Adding to do not use’ list requirement is dropped
Aggressive strategies needed to improve compliance
Failure to substantially eliminate the utilization of "do not use" abbreviations in medication orders remains — at 27% — one of the most frequent non-compliance findings during JCAHO surveys.
In light of these problems, the Joint Commission has dropped the requirement for organizations to add three organization-specific "do not use" abbreviations to the list.
The official "do not use" list applies to all orders and all medication-related documentation that is handwritten, including free-text computer entry and pre-printed forms.
It was created by JCAHO as part of the requirements for its National Patient Safety Goal (NPSG) on standardizing a list of abbreviations, acronyms, and symbols that are not to be used throughout the organization.
During a four-week public comment period, the Joint Commission received 5,227 responses, with more than 80% of the respondents in favor of a "do not use" list. However, the field was less supportive of additions to the list.
"Since organizations are still struggling with compliance with existing do not use’ abbreviations, the JCAHO decided not to add to the list at this time," says Richard J. Croteau, MD, JCAHO’s executive director for strategic initiatives.
"We dropped the requirement for organizations to add three or more items of their own choosing, mainly because our objective is to have a nationally standardized list," says Croteau. "We won’t prohibit organizations from adding to that list, but we felt it was inappropriate to require them to do so. If an organization wants to take our short list of nine items and add some more to it that they want to prohibit, they certainly may do that."
While no additions will be made to the official "do not use" list at this time, the following items will be reviewed annually for possible inclusion as part of the development of future NPSGs:
- the symbols ">" and "<"
- all abbreviations for drug names
- apothecary units
- the symbol "@"
- the abbreviation "cc"
- the abbreviation "µg"
"It’s not easy to make this behavioral change. These are documentation practices people were taught to do when they were trained and have been doing throughout their professional careers," says Croteau. "Even when there is a recognition that it’s dangerous, it’s such an ingrained practice that it’s going to take time."
At Rockingham Memorial Hospital in Harrisonburg, VA, a "Do it Write" campaign is being implemented.
The first step was mailing letters to the homes of all clinical staff members, asking them to commit to not documenting unsafe abbreviations in the medical record, with a list of "do not use" abbreviations. "We asked them and the medical staff to sign the card, so the signatures identify them as committing to that safe practice," says Rebecca Jessie, assistant director of quality and patient safety.
As a further incentive, completed cards are eligible for a restaurant gift certificate, with drawings done every three weeks, and a banner with the "Do it Write" slogan is hung in the medical staff lounge.
When quality professionals tried to address non-compliance with medical staff after receiving a requirement for improvement during their last JCAHO survey, medical staff asked for more specific data.
"They asked us to give them the names of the top offenders. We told them we couldn’t do that, since everyone is doing it. They write an order and somehow slip a QD’ in there — it’s a practice they’ve been doing for 30 years or more and hard to get out of the habit," says Jessie. "In order for us to really get staff’s attention, we had to give them names."
The quality department has a part-time staff member who audits a sample of medical records to determine which unauthorized abbreviations were used, on what day, and by what staff member, and enters the data into a database on a weekly basis.
"We will continue to do chart audits and give very specific feedback to medical staff. We found that we can’t just give them an overall number — they want very specific data," says Jessie. "That has been a huge help in getting their attention." There has been significant improvement as a result, with the compliance goal of 95% achieved in a short period of time, she reports.
At Baptist Health in Jacksonville, FL, compliance problems were corrected at one hospital with electronic medical records, says Missi Halvorsen, RN, BSN, senior consultant for JCAHO/regulatory accreditation. "But when hospitals are still documenting manually or using a mixture of electronic and handwritten records, it is still a challenge."
The "do not use" list is on screen savers, patient charts, and laminated cards, and is reviewed during orientation, mandatory inservices, and self-study, says Halvorsen. "You have to keep it in front of them all the time — not just physicians but all clinicians. Compliance is getting better, but this is still a challenge," she says.
Failure to substantially eliminate the utilization of do not use abbreviations in medication orders remains at 27% one of the most frequent non-compliance findings during JCAHO surveys.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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