HealthStream Regulatory Script. [Medication Terminology: Use of Abbreviations & Symbols] Version: [ ]

Transcription

1 HealthStream Regulatory Script [Medication Terminology: Use of Abbreviations & Symbols] Version: [ ] Lesson 1: Introduction Lesson 2: Recommendations

2 Lesson 1: Introduction 1001 Introduction Welcome to the introductory lesson on medication terminology. IMAGE: 1001.GIF This course covers the safe use of medication terms. As your partner, HealthStream strives to provide its customers with excellence in regulatory learning solutions. As new guidelines are continually issued by regulatory agencies, we work to update courses, as needed, in a timely manner. Since responsibility for complying with new guidelines remains with your organization, HealthStream encourages you to routinely check all relevant regulatory agencies directly for the latest updates for clinical/organizational guidelines. If you have concerns about any aspect of the safety or quality of patient care in your organization, be aware that you may report these concerns directly to JCAHO. Point 1 of 4

3 1002 Course Rationale This course will help you and your facility improve patient safety. IMAGE: 1002.GIF You will learn about: Risky [glossary] drug terms Safer terms to use instead Point 2 of 4

4 1003 Course Goals After completing this course, you should be able to: Identify JCAHO [glossary] recommendations related to risky drug terms. Recognize risky abbreviations and symbols. Select safer terms to use in place of risky terms. NO IMAGE Point 3 of 4

5 1004 Course Outline This lesson gives the course rationale, goals, and outline. FLASH ANIMATION: 1004.SWF/FLA Lesson 2 gives recommendations for the use of written drug terms. Point 4 of 4

6 Lesson 2: Recommendations 2001 Introduction Welcome to the lesson on recommendations for the use of drug terms. FLASH ANIMATION: 2001.SWF/FLA Point 1 of 16

7 2002 Objectives After completing this lesson, you should be able to: Identify JCAHO recommendations related to risky drug terms. Recognize risky abbreviations and symbols. Select safer terms to use in place of risky terms. NO IMAGE Point 2 of 16

8 2003 JCAHO Recommendations JCAHO recognizes the importance of using safe drug terms. IMAGE: 2003.GIF In the 2005 National Patient Safety Goals (NPSGs), JCAHO recommends: Each facility should identify and prohibit certain risky abbreviations, acronyms [glossary], and symbols. Point 3 of 16

9 2004 Risky Terms: Problems (1) Why is it so important for facilities to prohibit risky terms? NO IMAGE Let s take a look on the following screen. Point 4 of 16

10 2005 Risky Terms: Problems (2) Abbreviations and symbols can cause drug errors. IMAGE: 2005.GIF For example, when a doctor writes a drug order, he or she may use the term U (for unit ). A nurse reading the order might mistake the U for: o 0 (zero) o 4 (four) o cc (cubic centimeter) This could lead to confusion. Treatment may be delayed while the nurse checks the order. Even worse, the nurse might not check the order. He or she may misread the order and give the wrong dose. This could cause serious patient injury or death. Point 5 of 16

11 2006 Risky Terms: Prohibited List (1) In short: Certain terms can lead to serious drug errors. IMAGE: 2006.GIF Therefore, JCAHO recommends that each healthcare facility should: 1. Identify the abbreviations, acronyms, and symbols that staff members use commonly. 2. Review the list of common terms. 3. Identify terms on the list that might be confusing. 4. Place confusing terms on a risky list. Point 6 of 16

12 2007 Risky Terms: Prohibited List (2) Finally, each facility must prohibit [glossary] the use of certain terms from the risky list. IMAGE: 2007.GIF These terms must not be used on any type of written record. This includes: Any type of written order Progress notes Consultation reports Operative reports Point 7 of 16

13 2008 Risky Terms: Which Terms? (1) Which terms must be prohibited? NO IMAGE Let s take a look on the following screen. Point 8 of16

14 2009 Risky Terms: Which Terms? (2) Facilities may prohibit any terms from their risky list. IMAGE: 2009.GIF However, certain terms must be prohibited. A table of these terms appears on the following screen. Note: In the following table, terms appear in one form (upper case, with periods between letters). Be aware that any prohibited term is prohibited in all forms: Upper case Lower case With periods Without periods Point 9 of16

