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Eliminating dangerous abbreviations and dose expressions in the print and electronic world

From the February 20, 2002 issue

With pen and paper, there's no doubt that it's risky to use abbreviations and dose expressions that are prone to misinterpretation (see our May 2, 2001 issue). As a result, some health care organizations are attempting to eliminate their use in handwritten formats. But what about eliminating use of these same dangerous abbreviations and dose expressions in the print and electronic world?

Some health care providers, pharmaceutical companies, publishers, and information system vendors feel that handwritten materials present unique problems of illegibility, which do not affect printed or electronic materials. Without handwriting in the picture, they believe there's no reason to avoid using widely accepted abbreviations, including those that are knowingly dangerous such as U for units. In printed materials, standard publishing guidelines often dictate format, even when the format promotes dangerous methods of expressing doses. For example, if warfarin 1.5 mg is mentioned, then warfarin 2 mg must be carried out to the same decimal places and listed as 2.0 mg to promote consistency. In the end, we see abundant examples of dangerous abbreviations and dose expressions in professional literature, drug advertisements, preprinted prescriber order forms, computer screens and computer-generated materials.

With the tremendous emphasis on patient safety today, some new thinking on this subject is needed. While it's true that the typography used in printed materials and on computer screens presents a much clearer presentation of information than handwritten formats, even widely accepted abbreviations may not be interpreted as intended. For example, even if a practitioner can clearly read MTX on a screen, can you guarantee that it will be interpreted as methotrexate, as intended? Why not mitoxantrone? In print and electronic formats, some fonts, type color, and spacing make it difficult to differentiate between 100U and 1000, or between 1.0 and 10. It's also a fact that practitioners mimic what they see everyday in print and electronic formats. In short, we're setting a double standard by allowing use of knowingly dangerous abbreviations and dose expressions in electronic and print formats, but forbidding their use if handwritten.

It's time for a single standard. Publishers need to redesign their publishing style manuals and follow the example of the American Diabetic Association, which no longer allows the abbreviation U to be used in publications. The pharmaceutical industry needs to follow FDA requirements when designing the packages, labels, and advertisements for products. FDA needs to enforce this as a labeling requirement. Information system vendors need to set a good example and avoid the use of dangerous abbreviations and dose expressions in electronic forms of medical information. As purchasers of these products, health care providers need to stand firm on demands that vendors prohibit the use of knowingly dangerous abbreviations and dose expressions. Likewise, health care providers need to make sure that abbreviations and dangerous dose expressions are not used in printed materials (e.g., order forms, protocols, care maps, computer-generated medication administration records, prescription labels, in-house newsletters). Clearly, there's no excuse for using abbreviations or expressing doses in a manner that may cause confusion, regardless of the media in which it is used.

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