Eliminating dangerous abbreviations
and dose expressions in the print and electronic world
Click here for printer friendly version
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.
|
|