15 2010 Risky Terms: Minimum List of Prohibited Terms This prohibited term Is used to mean But could be mistaken for Therefore, this term should be written instead: [table only screen] U Unit - 0 (zero) - 4 (four) - cc (cubic centimeter) Unit I.U. International unit - IV (intravenous) - 10 (ten) International unit Q.D. Once a day - Q.O.D. (every other day) - Q.I.D. (four times a day) Daily Q.O.D. Every other day - Q.D. (once a day) - Q.I.D. (four times a day) Every other day MgSO 4 Magnesium sulfate MS or MSO 4 (morphine sulfate) Magnesium sulfate MS or MSO 4 Morphine sulfate MgSO 4 (magnesium sulfate) Morphine sulfate Using a trailing zero after a decimal point (e.g., 1.0 ) 1 (in the example given) Ten-fold higher dosage (e.g., 1.0 could be mistaken for 10 ) Value without a trailing zero (e.g., 1 ) Leaving out a leading zero before a decimal point (e.g.,.1 ) 0.1 (in the example given) Ten-fold higher dosage (e.g.,.1 could be mistaken for 1 ) Value with leading zero included (e.g., 0.1 ) Point 10 of 16

16 2011 Suggested Risky Terms: Which Terms? (2) NO IMAGE Facilities are only required to prohibit the terms on the minimum list. However, many other terms can be risky, as well. A table of other possible terms to avoid or prohibit appears on the following screen. Point 11 of16

17 2012 Risky Terms: Suggested List of Prohibited Terms This term Is used to mean But could be mistaken for Therefore, this term is suggested instead: [table only screen] ug Microgram mg (milligram), resulting in a fold overdose - mcg - microgram H.S. Half-strength H.S. (bedtime) Half-strength H.S. or q.h.s. T.I.W. S.C. or S.Q. Bedtime Three times a week Subcutaneous - H.S. (half-strength) - Q.H. (every hour) -T.I.D. (three times a day) - T.W. (twice weekly) - S.L. (sublingual) - Five every At bedtime - 3 times weekly - Three times weekly - Sub-Q - SubQ - Subcutaneously D/C Discharge Discontinue Discharge c.c. Cubic centimeter U (units) ml (for milliliters ) A.S. Left ear O.S. (left eye) Left ear A.D. Right ear - O.D. (right eye) - O.D. (once daily) Right ear A.U. Both ears - O.U. (both eyes) Both ears Point 12 of 16

18 2013 Risky Terms: Other Suggestions Other dangerous terms may be found at the Institute for Safe Medication Practices (ISMP) website. IMAGE: 2013.GIF Try not to use any of the terms on the ISMP list. Point 13 of 16

19 2014 Risky Terms: Exceptions Remember: A trailing zero should not be used when writing out drug dosages. NO IMAGE However, the trailing zero is acceptable for: Lab values (i.e., test results) Equipment sizes Point 14 of 16

20 2015 Review FLASH INTERACTION: 2015.SWF/FLA Drag and drop terms from the word bank to complete the following chart. Terms that healthcare facilities Acceptable terms must prohibit U ml MSO 4 mg Q.D. dl NOTE TO BV: Please edit existing 2015.SWF/FLA files to be consistent with the current version above. There were some last minute changes required for this interaction after it had already been created. Point 15 of 16

21 2016 Summary You have completed the lesson on recommendations. NO IMAGE Remember: On written documents, abbreviations, acronyms, and symbols can lead to drug errors. Drug terms prohibited by your facility should not be used. Point 16 of 16

22 Course Glossary # Term Definition acronym abbreviation formed from the initial letters of a series of words prohibit forbid, veto, command against risky in the context of medication terminology: a medication term that could lead to a medication error JCAHO Joint Commission on the Accreditation of Healthcare Organizations

