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The importance of deleting acronyms and abbreviations from your prescriptions

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Jeff Megahan
Features editor

 

It’s long been a comedic trope that medical prescriptions are illegible and confusing and that poor handwriting is an attribute of every health-care provider, including optometry therapeutic prescribers. Abbreviations and dose expressions on prescriptions are also a major cause of medical errors and are potentially dangerous.1

In the wider medical community, errors related to illegible prescriptions have been a subject of concern for many years. A 2005 study to identify the impact of prescribing errors in a large US urban teaching hospital found that 29 per cent of prescriptions contained a dangerous abbreviation.2

In 2007, one of the first studies to specifically quantify the harmful effect of abbreviations on prescriptions was undertaken by the University of Michigan in the USA. Researchers analysed 643,151 medication errors in records submitted to the US Pharmacopeia MEDMARX program from 682 facilities in 2004–2006. They found that 29,974 errors (4.7 per cent) were attributable to abbreviation use.

These findings lent support to the established ‘Do Not Use Abbreviation List’ (Table 1), and led the authors to conclude: ‘A simple risk-versus-benefit analysis of abbreviation use versus prohibition will reveal that whereas using abbreviations may save minutes, prohibiting abbreviations may save lives.’3

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Table 1. The Joint Commission’s ‘Do Not Use’ Abbreviation List. Applies to all orders and all medication-related documentation that is hand-written (including free-text computer entry) or preprinted forms.4

In 2008, the Australian Commission on Safety and Quality in Healthcare published its ‘Recommendations for Terminology, Abbreviation and Symbols used in the Prescribing and Administration of Medicine’5 (updated 2011).

The ACSQH argues convincingly that a rethinking of the language used to communicate medication prescribing and administration is necessary. ‘Patients and carers have a right to understand what is being prescribed to them and the use of abbreviations is a critical patient safety issue,’ they write.

‘Prescriptions should not contain ANY abbreviations other than those that are in universal and common use, such as the term “prn” meaning “when required”. All drug names, protocols and procedures should be in English and written in full.’5

Dr Isabelle Jalbert, who teaches ocular therapeutics at the University of New South Wales, uses the ACSQH document from the outset of her courses. ‘It’s one of the required readings,’ she said. ‘I tell my students that their scripts have to be legible and clear and not confusing. It’s common sense. If you write out your prescription, make it as clear as possible.’

Anthony Tassone, Victorian president of the Pharmacy Guild of Australia, agrees. ‘It comes back to this: we can’t be careful enough when we are prescribing, dispensing or talking to patents about medicines,’ he said.

Tassone, a practising pharmacist, says that there has been genuine improvement in prescription legibility. ‘From my experience and the experiences of my colleagues, I can say it is improving with optometrists prescribing. There has been quite a lot of care taken by prescribing optometrists,’ he said. ‘Of course there is always the opportunity for further improvement, but I think we are on the right path.’

Tassone attributes at least some of the progress to the gradual adoption of electronic prescriptions, particularly among optometrists, but he also explains that legible, clear prescriptions are all part of co-operating with the pharmacist.

For the prescriber, the choice is to either adopt these suggestions of accepted terminology when writing prescriptions or modify their electronic prescription software, which is easier and eliminates bad handwriting as well.

‘When someone is having an eye procedure or is undergoing a treatment, it can be quite overwhelming,’ Tassone said. ‘Writing clear prescriptions means that you value the contribution that your community pharmacists can offer in making sure that patients can get their medicine and understand how to take it properly.’

Dr Jalbert has been teaching this to her students for years. ‘We have a duty of care to write a clear and legible script for the pharmacist. It’s safer and there’s less chance that the patient will be put at risk,’ she said. ‘That’s reason enough for me.’

Dr Jalbert says that even in busy practices, time has to be made to ensure the prescriptions are written clearly and legibly. ‘Given how infrequently the practising optometrist actually writes out a prescription compared to, say, a general practitioner, it’s not an onerous task to take the time and do it the right way.’

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Table 2. Principles for consistent prescribing terminology5

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Table 3. Acceptable terms and abbreviations5 with common eye terms highlighted

  1. JCAHO. Sentinel Event Alert—Medication errors related to potentially dangerous abbreviations: Joint Commission on Accreditation of Healthcare Organisations, 2001.
  2. Garbutt J, Milligan P, McNaughton C, Waterman B, Clairborne Dunagan W, Fraser V. A practical approach to measure the quality of handwritten medication orders. J Patient Saf 2005; 1: 195-200.
  3. Brunetti L, Santell JP, Hicks RW. The impact of abbreviations on patient safety. Jt Comm J Qual Patient Saf 2007; 33: 576-583.
  4. The Joint Commission: National Patient Safety Goal on abbreviations clarified, implementation revised. Jt Comm Perspect 2003; 23: 14–15.
  5. Australian Commission on Safety and Quality in Healthcare, (2011). Recommendations for terminology, abbreviations and symbols used in the prescribing and administering of medicines. [online] Accessed 23 July 2015.


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