Manitoba introduces 'do not use' list for prescription abbreviations

People often joke about doctors' illegible handwriting — but it's no laughing matter for the Manitoba Institute for Patient Safety, which has launched a "do not use" list of symbols and abbreviations it says are unclear or could be misread on prescriptions.

About 16 symbols and abbreviations are included on the list, released Thursday in collaboration with the College of Registered Nurses of Manitoba, the Winnipeg Regional Health Authority and the Manitoba Pharmaceutical Association.

Symbols now deemed unacceptable include:

• @ for "at," which could be mistaken for a 2 or 5, according to the MBIPS.
• > for "greater than," which could be mistaken for a 7 or L.
• U for "units," which could look like a 0 next to another number, resulting in a tenfold increase of dose.
• QD and QOD for "daily" and "every other day," which could be mistaken for each other or for notations for "four times a day" (QID) or "right eye" (OD).  

In most cases, the campaign recommends simply writing out the problem abbreviations in full.

It's not known how many people may have received the wrong medication or dose because of confusing or misread symbols and abbreviations, but it's important for all health care providers to be on the same page, said institute spokeswoman Laurie Thompson.

"From nurses to pharmacists to physiotherapists to dietitians, all those folks use abbreviations in one way or another," she said. "What we're trying to do is improve communication and improve understanding efficiency so we're all clear on what directions and orders are being written to individual patients."

The institute cited a review by the Commonwealth of Pennsylvania Patient Safety Authority that found more than half of 103 critical incidents involved the use of prohibited abbreviations.

The "do not use" list will be distributed to all regional health authorities in the province. The institute is also calling for the list to become part of the medical school curriculum.

Prescriptions or other orders that use the prohibited symbols will not necessarily be considered invalid, the institute noted, especially in the near future. But if any order appears ambiguous — whether a banned abbreviation is used or not — it should be clarified with whomever wrote the order, officials said.