Medication Safety

Medication Safety Updated: 2/26/2004

Index:

Banned Abbreviations

Ascend-IP Medication Safety Features

Alerts and Guidelines issued at order entry

Other medication safety features

Upcoming medication safety features

Banned Abbreviations

JCAHO has published a list of abbreviations that should not be used (i.e., in order to meet national patient safety goals). The following are our recommendations to meet this requirement.

Banned abbreviations ("do not use" list)	Recommendations
QD, QOD, TIW, HS (dosing schedule "codes")	Ascend-IP (AIP) can automatically replace scheduling "codes" used in the "Sig" (i.e., directions for use) with a complete description. Example: "40MG QD By Mouth" can be automatically replaced with "40MG Daily By Mouth". To enable this feature, use the menus: "Utilities--> Options--> Administration times". Add a "Full description" in the column next to the corresponding "Sig code". This feature has been available since 1st quarter 2003. If you do NOT have this feature, you need to update to a more current version.
U (for "units")	A new version of AIP expands the "dose" and "per" fields (unit of measure) up to 5 bytes. This will provide space for the use of "units" in the formulary and order dosage fields. The update will replace "U" with "units" in existing records. Until you have installed the new version¹you can meet the requirement as follows: In the formulary and common order table records for drugs that currently use "U" (e.g., Insulin, Heparin, etc.) delete the "U" from the "dose" measurement field and append the word "units:" to the end of the drug description. A subsequent Insulin order for 20 units (100 unit/ml) might then look like this on the MAR/labels: "INSULIN units: 20 /0.2ML" or "INSULIN units: 20 ", if you don't include a volume in the "per" field.
IU (for "International units" )	Include "International units" in the drug description as above and remove it from any dosage field descriptions in the formulary/common orders (if any). Another option: omit the word "International" and just use "units" as described above.
Unnecessary trailing zero for even numbers, or lack of a leading zero with decimal fractions	We are not aware of any AIP function that fails this safety standard. If you discover an exception, please contact our office.
MS, MS04, MgSO4	Pharmacy should change abbreviated drug names to full descriptions in their AIP formulary and common order tables.
ug (for micrograms)	AIP already uses the recommended "mcg" unit in dosage fields. Pharmacists should modify drug descriptions in the formulary table and common orders that employ the unacceptable abbreviation.
HS	When intended to mean "half-strength", pharmacists should write out this phrase in the directions for use. Pharmacists should replace this abbreviation if used in formulary or common order records. If the meaning is intended to be "at bedtime", follow the recommendations for "QD, QOD, TIW, HS" listed above.
SC or SQ	A new version of AIP expands the "route" field to 4 bytes. This will provide space for the use of "subQ" in the formulary, common order and order dosage fields. The update will make these changes for you. Until you have installed the new version¹you can meet the requirement as follows: In the Ascend-IP route table (menus: "Utilities--> Options--> Routes") delete any SC and SQ records you may be using. (We also recommend NOT using "IJ"). At order entry time, include "subcutaneous" or "subQ" in the directions for use. You can also include a default comment in the drugs formulary record [ e.g., "Given by subcutaneous route" or "Route = subQ", or something similar] so that your descriptive phrase appears with orders and MARs automatically.
DC or D/C	Pharmacists should include the full description in order directions, comments, etc.
CC (for cubic centimeter)	AIP already uses the recommended "ML" unit in dosage fields. Pharmacists should modify any drug descriptions in the formulary table and common orders that employ the unacceptable abbreviation, and avoid its use in any orders they enter.
AS, AD, AU	If these abbreviations are used in AIP route tables, they should be deleted (menus: "Utilities--> Options--> Routes"). Pharmacists can include the full phrases "left ear", "right ear" or "both ears" in the order's directions for use where appropriate.

In addition to the features and recommendations described above, a new version of Ascend-IP will also provide a convenient means to automatically replace any other abbreviations that you enter in the "Sig" with full descriptions. This is similar in effect to the current AIP feature that allows you to automatically replace scheduling codes (such as "QD" --> "Daily"). However, the new function is not used to calculate dosing schedules. This will allow pharmacists to use any number of "user-defined" abbreviations during order entry and have them automatically replaced with a full description before they appear on the final order, labels and MARs. Examples that you might choose to configure include: "AU" --> "Both ears" "HA" --> "Headache" "N/V"--> "Nausea or Vomiting" "BP" --> "Blood Pressure" "BS" --> "Blood Sugar".

