Enemas Suppositories
  1. If someone else is administering the enema, lie on your left side with knees bent or in the knee-to-chest position (see drawings A and B). Position A is preferred for children older than 2 years. If self-administering the enema, lie on your back with your knees bent and buttocks raised (see drawing C). A pillow may be placed under the buttocks.
  2. If using a concentrated enema solution, dilute solution according to the product instructions. Prepare 1 pint (500 mL) for adults and 1/2 pint (250 mL) for children.
  3. Lubricate the enema tip with petroleum jelly or other nonmedicated ointment/cream. Apply the lubricant to the anal area as well.
  4. Gently insert the enema tip 2 (recommended depth for children) to 3 in. into the rectum.
  5. Allow the solution to flow into the rectum slowly. If you experience discomfort, the flow is probably too fast.
  6. Retain the enema solution until definite lower abdominal cramping is felt. The parent/caregiver may have to gently hold a child's buttocks closed to prevent the solution from being expelled too soon.
  1. Gently squeeze the suppository to determine if it is firm enough to insert. Chill a soft suppository by placing it in the refrigerator for a few minutes or by running it under cool running water.
  2. Remove the suppository from its wrapping.
  3. Dip the suppository for a few seconds in lukewarm water to soften the exterior.
  4. Lie on your left side with knees bent or in the knee-to-chest position (see drawings A and B). Position A is best for self-administration of a suppository. Small children can be held in a crawling position.
  5. Relax the buttock just before inserting the suppository to ease insertion. Gently insert the tapered end of the suppository high into the rectum. If the suppository slips out, it was not inserted past the anal sphincter (the muscle that keeps the rectum closed).
  6. Continue to lie down for a few minutes and hold the buttocks together to allow the suppository to dissolve in the rectum. The parent/caregiver may have to gently hold a child's buttocks closed.
  7. Remember that the medication is most effective when the bowel is empty. Try to avoid a bowel movement after insertion of the suppository for up to 1 hour so that the intended action can occur.

Download: Administration of Rectal Suppositories or Enemas

Thursday, 13 October 2011 19:29

Your Medicine: Play It Safe

Have you ever had a problem with your medicines? You are not alone. There are so many things to keep track of. For example, you may have asked yourself:

  • When exactly should I take my medicine?
  • Is it safe to take my vitamins when I am taking a prescription medicine?
  • Now that I feel better, can I stop taking my medicine?

Let's face it. Medicine is prescribed to help you. But it can hurt you if you take too much or mix medicines that don't go together. Many people are harmed each year, some seriously, because of taking the wrong medicine or not taking the right medicines correctly.

Learn more about how to take medicines safely.

Download the Your Medicine, Play It Safe Booklet.

Use the Medicine Record Form at the back of the booklet to keep track of your medicines.

Download: ISMP's List of Error-Prone Abbreviations, Symbols, and Dose Designations

The abbreviations, symbols, and dose designations found in this table have been reported to ISMP through the USP-ISMP Medication Error Reporting Program as being frequently misinterpreted and involved in harmful medication errors. They should NEVER be used when communicating medical information. This includes internal communications, telephone/verbal prescriptions, computer-generated labels, labels for drug storage bins, medication administration records, as well as pharmacy and prescriber computer order entry screens. The Joint Commission (TJC) has established a National Patient Safety Goal that specifies that certain abbreviations must appear on an accredited organization's do-not-use list; we have highlighted these items with a double asterisk (**). However, we hope that you will consider others beyond the minimum TJC requirements. By using and promoting safe practices and by educating one another about hazards, we can better protect our patients.

Abbreviations Intended Meaning Misinterpretation Correction
μg Microgram Mistaken as "mg" Use "mcg"
AD, AS, AU Right ear, left ear, each ear Mistaken as OD, OS, OU (right eye, left eye, each eye) Use "right ear," "left ear," or "each ear"
OD, OS, OU Right eye, left eye, each eye Mistaken as AD, AS, AU (right ear, left ear, each ear) Use "right eye," "left eye," or "each eye"
BT Bedtime Mistaken as "BID" (twice daily) Use "bedtime"
cc Cubic centimeters Mistaken as "u" (units) Use "mL"
D/C Discharge or discontinue Premature discontinuation of medications if D/C (intended to mean "discharge") has been misinterpreted as "discontinued" when followed by a list of discharge medications Use "discharge" and "discontinue"
IJ Injection Mistaken as "IV" or "intrajugular" Use "injection"
IN Intranasal Mistaken as "IM" or "IV" Use "intranasal" or "NAS"


