Medication Mistakes Caused By Unclear Medical Abbreviations

The U.S. Food and Drug Administration (FDA) and the Institute for Safe Medication Practices (ISMP) launched a nationwide health professional education campaign aimed at reducing the number of common but preventable sources of medication mix-ups and mistakes caused by the use of unclear medical abbreviations.

"Some abbreviations, symbols and dose designations are frequently misinterpreted and lead to mistakes that result in patient harm," said FDA Acting Commissioner Andrew C. von Eschenbach, M.D. "This joint campaign will promote safe practices among those who communicate medical information to help avoid serious and even potentially fatal consequences of medication errors."

According to the Institute of Medicine (IOM) of the National Academies, there are more than 7,000 deaths a year due to medication errors. Mistakes can occur anywhere in the medication-use system, from prescribing to administering a drug in a variety of settings (hospitals, outpatient clinics, nursing homes, home care, etc.)

FDA and ISMP's educational campaign focuses on eliminating the use of potentially confusing abbreviations by healthcare professionals, medical students, medical writers, the pharmaceutical industry and FDA staff. The campaign will address the use of mistake-prone abbreviations in all forms of medical communication, including written medication orders, computer-generated labels, medication administration records, pharmacy or prescriber computer order entry screens and commercial medication labeling, packaging and advertising.

"We recommend that ISMP's list of abbreviations, symbols and dose designations most often associated with medication errors be considered whenever medical information is communicated," said Michael Cohen, ISMP President. "ISMP's list includes abbreviations that have been associated with medication errors reported to the USP-ISMP Medication Errors Reporting Program."