Study Blames Abbreviations For Medication Errors

Main Category: Pharmacy / Pharmacist
Article Date: 29 Aug 2007 - 2:00 PDT


A new study in the Joint Commission Journal on Quality and Patient Safety highlights the role abbreviations play in medication errors.

According to researchers from Rutgers University who analyzed data on nearly 30,000 medication error reports contained in the United States Pharmacopeia's MEDMARX® database, nearly five percent were due to abbreviations problems.

Results showed:

-- The most common abbreviation resulting in a medication error was the use of "qd" in place of "once daily," accounting for 43.1 percent of all errors.
-- The other most common abbreviations resulting in medication errors were "U" for units, "cc" for mL, "MSO4" or "MS" for morphine sulfate, and decimal errors.
-- Eighty-one percent of the errors occurred during prescribing; errors during transcribing and dispensing represented 14 percent and 2.9 percent, respectively.
-- Abbreviation errors originated most often from medical staff.
-- The three most common types of abbreviation-related errors were prescribing, improper dose/quantity, and incorrectly prepared medication.

The authors conclude more abbreviations should be added to the standard "do not use" list. Top candidates for an expanded list include drug name abbreviations, such as PCN, DCN, TCN; stem abbreviations (amps, nitro, succs), µg (mcg), cc (mL); and dose scheduling (BID, TID, QID).

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