Jennifer Gold

Jennifer Gold

Monday, 23 January 2012 22:43

U-500 Insulin Errors

img vial syringeHumulin R is the brand name for Eli Lilly's recombinant human regular insulin. The usual version of Humulin R is U-100 and contains 100 units of insulin activity per 1 milliliter of fluid. But there's also a rarely-used version called U-500. The U-500 insulin is 5 times more potent than U-100 insulin. U-500 insulin contains 500 units of insulin activity per 1 milliliter of fluid. People may need to use U-500 if their diabetes is not well-controlled with U-100. The U-500 version should be used only for patients requiring doses above 200 units a day.

Important information about U-500 insulin

Since the use of U-500 insulin is not as common as the use of U-100 insulin, some health professionals may not be aware of it. This by itself increases the chance of dispensing errors.

The main problem with U-500 insulin is the risk of a mix-up between the insulin U-100 and insulin U-500 versions. If this occurs, it can result in very dangerous low blood sugar or very high blood sugar. A mix-up between the two insulin concentrations may occur if doctors or pharmacists select the wrong concentration (for example, selecting the U-500 regular insulin from computer screen instead of U-100). Sometimes the two concentrations appear one line apart on the computer screen, which sets up the possibility of selection errors. Depending on the screen size, the prescriber may see only the first few words of the product listing, so the drug concentration is not seen. Prescribers may assume the patient needs U-100 and may not even look for the concentration on the screen.

A mix-up may also occur if U-100 insulin and U-500 insulin are stored next to each other at the pharmacy, in the hospital or even in your home. Although the colors of the vials are different, if someone is not aware to look out for the concentration on the vials, the vials could be confused for one another.

U-500 insulin syringe

As of November 2016, a new syringe to administer concentrated Humulin R U-500 (insulin regular) has been made available from the manufacturer, BD. The syringe measures U-500 insulin doses ranging from 25 units to 250 units in 5-unit segments. Prior to the release of the U-500 syringe, it was recommended to use a U-100 syringe or tuberculin syringe to administer U-500 insulin. But dosing errors frequently occurred to patients who drew doses from a vial into a U-100 or tuberculin syringe. Every unit on the U-100 syringe scale is equal to 5 units of U-500 insulin. So, a dose measuring “40” units in a U-100 syringe is really 200 units of U-500 insulin. With a tuberculin syringe, the U-500 insulin dose has to be measured in mL, not units. Both situations have led to serious insulin dosing errors.

Now that a U-500 syringe is available, a U-100 syringe or tuberculin syringe should no longer be used to administer U-500 insulin in healthcare facilities or in the home.

Humulin R U-500 is also available in a prefilled pen, which also measures the concentrated insulin in 5-unit segments. With the Humulin R U-500 KwikPen, and now with the U-500 insulin syringe, the actual dose of U-500 insulin prescribed is the actual dose that is measured in the syringe or dialed with the pen. The updated information for physicians who prescribe Humulin R U-500 now requires all prescriptions for the U-500 insulin vials to be accompanied by prescriptions for the new U-500 insulin syringes. The updated information also recommends that healthcare providers:

  • Instruct patients who use vials of U-500 to use only a U-500 insulin syringe
  • Teach patients how to correctly draw the prescribed dose into the U-500 insulin syringe
  • Confirm that the patient has understood the directions If you are uncertain how to use the new syringe, ask your pharmacist, doctor, or office nurse.

If you are uncertain how to use the new syringe, ask your pharmacist, doctor, or office nurse.

Other Recommendations

Individuals who use insulin must be aware of the concentration and insulin type that you normally use. If you see U-500 on the label when you are supposed to be getting U-100, or if the opposite is true, make sure you question your pharmacist or doctor before taking it.

Also, if another individual in your home also uses insulin that is not the same concentration as yours, store the insulin in different areas. This way you will not inadvertently grab the wrong vial.

If you are to be hospitalized and you use U-500 insulin, be sure to clarify this with the medical staff. It is recommended to bring whichever syringe you use at home to the hospital and demonstrate where you normally draw up your insulin to.

Monday, 23 January 2012 22:26

Insulin safety during a hospitalization

If you need to be hospitalized

isc patientinhospIf you are someone who requires insulin, one of the most important things you can do to stay safe is to have an emergency plan in the event you become ill and need to be hospitalized. In preparing for such an emergency, it's important to take into consideration that you may be too ill to speak for yourself at this time. Therefore, you should always designate another individual who can assist in this process, as needed.

