health care community. The article also identifies the Patient Safety Issue in Healthcare involving the contribution of the use of abbreviation and medical notation's significant contribution to the statistic of serious errors and deaths. The most common problem types of its usage are:

1. Ambiguity - Abbreviations or acronyms can stand for more than one word and therefore can be misinterpreted.
2. Unfamiliar abbreviations- A reality of healthcare today is the specialized nature of individual services and disciplines.
3. Look-alike abbreviations -Throughout the healthcare literature are widespread examples of common errors due to look-alike abbreviations or symbols. These problems involve numbers as well as letters.

The article also identifies the efforts of many organizations to the development of a National Patient Safety Goal focusing on the creation of a "do not use" abbreviation list. Another is to mandate institutions to standardize a list of abbreviations, acronyms, and symbols that were not to be used throughout any accredited organization.

I have seen some local hospitals posted the list of these acronyms and abbreviations. Yet, the nurse should always be assertive when something is not clear within the orders and medication documentation.

While "The benefits of the use of abbreviation and acronyms in general documentation may appear obvious. In the case of abbreviations, they have not changed over centuries. Abbreviations and acronyms are short, space-saving, convenient and easy to use. They are simple and hard to misspell. They also may be exclusive, and therefore understandable only to a specific group of professionals (Kushlan, 1995).", it is within the bounds of professional responsibility to deal with the dynamics of this existing problem especially in a health care delivery system that has limited resources. Hence, another challenge to nursing and the rest of the members of the health care team.