At bedtime, hours of sleep
Mistaken as bedtime

Mistaken as half-strength
Use "half-strength" or "bedtime"
IU** International unit Mistaken as IV (intravenous) or 10 (ten) Use "units"
o.d. or OD Once daily Mistaken as "right eye" (OD-oculus dexter), leading to oral liquid medications administered in the eye Use "daily"
OJ Orange juice Mistaken as OD or OS (right or left eye); drugs meant to be diluted in orange juice may be given in the eye Use "orange juice"
Per os By mouth, orally The "os" can be mistaken as "left eye" (OS-oculus sinister) Use "PO," "by mouth," or "orally"
q.d. or QD** Every day Mistaken as q.i.d., especially if the period after the "q" or the tail of the "q" is misunderstood as an Use "daily"
qhs Nightly at bedtime Mistaken as "qhr" or every hour Use "nightly"
qn Nightly or at bedtime Mistaken as "qh" (every hour) Use "nightly" or "at bedtime"
q.o.d. or QOD** Every other day Mistaken as "q.d." (daily) or "q.i.d. (four times daily) if the "o" is poorly written Use "every other day"
q1d Daily Mistaken as q.i.d. (four times daily) Use "daily"
q6PM, etc. Every evening at 6 PM Mistaken as every 6 hours Use "6 PM nightly" or "6 PM daily"
SC, SQ, sub q Subcutaneous SC mistaken as SL (sublingual); SQ mistaken as "5 every;" the "q" in "sub q" has been mistaken as "every" (e.g., a heparin dose ordered "sub q 2 hours before surgery" misunderstood as every 2 hours before surgery) Use "subcut" or "subcutaneously"
ss Sliding scale (insulin) or ½ (apothecary) Mistaken as "55" Spell out "sliding scale;" use "one-half" or "½"

Sliding scale regular insulin

Sliding scale insulin
Mistaken as selective-serotonin reuptake inhibitor

Mistaken as Strong Solution of Iodine (Lugol's)
Spell out "sliding scale (insulin)"
i/d One daily Mistaken as "tid" Use "1 daily"
TIW or tiw 3 times a week Mistaken as "3 times a day" or "twice in a week" Use "3 times weekly"
U or u** Unit Mistaken as the number 0 or 4, causing a 10-fold overdose or greater (e.g., 4U seen as "40" or 4u seen as "44"); mistaken as "cc" so dose given in volume instead of units (e.g., 4u seen as 4cc) Use "unit"

Dose Designations
and Other Information
Intended Meaning Misinterpretation Correction
Trailing zero after decimal point (e.g., 1.0 mg)** 1 mg Mistaken as 10 mg if the decimal point is not seen Do not use trailing zeros for doses expressed in whole numbers"

Dose Designations
and Other Information
Intended Meaning Misinterpretation Correction
Drug name and dose run together (especially problematic for drug names that end in "l" such as Inderal40 mg; Tegretol300 mg) Inderal 40 mg

Tegretol 300 mg
Mistaken as Inderal 140 mg

Mistaken as Tegretol 1300 mg
Place adequate space between the drug name, dose, and unit of measure
Numerical dose and unit of measure run together (e.g., 10mg, 100mL) 10 mg

100 mL
The "m" is sometimes mistaken as a zero or two zeros, risking a 10- to 100-fold overdose Place adequate space between the dose and unit of measure
Abbreviations such as mg. or mL. with a period following the abbreviation mg

The period is unnecessary and could be mistaken as the number 1 if written poorly Use mg, mL, etc. without a terminal period
Large doses without properly placed commas (e.g., 100000 units; 1000000 units) 100,000 units

1,000,000 units
100000 has been mistaken as 10,000 or 1,000,000; 1000000 has been mistaken as 100,000 Use commas for dosing units at or above 1,000, or use words such as 100 "thousand" or 1 "million" to improve readability

Drug Name Abbreviations Intended Meaning Misinterpretation Correction
ARA A vidarabine Mistaken as cytarabine (ARA C) Use complete drug name
AZT zidovudine (Retrovir) Mistaken as azathioprine or aztreonam Use complete drug name
CPZ Compazine (prochlorperazine) Mistaken as chlorpromazine Use complete drug name
DPT Demerol-Phenergan-Thorazine Mistaken as diphtheria-pertussis-tetanus (vaccine) Use complete drug nam
DTO Diluted tincture of opium, or deodorized tincture of opium (Paregoric) Mistaken as tincture of opium Use complete drug name
HCl hydrochloric acid or hydrochloride Mistaken as potassium chloride
(The "H" is misinterpreted as "K")
Use complete drug name unless expressed as a salt of a drug
HCT hydrocortisone Mistaken as hydrochlorothiazide Use complete drug name
HCTZ hydrochlorothiazide Mistaken as hydrocortisone (seen as HCT250 mg) Use complete drug name
MgSO4** magnesium sulfate Mistaken as morphine sulfate Use complete drug name
MS, MSO4** morphine sulfate Mistaken as magnesium sulfate Use complete drug name
MTX methotrexate Mistaken as mitoxantrone Use complete drug name
PCA procainamide Mistaken as patient controlled analgesia Use complete drug name
PTU propylthiouracil Mistaken as mercaptopurine Use complete drug name
T3 Tylenol with codeine No. 3 Mistaken as liothyronine Use complete drug name
TAC triamcinolone Mistaken as tetracaine, Adrenalin, cocaine Use complete drug name
TNK TNKase Mistaken as "TPA" Use complete drug name
ZnSO4 zinc sulfate Mistaken as morphine sulfate Use complete drug name