If you are hospitalized, or admitted for any emergent situation, it will be very important for you to tell your doctor and nurse the type of insulin you take, what dose and how you are taking insulin. You should carry an updated list of all medications you take with you at all times. Ideally, it is safest to bring your medications and insulin delivery system into the hospital to prevent any misunderstandings.

It will also be helpful to inform the health care team of your recent blood sugar readings. However, keep in mind, your usual insulin requirement may change with possible illness or emergent care. Be prepared for potential changes in your insulin regimen, which may be needed during your condition and as determined by your doctor.

During your hospitalization or for emergency care, you (or whomever you have designated) will need to pay close attention to your care. Here are some additional tips to avoid errors with your insulin during hospitalization:

  • Be sure the nurse confirms your identity with two identifiers before any insulin injection. For example, calling you by your first name and checking your arm band. Never accept an insulin injection without the nurse checking you identification band or scanning it if the hospital uses bar coding. Your identification band must always be legible.
  • Have the nurse confirm the type and dose of insulin prior to injection. Also request to visualize the syringe to confirm the amount of units in the syringe.
  • Keep accurate documentation of your blood sugar results. This can serve as a double check in the event a nurse either brings you insulin you did not need, or forgot to administer insulin you did need. Keeping documentation of your blood sugar results can also protect you from getting your roommate's dose instead of yours.
  • If the hospital is using an insulin pen, be sure a label is affixed to the pen with only your name. Insulin pens must never be used for more than one patient. Ask the nurse about this.
  • Keep in mind that some hospitals allow and even encourage patients who are experienced in using insulin at home to self administer their own insulin while hospitalized. If you are comfortable doing this, it is good opportunity for you to maintain control of your own insulin and ensure you are receiving your insulin in a timely manner.
  • If you have special equipment you use to take your insulin, such as a pen or a pump, never assume others will know how to use it. Always try to go over instructions for use with a nurse before surgery or hospitalization. Teach a family member or friend how to use the equipment in case you are too sick or unable to explain it.  
  • During hospitalizations, there may be procedures when you are required not to eat anything. If this occurs, your insulin will likely need to be adjusted or held. Unfortunately, there have been instances when nursing staff have continued insulin injections in error, despite a patient not eating. 
Monday, 23 January 2012 22:21

Insulin safety in your home

Staying safe with insulin in your home: avoiding an insulin mix-up

Mistakes with insulin can happen at home. In fact, people who have been using insulin for many years may be more likely to make a mistake. The more often you perform a task, the more you may do so without acting carefully. For example, if you always keep your long-acting insulin on your bedside table and accidentally switch it with your short-acting insulin, you could mistakenly grab the incorrect insulin thinking it was your long-acting insulin. If you do not carefully read the label, you can inject too much of the short acting form and cause a low blood sugar.

Below are some tips to help avoid an insulin mix-up in your home:

After opening an insulin vial, throw out the carton:

  • Storing insulin vials in the original cardboard carton after the packages have been opened can lead to a mix-up.
  • This happens if you replace the vial into the wrong carton.
  • By eliminating storage of vials in their cartions, the chance of error is eliminated.

If you are using more than one type of insulin, consider using two different insulin devices to inject your insulin.

  • For instance, use a vial and a needle/syringe for your long-acting insulin and an insulin pen for your rapid-acting insulin.
  • If you are unable to use different devices, then consider making each vial, pen, or cartridge look different by putting a rubber band around one type of insulin.
  • You can also use colored stickers to help differentiate the insulin.

Do not ever assume you are using the correct insulin based solely on what it looks like or where it is stored.

  • Some people may think that fast-acting insulin is the only insulin that's a clear liquid. But that's not true. For example, insulin glargine (Lantus) is a clear, 24-hour insulin.
  • Likewise, not all intermediate- or long-acting insulins are cloudy. For example, some pre-mixed combinations of intermediate- and rapid-acting insulins are cloudy.
  • Never rely only on the container or label color to identify your insulin. The label color can be used as a guide to identify insulin but should never be used by itself. In some cases, different types of insulin may have similar label colors. Always look carefully at the label and read it before using any insulin. Differentiate any similiar looking insulin products (e.g. place a rubber band around one type of insulin).

ALWAYS read the label before using your insulin

  • Insulin that is usually stored in one location can be accidently switched by accident or by another person. If you use your insulin based on where it is stored (e.g. butter compartment in refrigerator) and inject it without reading the label carefully, the wrong insulin and dose might be used.

