Dangerous Abbreviations

Full update September 2019

The U.S. healthcare accreditation body, the Joint Commission, has focused on communication among healthcare professionals for a number of years. One aspect, which has been incorporated into their standards, is to eliminate the use of dangerous abbreviations, acronyms, and symbols.1 Organizations seeking accreditation must develop and adhere to a list of abbreviations not to be used within the organization. These abbreviations can’t be used on handwritten or computer free-text orders or medication-related documentation, or on pre-printed orders. The list MUST include the abbreviations on Joint Commission’s “Do Not Use” list.1 These abbreviations are provided in the chart below. The chart also includes abbreviations listed by the Institute for Safe Medication Practices (ISMP). Their full and most current list can be found at http://www.ismp.org/Tools/errorproneabbreviations.pdf. Keep in mind, ISMP recommends against abbreviating drug names in general.2

Abbreviation

Intended Meaning

Potential Error

Recommendation

 

Joint Commission’s “Do Not Use” List1

U or u

Unit

Misread as “0,” “4,” or “cc”

Write “unit”

 

 

IU

International unit

Misread as IV (intravenous) or “10”

Write “international unit”

 

 

q.d., Q.D., qd, QD

 

Every day

Misread as four times daily (qid)

Write “daily”

 

q.o.d., Q.O.D., QOD

 

Every other day

Misread as daily (q.d.) or four times daily (qid)

Write “every other day”

 

X.0 mg

 

X mg

Decimal point is missed

Never write a “0” by itself after a decimal point

 

.X mg

 

0.X mg

Decimal point is missed

Write “0” before a decimal point

 

MS

Morphine sulfate or magnesium sulfate

 

Confused for the opposite intended

Write “morphine sulfate”

 

MSO4

Morphine sulfate

 

Confused for magnesium sulfate

Write “morphine sulfate”

 

MgSO4


Magnesium sulfate

Confused for morphine sulfate

Write “magnesium sulfate”

 

Examples of other error-prone abbreviations2-5

µg

 

Microgram

Misread as milligram (mg)

Write “mcg” or “micrograms”

 

>

 

Greater than

Misread as “7” or “less than”

Write “greater than”

 

<

 

Less than

Misread as “L” or “greater than”

Write “less than”

 

Drug abbreviations (e.g., TAC)

 

Varies

Misread as drug with similar name or abbreviation

Write entire drug name

 

@

 

At

Misread as “2”

Write “at”

 

c.c.

 

Cubic centimeter

Misread as “U” (units)

Write “mL” or “milliliters”

 

Apothecary units (e.g., minims, grains)

 

Varies

Confused with metric units; unfamiliar to some healthcare professionals

Use metric system

 

APAP

 

Acetaminophen

Not recognized as meaning acetaminophen

Write full drug name

 

AZT

 

Zidovudine (Retrovir)

Mistaken as azathioprine, aztreonam

Write full drug name

 

CPZ

Compazine (prochlorperazine)

 

Mistaken as chlorpromazine

Write full drug name

 

HCT

 

Hydrocortisone

Mistaken as hydrochlorothiazide

Write full drug name

 

HCTZ

 

Hydrochlorothiazide

Mistaken as hydrocortisone

Write full drug name

 

MTX

Methotrexate

Mistaken as mitoxantrone

Write full drug name

 

Nitro

Nitroglycerin

Nitroprusside

Write full drug name

 

PTU

Propylthiouracil

Mistaken as mercaptopurine

Write full drug name

 

IV vanc

Intravenous vancomycin

Mistaken as Invanz

Write full drug name

 

SSRI

Sliding scale regular insulin

Mistaken as selective-serotonin reuptake inhibitor

Spell out “sliding scale (insulin)”

 

T3

Tylenol with codeine No. 3

 

Mistaken as liothyronine

Write full drug name

 

TAC

 

Triamcinolone

Mistaken as “tetracaine, Adrenalin, cocaine”

Write full drug name

 

TKA

 

Tenecteplase (TNKase)

Mistaken as alteplase (Activase)

Write full drug name

 

TPA or tPA

Alteplase (Activase)

Mistaken as tenecteplase (TNKase)

 

Write full drug name

 

/

 

Separate doses or “per”

Misread as the numeral “1”

Write “per”

 

H.S.

