- I can’t write “U” anymore because it could be mistaken for any of the following: “0,” “4” or “cc”
- I can’t write QD or QOD because the period after the Q might be mistaken for an “I” and the “O” might be mistaken for an “I”
- I can’t write “MS” for morphine sulfate because someone might confuse it for magnesium sulfate. Similarly, MSO4 and MgSO4 might be confused.
We’re soon going to be blessed with even more additions to the “Do Not Use List”:
- Don’t write “> or <” because they could be mistaken for the number “7” or the letter “L”
- Don’t write “&” because it could be mistaken for the number “2”
- Don’t write “cc” because it could be mistaken for “U” (units) when poorly written. Instead we will have to write out the term “ml” instead.
There are other “safety measures” to keep us from hurting ourselves, but these are the ones that stick out most in my mind.
Now hold on a second while I get my soapbox.
Tap tap tap. Is this thing on?
There, that’s better.
The “U” for units might get confused with a number “0”
Maybe there could be some confusion.
Now let me ask the nurses a question: If you get an order for “500 reg insulin SQ,” are you going to
(a) question the order or
(b) fill up a 30 cc syringe (HA! I wrote “cc” instead of “ml” – cc cc cc cc cc) with regular insulin and inject a bolus the size of a kiwifruit under someone’s skin?
Would any medically trained person give “50 regular insulin” instead of “5 u regular insulin” to someone with a glucose of 250? I didn’t think so.
So this rule must have been written for people who have no knowledge of how to use insulin – just in case the housekeeping staff wants to get into the act and start treating hyperglycemia on the sly.
While I’m at it, will all of the communications from Medical Marijuana Advocates be required to go without the “cc” designation, too? What a waste of trees. Have to write a new letter to every addressee.
We can’t use MSO4 and MgSO4 because someone might not know that MSO4 is morphine and MgSO4 is magnesium
Would anyone question why a physician was giving a patient with a kidney stone 10 mg of Magnesium for pain? Considering that the dose of magnesium is usually 1000 mg, would it not set off a red flag in a normal person’s mind when you have to use a micropipette to get the proper dose of a medication and then administer three drops to medicate the patient?
And what better way to terminate an episode of torsades de pointes than 1 gram of morphine IV over 30 minutes? Just think, junkies from miles around would figure out ways to put themselves into cardiac arrhythmias just to get treated in your ED! I can see them now: Hey! Wait a minute, JACK! NOOOObody said nothing about no motherf%#$ing shocks!
The ampersand “&” might be mistaken for a “2”
First, I want to know who even writes ampersands any more. Then I want to see how someone can morph an ampersand into a number 2. Right after that, they can go to my bank and turn the $155 dollars in my checking account into a king’s ransom. Not happening.
“> or <” could be mistaken “7” or “L” and “cc” could be mistaken for “U” (units) when poorly written
I understand how an order to give “10 cc insulin SQ if BGL 7 350” would be confusing. I routinely dose insulin by “cc” instead of “units” and I frequently see blood glucose levels more than 7000 in my daily practice (the normal glucose level is between >0 and 110). I thought long and hard about this one, though, and have come to the conclusion that we should probably stop using the “ml” term also. Because if written poorly, “ml” might actually appear to be the number “11111” which could accidentally increase the dosage of any medication by 11111-fold.
See? Instead, I propose that we use the symbol from the Artist Formerly Known as Prince:
Think of how many times we could avert the tragedy of some poor patient getting a 50011111 bolus of saline.
A period in Q.D or the letter “O” in QOD might be mistaken for an “I”
Good point. But because they are so confusing, we shouldn’t just stop at using “.” and “O” with Q.D. and QOD, we should stop using them altogether. By doing so, we would avoid confusing orders such as “STIP patient’s ciumadin NIW”
And this whole thing just gives me flashbacks about one time when I narrowly escaped ordering emergency dialysis for a patient whose potassium level looked like it was “315” on the computer printout. Boy was I embarrassed. Oh, and I almost forgot the time I nearly intubated a patient whose pH appeared to be 7144. Phew!
Attention Medical Marijuana Advocates …
Here’s a patient safety measure for you:
If health care providers are so incapable of determining whether a dose of medication is 100 times more than it should be and are at such a loss of medical knowledge that they can’t remember whether to use morphine or magnesium for pain management, they either need to call the physician to clarify the order or they need to find another profession.
Maybe they could work for the Joint Commission. Betcha they’d fit right in.
Want to see one solution to the medical abbreviation problem? Check out this post on physician handwriting.