As with any prescription medication, it's important to make sure that what you receive from the pharmacist matches what the doctor prescribed. Let's look at some of the reasons dispensing errors happen:


Mix-up of similar insulin product names

similiarInsulinNames

Dispensing errors can happen when the names of two insulin products get confused. As you can see by reading the labels, Novolin 70/30 and Novolog Mix 70/30 have similar names. However, the way that they act when injected is quite different. Occasionally we do hear about cases where one product is dispensed incorrectly for the other. If Novolog 70/30 is given by mistake, too far from meal time, a patient's blood sugar may fall too low. 

 

 

 

Here are some other insulin names that have been involved with insulin mix-ups:

  • Humalog and Humalog 75/25
  • Humalog and Humulin Regular
  • Humulin Regular and Humulin NPH
  • Humalog 75/25 and Humulin 70/30
  • Novolog and Humalog
  • Novolog 70/30 and Novolin 70/30 and Humulin 70/30
  • Novolin Regular and Novolin NPH

 

 

Mix-Ups of Similar Names of Other Medicines:

Sometimes insulin looks like another medicine when written on the prescription. If the handwriting is hard to read, a medication mix-up can occur. The example below is an actual prescription written for the insulin Levemir. The pharmacist however misread the name of the drug for Lovonox. Lovonox is is a medication for preventing and treating blood clots. Like insulin it is prescribed in units. This is a dangerous mix-up and can result in harm and even death.

lovenox.levemirmix-up

Computer selection errors

When a doctor prescribes electronically, or when the pharmacy staff receives an insulin prescription, they must select the insulin product from a computer screen. As shown below, many insulin products appear quite similar when seen on the pharmacy computer screen. Look complicated? It can to a pharmacist or doctor too.  Although it happens rarely, selecting the wrong product from the computer screen has led to patients getting the wrong insulin. While healthcare computer system vendors are working to improve the way drugs are selected on computer screens, be aware that this is one important reason for an error. It's good evidence to show why it's so important for you to know the name and proper dose of the insulin that's being prescribed for you.  

insulinscreenshot2

Misreading the abbreviation "U" (U = units) as the number 0 or the number 4:

Insulin is dosed in units. Some doctors dangerously abbreviate the word "unit" with the letter "U." This has been known to increase the risk of errors dramatically. A "U" can look like a 4 or a zero, thus causing as much as a tenfold overdose!  This abbreviation is so dangerous that it should never be used. In fact the Joint Commission, forbids its use in organizations that it accredits. That hasn't stopped some healthcare practitioners though, who may not understand the risk. Doctors should always spell out the word "unit" when writing a prescription for insulin.

 4Units

In this example, the abbreviation "U" can be misread as the number 4. This would cause the patient to get 44 units instead of 4, a dangerous overdose.

 


 

 a6unitsor60

In this example, the "U" looks like a zero.  This would also cause a dangerous overdose of 60 units instead of 6.

 


 

 8unitsor80

Inadequate spacing between the word "Unit" and the dose can lead to an error when reading the prescription. The dose of 8 units is replaced by a dangerously high dose of 80 units.

Saturday, 21 January 2012 04:44

Insulin Safety Center

Why an Insulin Safety Center?

 

The Insulin Safety Center is a unique resource dedicated entirely to medication error prevention with the use of insulin.

Insulin is an essential and lifesaving drug safely used by millions of Americans every year. Insulin enables individuals with diabetes to lead a healthy lifestyle. However, insulin use is associated with some risks and any misuse can cause harm or even death.

Insulin is considered a "high-alert medication" by the Institute for Safe Medication Practices. High alert medications have been proven to be safe and effective when taken according to instructions approved by your healthcare provider. But, they are more likely to cause injury or even death if a mistake happens while taking them. This means that it is critically important for you to know about this medicine and how to take it exactly as prescribed by your healthcare provider or explained to you by your pharmacist.

In addition to insulin being considered a high-alert medication, insulin has also been known to be associated with more medication errors than most other medicines. The Institute for Safe Medication Practices performed a safety study on drug use in hospitals and found that 11% of all serious drug errors involved insulin misadministration. Another recent study at four U.S.A. poison centers looked at calls taken over the past 10 years. They found that calls about insulin concerns have "skyrocketed." On average, the number of calls per year has almost tripled since 2002.

This Insulin Safety Center is a great place to access information regarding all aspects of safe insulin use. Here you will learn all about the most frequent types of errors associated with insulin use. In addition, you will see how these errors can occur and what you and your caregivers can do to prevent them from happening to you.

