JCAHO “Do Not Use” List
Today’s Dietitian
By Becky Dorner, RD, LD
Vol. 6 No. 3 p. 50

A tragic and unnecessary death … A 9-month-old baby girl mistakenly received two lethal 5-milligram IV doses of morphine for postsurgical pain management. A simple transcription error turned a physician’s order for “.5 mg” IV morphine into major heartbreak for a young family in May 2001. If only the physician had used the term “0.5 mg,” this deadly error could have been avoided. Sadly, it is not the first time that this kind of medical error has occurred.1

Objective: Eliminate or Drastically Reduce Incidence of Harm
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued a list of abbreviations that should no longer be used in documentation. The move was in conjunction with the National Patient Safety Goals related to abbreviations, acronyms, and symbols not to use. The fear is that certain information may be misinterpreted, causing the potential for major harm.

“One hundred percent compliance, in all forms of clinical documentation, with a reasonably comprehensive list of prohibited ‘dangerous’ abbreviations, acronyms, and symbols is the long-term objective of this requirement,” says Rick Croteau, MD, executive director of strategic initiatives. “However, we recognize that this type of change will take time, so we have modified the survey and scoring of this requirement for surveys conducted through the end of 2004.”2

According to the JCAHO Web site, if your organization has not yet achieved 100% compliance during your next survey, the record will show that your facility is in compliance if:
• “Use of any item on the list is ‘sporadic’ (less than 10% of the instances of the intended term are abbreviated or symbolized);
• Whenever any prohibited item has been used in an order, there is written evidence of confirmation of the intended meaning before the order is carried out; and
• The organization has implemented a plan for continued improvement to achieve 100% compliance by the end of 2004.”2

The Minimum List
Any abbreviation or symbol on the “Do Not Use” list should not be used in any form, such as upper or lower case (QOD or qod) and with or without periods.

The January 1 list included the items in Table 1, which must be included on each accredited organization’s “Do Not Use” lists.2

The Additional List
Beginning April 1 (if your organization does not already have additional “Do Not Use” items in place), JCAHO-accredited facilities must add at least three additional “Do Not Use” abbreviations, acronyms, or symbols to add to their “Do Not Use” lists. Items in Table 2 can be considered for addition to the lists.2

Action Steps
1. Identify abbreviations, acronyms, and symbols that are potentially dangerous (not acceptable) for use in your facility (using the charts above).
2. Identify abbreviations that are acceptable for use in your facility.
3. Train staff on proper terms to be used in all documentation.
4. Communicate this information to all staff in writing.
5. Monitor documentation for follow-through on a regular basis.
6. Retrain staff as needed.3

— Becky Dorner, RD, LD, is a speaker and author who provides publications, presentations, and consulting services to enhance the quality of care for our nation’s older adults. Visit www.beckydorner.com or call 800-342-0285.

References
1. Institute for Safe Medication Practices. Available at: http://www.ismp.org. Accessed January 27, 2004.
2. http://www.jcaho.org/accredited+organizations/long+term+care/ltc+update/2003issue3/npsg_04.htm. Accessed January 27, 2004.
3. http://www.jcaho.org/accredited+organizations/long+term+care/standards/faqs/management+of+info/planning/acceptable_abbreviations.htm. Accessed January 27, 2004.

Resource
For more information, visit: www.jcaho.org/accredited+organi-zations/patient+safety/04+npsg/2004+national+patient+safety+goals.pdf

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