If any new or existing safety requirements are not addressed by the program features or recommendations described above, please contact our office.

¹ To provide new features in Ascend-IP that address abbreviations, we must modify your database structure and replace your program and interfaces. Therefore, we will need to schedule your update process in advance so that you, your IT department and our IT staff can work together to accomplish it. We can't convert everyone at the same time. Therefore, please follow our recommendations to meet current requirements until your conversion has been completed.

Ascend-IP Medication Safety Features

Alerts and Guidelines Issued at Order Entry Time:

Allergy class checks
Drug-drug interaction checks
Drug-food interaction checks
Duplicate therapy checks
Renal function warnings
Pediatric warnings
Geriatric warnings
Pregnancy warnings
Lactation warnings
Dosage guidelines

Other Medication Safety Features:

Full support for all required changes in medical abbreviations (see above)
Unlimited space for allergies which are prominently displayed in bold print on all patient and order screens, and on relevant medication reports.
If all allergies cannot be displayed on one profile screen, the "Allergies (more)" label is highlighted in red advising the user to view additional allergies on the patient’s admission screen.
AIP can be configured to block order entry unless specific patient information has been documented (e.g., allergies, height or weight could be required before order entry proceeds, if desired.)
The standard medication administration record (MAR) includes allergies, height (inches and cm), weight (lbs and kgs), and renal function data (e.g., Creatinine clearance) which can be used to better manage patient care.
The AIP standard MAR includes multiple patient identifiers (name, birth-date, account number) to help prevent “wrong patient” type errors.
Medication instructions entered with coded administration schedules are converted to English automatically (e.g., “QID” becomes “Four Times Daily”)
The patient’s age is highlighted in red if the patient is under 18 years of age. This reminds the user to consider the patient's age during order entry, drug dosing, and similar pediatric patient evaluations.
Discontinued patient’s discharge dates are highlighted in red to clearly alert users and reduces “wrong patient” type errors.
AIP provides the ability to prevent the entry of controlled drug orders (e.g., narcotics) for specified doctors unless these doctors are licensed to do so, ultimately reducing unauthorized adminstration of these dangerous drugs.
AIP’s pre-defined drug administration schedules/times reduce the opportunity for user error in scheduling and administering medication dosages.
Drugs may be pre-configured with defined routes of administration, directions for use, warnings, pop-up reminder messages, label content, comments, administration times, dosages, and etc. to reduce order entry errors, improve order clarity, conform to established policies/procedures, and the like.
AIP prints clear, uniform and legible medication labels, MARs and reports to reduce errors commonly associated with handwritten, transcribed materials.
Automatic documentation of alerts (above), and documentation of related pharmacy/nursing/physician actions, patient outcomes. These records may be compiled in reports that can be used to identify and trend problems, and used to develop policies/procedures to improve patient care.
No duplicate data entry. For example, drug names need only be entered/selected once for continued use throughout the application, reports, labels, etc. This reduces the opportunity for user error.
Doctors can use current AIP program to perform order entry directly, reducing transcription/interpretation errors, and providing doctors with more timely warnings (e.g., 1-5 above).
ADT interfaces for AIP reduce manual entry, which in turn reduces the opportunity for user error. Interfaces maintain patient data in a more timely/thorough manner (e.g., patient age, height, weight, location, etc), which may be important for proper medication dosage, delivery and administration.

Upcoming anticipated changes to further improve patient medication safety:

(estimated availability):

Dynamic replacement of codes in the directions for use (SIG) with a full description (e.g., "AU" could be replaced automatically with "Both Ears".) (2^nd quarter 2004)
Duplicate patient name alerts (1^st quarter 2005)
Dosage warnings on order entry (3^rd quarter 2005)

Dates for software availability provided above are estimates only. Hann's On Software makes no guarantee as to when such features may be made available. Other software enhancements, not listed above, may also be identified and developed in the future. Hann’s On Software reserves the right to schedule and prioritize software development projects as it sees fit.