Friday, 20 January 2012 20:13

Get Financial Help with Purchasing Medicine

Tough economic times make it hard for people to fill their prescriptions and take the medicine as directed. There are no easy solutions to the high cost of medicines. But there are often safer alternatives than cutting back on your medicine, skipping doses, taking less than the recommended dose, or not filling your prescription at all. If you find it hard to pay for your prescription medicines:

Talk to your doctor. Don't be embarrassed to tell your doctor if you have trouble paying for your prescriptions. He might be able to prescribe a less costly medicine that will work for you. He also may have samples of medicine that he can give you, at least in small supplies to hold you over. If your doctor gives you samples, always ask for written directions on how to take the medicine. Keep the directions with the sample medicine.

Search out assistance programs. There are many patient assistance programs that might be able to help you obtain medicines at no cost or at a significant discount. Look at these websites that steer patients to public and private support programs that may be useful.

Partnership for Prescription Assistance

http://pparx.org

Needy Meds

www.needymeds.com

RxAssist

www.rxassist.org

RxHope

www.rxhope.com

Patient Advocate Foundation

http://www.copays.org

FreeDrugCard.US

http://freedrugcard.us

Together Rx Access

http://www.togetherrxaccess.com

Also visit the website of the drug manufacturer who makes your medicine. Many companies offer coupon discounts or other forms of assistance (for those who qualify). In addition, look for groups that support patients with your particular disease. A few examples are provided:

Mental Health America

http://www.mentalhealthamerica.net/prescription-assistance 

The American Kidney Foundation

http://www.kidneyfund.org

The Epilepsy Foundation

http://www.aesnet.org/files/dmfile/PatientAssistanceProgramsFINAL2010.pdf

National Organization for Rare Diseases

www.rarediseases.org/patients-and-families/patient-assistance

freerxTough economic times make it hard for people to fill their prescriptions and take the medicine as directed. There are no easy solutions to the high cost of medicines. But there are often safer alternatives than cutting back on your medicine, skipping doses, taking less than the recommended dose, or not filling your prescription at all. If you find it hard to pay for your prescription medicines:

Talk to your doctor. Don't be embarrassed to tell your doctor if you have trouble paying for your prescriptions. He might be able to prescribe a less costly medicine that will work for you. He also may have samples of medicine that he can give you, at least in small supplies to hold you over. If your doctor gives you samples, always ask for written directions on how to take the medicine. Keep the directions with the sample medicine.

Search out assistance programs. There are many patient assistance programs that might be able to help you obtain medicines at no cost or at a significant discount. Look at these websites that steer patients to public and private support programs that may be useful.

Partnership for Prescription Assistance

http://pparx.org

Needy Meds

www.needymeds.com

RxAssist

www.rxassist.org

RxHope

www.rxhope.com

Patient Advocate Foundation

http://www.copays.org

FreeDrugCard.US

http://freedrugcard.us

Together Rx Access

http://www.togetherrxaccess.com

Also look for groups that support patients with your particular disease. A few examples are provided:

The American Kidney Foundation

http://www.kidneyfund.org

The Epilepsy Foundation

http://www.aesnet.org/files/dmfile/PatientAssistanceProgramsFINAL2010.pdf

National Organization for Rare Diseases

www.rarediseases.org/patients-and-families/patient-assistance

Friday, 20 January 2012 18:04

Keep Track of Your Medicine

Keeping an up-to-date record of your medicines may help protect you from a mistake. First, it helps you and your family remember all the medicines you are taking. Next, it helps your doctor, nurses, and pharmacists make sure that the medicines prescribed for you can be taken safely together. A list also helps make sure that important medicines you take at home will be continued if you are hospitalized. Finally, your medicine list will help your doctor determine if any illness or symptoms you experience could be related to the medicine you take.

To create an up-to-date medicine list, think about the doctors you visit and the medicines each one has prescribed for you. Then think about your health conditions and the over-the-counter and prescription medicines you take for each one. Finally, think about the vitamins and herbal products you take to stay healthy.

Below is an example of a form you can use to help organize your medicine list.

For a PDF version of this form click here.

For a Word document click here

 

medform1

medform2

medform3

medform4

Thursday, 19 January 2012 03:31

Unsafe Medical Abbreviations

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.

AbbreviationsIntended MeaningMisinterpretationCorrection
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"
HS

hs
Half-strength

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"
SSRI

SSI
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 MeaningMisinterpretationCorrection
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 MeaningMisinterpretationCorrection
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

mL
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 AbbreviationsIntended MeaningMisinterpretationCorrection
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 NamesIntended MeaningMisinterpretationCorrection
"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

 

SymbolsIntended MeaningMisinterpretationCorrection


Dram

Minim
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 www.jointcommission.org 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). 

Wednesday, 18 January 2012 19:58

Tools and Resources