Lessons Learned

Abbreviations in Patient Communications

Rules for abbreviation use generally focus on medication safety—identifying visual and textual ambiguities that may confuse other medical professionals. The ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations includes items like IU that could appear like IV or 10; and DPT, which could stand for Demerol-Phenergan-Thorazine or diphtheria-pertussis-tetanus.

CHPSO has received incident reports in which abbreviations caused or had the potential to cause communication problems with patients. The two primary settings involved were consents for procedures and discharge instructions. For example, a patient may be told to visit her PCP after discharge without understanding what or who a PCP is. Moreover, in several cases, surgical consent abbreviations confused not only patients, but staff as well.

Plain language should be used when communicating with patients. Communication is ineffective if the recipient does not understand, and ineffective communication impairs the ability of the patient to participate in the care. Potential consequences are many, such as misinterpretation of discharge medication instructions resulting in a readmission or wrong site surgery if the patient is unable to identify the correct body part and procedure. Cases in the CHPSO database support the role of patient confusion in both medication errors and wrong-site surgery.

Plain language means:

  • Use simple language or define technical terms,
  • Break complex information into understandable chunks,
  • Organize information so the most important information comes first, and
  • Lay out the text on the page so that it is easy to read.

Abbreviations, even when readily understandable to medical professionals, are not necessarily understood by patients. There are occasional abbreviations that are acceptable in communications, but clinicians should be very careful whenever using them. Ambiguities and other errors may occur even with apparently acceptable common abbreviations. UK may mean United Kingdom to one person and University of Kentucky to another.

Nonetheless, some abbreviations are so commonplace as to be more understandable than the full term and should be used in communications. For example, TV may be preferable to television and a.m. unquestionably is much better than ante meridiem. Therefore, CHPSO recommends that abbreviations be used with extreme caution in important patient communications such as informed consents and discharge instructions.

References:

Institute For Safe Medication Practices: List of Error-Prone Abbreviations, Symbols, and Dose Designations

HHS Office of Disease Prevention and Health Promotion: Plain Language: A Promising Strategy for Clearly Communicating Health Information and Improving Health Literacy.

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