Half-strength or at bedtime

 

Misread as the opposite intended. If written “qH.S.” misread as every hour.

Write “half-strength” or “at bedtime”

 

T.I.W.

 

Three times a week

Misread as three times a day or twice weekly

Write “three times weekly”

 

S.C., S.Q., sub q

Subcutaneous

Misread as sublingual (SL), “5 every,” or the “q” as “every”

 

Write “subcut” or “subcutaneously”

 

D/C

Discharge

Misread as “discontinue” whatever follows
(e.g., discharge meds are discontinued)

 

Write “discharge”

 

A.S., A.D., A.U.

 

Left, right, both ears

Misread as OS, OD, OU (left, right, both eyes)

Write “left ear,” “right ear,” “both ears”

 

O.S., O.D., O.U.

 

Left, right, both eyes

Misread as AS, AD, AU (left, right, both ears)

Write “left eye,” “right eye,” “both eyes”

 

UD

 

Use as directed

Misread as unit dose

Write “as directed”

 

+

 

“Plus” or “and”

Misread as the numeral “4”

Write “and”

 

q 6PM, etc.

Nightly at 6 PM

Misread as every 6 hours

Write “nightly at 6 PM”

 

 

x3d

 

For three days

Misread as for three doses

Write “for three days”

 

ss

One-half or sliding scale (insulin)

 

Misread as “55”

Write “1/2” or “one-half”; write “sliding-scale”

 

qn

 

Nightly or at bedtime

Misread as “qh” (every hour)

Write “nightly”

 

IN

Intranasal

Misread as “IV” (intravenous)

or “IM” (intramuscular)

 

Write “intranasal”

 

IT

Intrathecal

Mistaken for other routes of administration
(e.g., intratracheal)

 

Write “intrathecal”

 

QM, QW, etc

Every month, every week, etc

 

Mistaken for other dosing intervals such as every day

Write out intended dosing interval

 

B-L-D

With breakfast, lunch, and dinner

 

May be misread as “BID” (twice daily)

Write out intended dosing interval

 

BT

Bedtime

Mistaken for “BID” (twice daily)

Write out intended dosing interval

 

 

IJ

Injection

Mistaken for “IV” (intravenous) or “IJ” (intrajugular)

Write “injection”

 

 

In the U.S., report adverse drug events, product quality problems, or product use errors to the FDA MedWatch program. FDA MedWatch can be contacted at 800-FDA-1088. The MedWatch reporting form is available online at http://www.fda.gov/medwatch/report/hcp.htm. Medication errors, preventable adverse drug reactions, close calls, and hazardous conditions may be reported to ISMP’s National Medication Errors Reporting Program (ISMP MERP). The reporting form for ISMP MERP can be accessed at http://www.ismp.org/orderforms/reporterrortoismp.asp.

In Canada, report adverse events to Canada Vigilance at 866-234-2345 or online at http://www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/ar-ei_form-eng.php. Medication incidents and near misses can be reported to ISMP Canada at http://www.ismp-canada.org/err_ipr.htm.

Project Leader in preparation of this clinical resource (350928): Stacy A. Hester, R.Ph., BCPS, Associate Editor

References

  1. Joint Commission. Facts about the official “Do not use” list. June 28, 2019. http://www.jointcommission.org/assets/1/18/Official_Do_Not_Use_List_6_111.PDF. (Accessed August 9, 2019).
  2. Institute for Safe Medication Practices. List of error-prone abbreviations, symbols, and dose designations. October 2, 2017. http://www.ismp.org/Tools/errorproneabbreviations.pdf. (Accessed August 9, 2019).
  3. Anon. “IT” abbreviation misunderstood. ISMP Medication Safety Alert! March 7, 2013. http://www.ismp.org. (Accessed August 9, 2019).
  4. Anon. Ambiguous abbreviation B-L-D. ISMP Nurse AdviseERR. April 2016. http://www.ismp.org. (Accessed August 9, 2019).
  5. ConsumerMedSafety.org. Unsafe Medical Abbreviations. 2019. https://consumermedsafety.org/tools-and-resources/medication-safety-tools-and-resources/know-your-medicine/unsafe-medical-abbreviations. (Accessed August 9, 2019).

Cite this document as follows: Clinical Resource, Dangerous Abbreviations. Pharmacist’s Letter/Prescriber’s Letter. September 2019.

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