- Graphic by SCOTT CARMINE/THE FREE LANCE-STAR

Patient safety is the goal of a program at Mary Washington Hospital that bans the use of potentially confusing drug abbreviations

By JIM HALL

Date published: 9/25/2005

If a doctor at Mary Washington Hospital orders ".5 mg" of a medicine and wants the patient to take it "q.d.," the doctor can expect a phone call from one of the the hospital's pharmacists.

"You've used a prohibited abbreviation," the pharmacist will tell the physician. "We have to call and clarify."

The calls are intended to clear up any misunderstanding about potentially dangerous medication abbreviations. But they also remind physicians that the way they've always written medication orders is changing.

Since June 1, the Fredericksburg hospital has banned the use of a dozen easily misinterpreted medication abbreviations. Physicians are now required, for example, to place a zero before the decimal point when prescribing a fractional dose of medicine.

They also are expected to avoid potentially confusing abbreviations such as "q.d.," short for the Latin phrase quaque die. Instead, they must write out "daily" or "every day" if that's how often they want the patient to take a medicine.

The idea behind the hospital's "Dangerous Abbreviations and Dose Designations" list is to make patient stays safer.

"If you're supposed to get Lanoxin, a heart medicine, once a day, and you get it four times a day, that's not a good thing," said Dr. Thomas Ryan, vice president for medical affairs for Mary Washington.

Mary Washington's effort is part of a national campaign to eliminate once-common but potentially lethal abbreviations. The effort has been championed by patient-safety groups such as the Institute for Safe Medication Practices and the U.S. Pharmacopeia. The Joint Commission on Accreditation of Healthcare Organizations also has lent its support.

The accrediting agency sponsored a national summit on dangerous abbreviations last year. In May, it told the nation's hospitals that they should ban the nine abbreviations on its "Do Not Use" list. Mary Washington added three more abbreviations to the list to make an even dozen.

Patients can be at risk when physicians use these abbreviations if the doctor's handwriting is misunderstood, according to the Joint Commission.

"We are trying to move in the direction of more standardization," said Dr. Rich Croteau, executive director for patient safety at the commission.

Problems can arise when the person who fills the order in the hospital pharmacy misinterprets the physician's order. The patient may receive the medicine more often than intended, or in the wrong dose.

The problem is compounded by the sheer volume of prescriptions filled in a typical hospital. At Mary Washington, for example, the medical staff of about 360 doctors sends to the pharmacy about 1,100 order sheets each day. Each order sheet can have from one to 20 different medicines on it, said Karel Cushing Clore, clinical manager for pharmacy services.

Doctors at Mary Washington write their medication orders by hand on the patient floors. A nurse or secretary scans the order and sends it downstairs to the hospital pharmacy.

One of the pharmacists must examine the scanned copy and decipher the doctor's handwriting before filling the order.

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Date published: 9/25/2005