Enhancing medication safety with computerized alerts

Feb 18, 2011

Medication errors are responsible for a large number of adverse drug events in patients each year, and the use of medication-related abbreviations accounts for nearly five percent of these errors. Strategies to reduce the use of problematic abbreviations -- which can lead to overdosage or incorrect or missed medications because of staff misinterpretation -- have largely focused on education, primarily a “Do Not Use” list of abbreviations produced by professional and regulatory bodies. However, there has generally been poor compliance by hospital staffs with this practice.

In a study published in JAMIA, the Journal of the American Medical Informatics Association, Jennifer S. Myers, MD, patient safety officer of the Hospital of the University of Pennsylvania, and her colleagues found that computerized alerts inserted within an electronic progress note program could reduce the use of these abbreviations, ultimately enhancing patient safety.

Some examples of problematic abbreviations include:

• IU (for international unit), possibly mistaken as IV (intravenous) or 10 (ten)
• µg (for microgram), possibly mistaken for mg (milligrams), resulting in a one thousand-fold dosing overdose
• D/C (for discharge), possibly interpreted as “discontinue whatever medications follow” (typically discharge medications)
• MS, could mean either morphine sulfate or magnesium sulfate

In the study, 59 Penn internal medicine interns were randomized to one of three groups: a forced correction alert group, an auto-correction alert group, or a group that received no alerts.

In the first -- or forced correction alert group -- an alert identified the unapproved abbreviation, informed interns of the correct non-abbreviated notation, and forced them to correct the abbreviation before allowing them to save or print their note. For example, when the physician attempted to type in “QD” (relying on a customary -- but non-intuitive -- abbreviation for “daily”), the pop-up precluded the term from being entered and instead directed the physician to “use ‘daily’ instead.”

In the second -- or auto-correction alert group -- physicians received an alert when an unapproved abbreviation was entered, but instead of forcing the interns to make a correction, an auto-correction feature displayed the correction and automatically replaced the abbreviation with the acceptable non-abbreviated notation. Group 3 was a control group and received no alerts.

Over time, physicians in all three groups significantly reduced their use of the problem abbreviations as measured by frequency of electronic alerts triggered and within subsequent handwritten notes. Alerts with the forced correction feature lowered the use of abbreviations to a much greater extent than alerts with an auto-correction feature. “It may be that forcing physicians to correct abbreviations themselves, as opposed to having it automatically done for them, better solidifies their knowledge of these banned abbreviations,” said Myers.

An unanticipated finding was that reductions in abbreviation use were observed in the control group. Even though they were not directly exposed to alerts, their behavior may have been influenced by the improving documentation patterns of the interns exposed to the intervention who worked with them.

“Eliminating error-prone medication abbreviations has been extremely challenging for hospitals, and there are few effective strategies in the literature for addressing it,” said Myers. “Given the strong association between abbreviation use and , it’s vital for healthcare leaders to consider multiple strategies, including the alerts we tested, as effective additions to education and training.”

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

add to favorites email to friend print save as pdf

Related Stories

Teaching future doctors the basics of medication errors

Jan 19, 2011

Medical students should have basic knowledge of common medication errors before they begin seeing patients at the hospital, and researchers from the Johns Hopkins Children's Center report that allowing them to play detective ...

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0

More news stories

Treating depression in Parkinson's patients

A group of scientists from the University of Kentucky College of Medicine and the Sanders-Brown Center on Aging has found interesting new information in a study on depression and neuropsychological function in Parkinson's ...

Impact glass stores biodata for millions of years

(Phys.org) —Bits of plant life encapsulated in molten glass by asteroid and comet impacts millions of years ago give geologists information about climate and life forms on the ancient Earth. Scientists ...