Stemmed Drug Names Intended Meaning Misinterpretation Correction
"Nitro" drip nitroglycerin infusion Mistaken as sodium nitroprusside infusion Use complete drug name
"Norflox" norfloxacin Mistaken as Norflex Use complete drug name
"IV Vanc" intravenous vancomycin Mistaken as Invanz Use complete drug name

Symbols Intended Meaning Misinterpretation Correction


Symbol for dram mistaken as "3"

Symbol for minim mistaken as "mL"
Use the metric system
x3d For three days Mistaken as "3 doses" Use "for three days"
> and < Greater than and less than Mistaken as opposite of intended; mistakenly use incorrect symbol; "< 10" mistaken as "40" Use "greater than" or "less than"
(slash mark)
Separates two doses or indicates "per" Mistaken as the number 1 (e.g., "25 units/10 units" misread as "25 units and 110" units) Use "per" rather than a slash mark to separate doses
@ At Mistaken as "2" Use "at"
& And Mistaken as "2" Use "and"
+ Plus or and Mistaken as "4" Use "and"
° Hour Mistaken as a zero (e.g., q2° seen as q 20) Use "hr," "h," or "hour"

**These abbreviations are included on TJC's "minimum list" of dangerous abbreviations, acronyms and symbols that must be included on an organization's "Do Not Use" list, effective January 1, 2004. Visit for more information about this TJC requirement.

Permission is granted to reproduce material for internal newsletters or communications with proper attribution. Other reproduction is prohibited without written permission. Unless noted, reports were received through the USP-ISMP Medication Errors Reporting Program (MERP). Report actual and potential medication errors to the MERP via the web at or by calling 1-800-FAIL-SAF(E). ISMP guarantees confidentiality of information received and respects reporters' wishes as to the level of detail included in publications.

Tuesday, 11 October 2011 13:25

Oral Dosage Forms That Should Not Be Crushed

Mistakes can occur when people have trouble swallowing a tablet or capsule and they try to chew, crush, break or mix the tablet or capsule in food or drink. The reason is certain medications have a special release mechanism designed to slowly release a certain amount of medication over a given extended time. If the medication is altered or destroyed in any way, the medication can be released too fast and cause a bad effect.

Click here for a list of medications that should be swallowed whole.

Thursday, 01 December 2011 20:07

Learn to read your prescription

Famous author Mark Twain wrote, in 1864, that doctors should "discard abbreviations… to avoid the possibility of mistakes." We agree! A prescription for medicine should not be a mystery to understand. Many abbreviations and words in prescriptions come from Latin. We'd like to help by explaining each part of a typical prescription and translating some of the Latin abbreviations into English words.

Download: Learn to read your prescription

Rollover letters A-K to for an explanation of each part of a prescription.

{jumi [*3]}

Common abbreviationLatin words that make up the abbreviationThe meaning on your prescription
ac ante cibum before meals
bid bis in die twice a day
gtt gutta drop (as in 1 drop, 2 drops, and so on)
hs hora somni at bedtime
od* oculus dexter right eye
os oculus sinister left eye
po per os by mouth
pc post cibum after meals
prn pro re nata as needed
qd** quaque die every day, or daily
qid quarter in die 4 times a day
tid ter in die 3 times a day

*Sometimes, od is used to mean "once daily." The word "daily" should be used instead to prevent mistakes.

**The abbreviation qd is considered dangerous. It should not be used because it has been mistaken as qid frequently. This mistake has led to serious harm, since people took once-a-day medicine four times each day.

Tuesday, 04 October 2011 15:35

Avoiding Maalox Mix-ups

All liquid Maalox products are not the same. Maalox Total Relief, Maalox Advanced Regular Strength, and Maalox Advanced Maximum Strength may look similar but they are not interchangeable. In fact, using the wrong one could be harmful.

Tuesday, 04 October 2011 15:32

Suicide Risk with Tramadol

Ortho-McNeil-Janssen is notifying healthcare professionals about strengthened warnings for Ultram (tramadol hydrochloride) and Ultracet (tramadol hydrochloride/acetaminophen). These drugs contain tramadol, which is a synthetic opioid analgesic used to manage chronic pain.

Epinephrine inhalers that use chlorofluorocarbons (CFCs) as a propellant will no longer be sold in the U.S. after December 31, 2011. CFCs released into the environment damage the ozone layer in the atmosphere.

FDA is warning people about harmful effects in children and pets if they unintentionally come in contact with Evamist (estradiol transdermal spray), a topical hormone treatment used to relieve hot flashes in post-menopausal women. This can lead to premature puberty in girls and breast enlargement in boys. Similar effects have been observed in exposed pets.

The U.S. Food and Drug Administration announced that all prescription combinations of opioids and acetaminophen will be required to contain no more than 325mg of acetaminophen per tablet.

Page 2 of 7