23 [Medication Terminology: Use of Abbreviations & Symbols] Pre-Assessment 1. When reporting lab values, which of the following is (are) a prohibited written form? Answer 1: 10 mg/dl Answer 2: 10.0 mg/ml Answer 3: 10 milligrams/deciliter Answer 4: Both 10 mg/dl and 10.0 mg/dl Answer 5: None of these answers Correct Answer: None of these answers Answer Rationale: Use of a trailing zero is prohibited when documenting drug dosage. However, trailing zeroes are acceptable for lab values. Neither mg nor dl is a prohibited term. Therefore, 6 mg/dl, 6.0 mg/dl, and 6 milligrams/deciliter all are acceptable forms for reporting lab results. 2. Which of the following terms should not be used in an operative report? Answer 1: 5.0 Units Answer 2: 0.5 I.U. Answer 3:.25 mcg Answer 4: All of these answers Answer 5: None of these answers Correct Answer: All of these answers Answer Rationale: The term I.U., the use of trailing zeroes (for example, 5.0 instead of 5), and the omission of leading zeroes (for example,.25 instead of 0.25) all are prohibited in clinical documentation. They should not be used when documenting drug dosage, including on operative reports. 3. Which of the following terms is (are) acceptable on a drug order? Answer 1: MSO 4 Answer 2: 0.5 mg Answer 3: 10.0 micrograms

24 Answer 4: All of these answers Answer 5: None of these answers Correct Answer: 0.5 Units Answer Rationale: The term MSO 4 and the use of trailing zeroes (for example, 10.0 instead of 10) are prohibited on drug orders. 0.5 mg is acceptable because it uses a leading zero, and the abbreviation mg for milligram is acceptable. 4. Of the following, which is most likely to result in a drug dosage 1000 times greater than it should be? Answer 1: Using the term ug on a drug order Answer 3: Using the term A.U. on a drug order Answer 4: Using the term MSO 4 on a drug order Answer 2: Leaving out a leading zero on a drug order Correct Answer: Using the term ug on a medication order Answer Rationale: The term ug (microgram) could be mistaken for mg (milligram), resulting in a 1000-fold overdose. The other terms listed could cause drug errors, but are unlikely to cause the error of a 1000-fold overdose. 5. Prohibited terms may be used on drug orders if written: Answer 1: In block letters Answer 2: In all capital letters Answer 3: With periods between letters Answer 4: Without periods between letters Answer 5: None of these answers Correct Answer: None of these answers Answer Rationale: Prohibited abbreviations may not be written on drug orders in any form: upper case, lower case, with periods, without periods, in cursive handwriting, or in print.

25 Final Exam Question Title: Question 1 Question: When reporting lab values, it is prohibited to write: Answer 1: 6 mg/ml Answer 2: 6.0 mg/ml Answer 3: 6 milligrams/milliliter Answer 4: Both 6 mg/ml and 6.0 mg/ml Answer 5: None of these answers Correct Answer: None of these answers Answer Rationale: The trailing zero is prohibited for documenting drug dosage. However, trailing zeroes may be used with lab values. Neither mg nor ml is a prohibited term. Therefore, 6 mg/ml, 6.0 mg/ml, and 6 milligrams/milliliter all are acceptable for lab results. Question Title: Question 2 Question: In an operative report, do not use the term: Answer 1: 5 I.U. Answer 2: MSO 4 Answer 3: 0.25 U Answer 4: All of these answers Answer 5: None of these answers Correct Answer: All of these answers Answer Rationale: I.U., MSO 4, and U all are prohibited terms. They should not be used in any written order or record of drug dosage. This includes operative reports. Question Title: Question 3 Question: On a drug order, it is okay to use the term: Answer 1: Q.O.D. Answer 2: 0.5 Units Answer 3: 5.0 International Units Answer 4: All of these answers

26 Answer 5: None of these answers Correct Answer: 0.5 Units Answer Rationale: Q.O.D. and the trailing zero are prohibited on drug orders. 0.5 Units may be used because it uses a leading zero and spells out the term Units. Question Title: Question 4 Question: A nurse misreads an order and gives a patient a ten-fold drug overdose. This is most likely if the order used: Answer 1: The term D/C Answer 2: A trailing zero Answer 3: The term Q.D. Answer 4: The term q.h.s. Correct Answer: A trailing zero Answer Rationale: If a trailing zero is used on an order (for example, 5.0 instead of 5), the person reading the order may miss the decimal point. He or she may give the patient 50 units instead of five: a ten-fold overdose. The other terms listed could cause drug errors. However, they are unlikely to cause the error of a ten-fold overdose. Question Title: Question 5 Question: Clinical staff frequently use a certain abbreviation to mean half-strength. This abbreviation also means: Answer 1: Every hour Answer 4: Sublingual Answer 2: At bedtime Answer 3: Three times a week Correct Answer: At bedtime Answer Rationale: H.S. is commonly used for half-strength. H.S. is also used for at bedtime. Therefore, this term can lead to errors.