do not use these dangerous abbreviations or dose designations

Abbreviation/Dose Expression	Intended Meaning	Misinterpretation	Correction
Apothecary symbols	dram minim	Misunderstood or misread (symbol for dram misread for “3” and minim misread as “mL”).	Use the metric system.
AU	aurio uterque (each ear)	Mistaken for OU (oculo uterque—each eye).	Don’t use this abbreviation.
D/C	discharge discontinue	Premature discontinuation of medications when D/C (intended to mean “discharge”) has been misinterpreted as “discontinued” when followed by a list of drugs.	Use “discharge” and “discontinue.”
Drug names			Use the complete spelling for drug names.
ARAºA	vidarabine	cytarabineARAºC
AZT	zidovudine (RETROVIR)	azathioprine
CPZ	COMPAZINE (prochlorperazine)	chlorpromazine
DPT	DEMEROL-PHENERGAN-THORAZINE	diphtheria-pertussis-tetanus (vaccine)
HCl	hydrochloric acid	potassium chloride (The “H” is misinterpreted as “K.”)
HCT	hydrocortisone	hydrochlorothiazide
HCTZ	hydrochlorothiazide	hydrocortisone (seen as HCT250 mg)
MgSO4	magnesium sulfate	morphine sulfate
MSO4	morphine sulfate	magnesium sulfate
MTX	methotrexate	mitoxantrone
TAC	triamcinolone	tetracaine, ADRENALIN,cocaine
ZnSO4	zinc sulfate	morphine sulfate
Abbreviation/Dose Expression	Intended Meaning	Misinterpretation	Correction
Stemmed names
“Nitro” drip	nitroglycerin infusion	sodium nitroprusside infusion
“Norflox”	norfloxacin	NORFLEX
m g	microgram	Mistaken for “mg” when handwritten.	Use “mcg.”
o.d. or OD	once daily	Misinterpreted as “right eye” (OD—oculus dexter)and administration of oral medications in the eye.	Use “daily.”
TIW or tiw	three times a week.	Mistaken as “three times a day.”	Don’t use this abbreviation.
per os	orally	The “os” can be mistaken for “left eye.”	Use “PO,” “by mouth,” or “orally.”
Abbreviation/Dose Expression	Intended Meaning	Misinterpretation	Correction
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 “i.”	Use “daily” or “every day.”
qn	nightly or at bedtime	Misinterpreted as “qh” (every hour).	Use “nightly.”
qhs	nightly at bedtime	Misread as every hour.	Use “nightly.”
q6PM, etc.	every evening at 6 PM	Misread as every six hours.	Use 6 PM “nightly.”
q.o.d. or QOD	every other day	Misinterpreted as “q.d.” (daily) or “q.i.d. (four times daily) if the “o” is poorly written.	Use “every other day.”
sub q	subcutaneous	The “q” has been mistaken for “every” (e.g., one heparin dose ordered “sub q 2 hours before surgery” misunderstood as every 2 hours before surgery).	Use “subcut.” or write “subcutaneous.”
SC	subcutaneous	Mistaken for SL (sublingual).	Use “subcut.” or write “subcutaneous.”
U or u	unit	Read as a zero (0) or a four (4), causing a 10‑fold overdose or greater (4U seen as “40” or 4u seen as 44”).	“Unit” has no acceptable abbreviation. Use “unit.”
IU	international unit	Misread as IV (intravenous).	Use “units.”
cc	cubic centimeters	Misread as “U” (units).	Use “mL.”
x3d	for three days	Mistaken for “three doses.”	Use “for three days.”
BT	bedtime	Mistaken as “BID” (twice daily).	Use “hs.”
ss	sliding scale (insulin) or ½ (apothecary)	Mistaken for “55.”	Spell out “sliding scale.” Use “one-half” or use “½.”
> and <	greater than and less than	Mistakenly used opposite of intended.	Use “greater than” or “less than.”
/ (slash mark)	separates two doses or indicates “per”	Misunderstood as the number 1 (“25 unit/10 units” read as “110” units.	Do not use a slash mark to separate doses. Use “per.”
Name letters and dose numbers run together (e.g., Inderal40 mg)	Inderal 40 mg	Misread as Inderal 140 mg.	Always use space between drug name, dose and unit of measure.
Zero after decimal point (1.0)	1 mg	Misread as 10 mg if the decimal point is not seen.	Do not use terminal zeros for doses expressed in whole numbers.
No zero before decimal dose (.5 mg)	0.5 mg	Misread as 5 mg.	Always use zero before a decimal when the dose is less than a whole unit.

Source: http://www.ismp.org/

- Print list on brightly colored paper/post-it notes/posters/stickers/magnets and place in medical records/patient charts, place at/on/near computers, and post in patient care areas.
- Provide pocket-sized cards with the list to staff.
- Print the list in the margin or bottom of the physician order sheets and/or progress notes.
- Attach laminated copies of the list to the back of the physician order divider in the patient chart.
- Delete prohibited abbreviations from preprinted order sheets and other forms.
- Create clipboard cover that provides the list.
- Provide the list on the front page of the intranet.
- Provide a card with the list that can be attached to the back of the identification badge.
- Place tent cards with the list where physicians write orders and dictate.
- Have the list printed on pens.
- Send monthly reminders of the list to staff via computer.
- Educate and monitor staff who document in the medical record.
- Create an educational display for use during Patient Safety Awareness Week.
- Educate affiliated health care professional education programs about the list.
- Place articles in employee and physician newsletters.
- Provide mouse pads with the list.
- Convene regional/community meeting to develop consistent list for physicians who maintain privileges at two or more facilities.
- Direct pharmacy not to accept any of the prohibited abbreviations. Orders with dangerous abbreviations or illegible handwriting must be corrected before being dispensed.
- Conduct a mock survey and question staff to test their knowledge.
- Work with software vendor to ensure changes are made to be consistent with the list.
- At every medical staff meeting, give patient safety updates, including information about the prohibited abbreviations.
- Identify and promote "Physician Champions" who support accreditation-related activities and advocate for full compliance with the NPSGs.
- Ask every staff person to sign a statement that he/she has received the list and agrees not to use the abbreviations.
- Create a catchy name or theme: Do the "Write" Thing; Dirty Dozen; Outlaw Abbreviations—Join the Patient Safety Posse; "Operation BANEM" (Banned Items); Uncle Sam-style poster saying - "You can prevent a fatal error;" P.S. It's all about Patient Safety.
- Promote a "Do not use abbreviation of the month" campaign.
- Create a song incorporating the "do not use" list.
- Create a slide show/presentation illustrating poor handwriting and dangerous abbreviations. Include actual examples from your organization.