Excess weight is shed not all at once but ounce by painful ounce. Today's cars are more fuel efficient not because of one or two breakthroughs but because of the sum of many small improvements. And so, too, as I was reminded by a new study, is healthcare made better and safer—more by looking for small and simple steps, preferably obvious ones, than by seeking a few radical changes. The case in point: medical abbreviations.
The time-honored ritual of writing a prescription involves an inscrutable scribble, saving time by using abbreviations like U for unit and Q.D. for every day (from the Latin quaque die). The problem is that misreading the scrawls is all too easy. A U can look like a zero, turning 10U into 100. If a period looks more like a short stroke than a nice clean dot, Q.D. can be read as QID (quater in die), suddenly elevating the dosing schedule to four times a day. IU (international unit, a measure of dosage) can look like—shudder—IV. It's happened.
Medication errors from all causes are blamed for about 7,000 patient deaths a year; how many of these result from misinterpreted abbreviations, no one knows. Doctors—the main offenders—and nurses have been advised, begged, and warned for years to drop the shorthand and write out drug names and dosing information. The Joint Commission, which accredits hospitals, issued a list of "do not use" abbreviations in 2004, among them dosing instructions starting with a Q.
But old habits die hard, especially if they save time, and the practice continues. The new analysis, which appears in the September issue of the Joint Commission Journal on Quality and Patient Safety, shows that use of abbreviations caused nearly 5 percent of the medication errors reported by 682 hospitals from 2004 to 2006 to a national database called Medmarx. Q.D., the major offender, accounted for more than 40 percent of the errors.
Now comes the reassuring part—99.7 percent of the errors were either caught before the patient touched the drug or caused no harm. Altogether, the 682 reporting hospitals committed 54 harmful errors, most of which caused little harm, over the three-year period—an average of 18 per year. That works out to one harmful error (or reported error, given the usual possibilities) per year for every 38 hospitals.
The pharmacists and nurses who fill the prescriptions and medicate patients clearly are doing a very good job indeed of catching mistakes before they happen. The question is why physicians have to challenge them. As the authors of the study noted: "[U]sing abbreviations may save minutes, [but] prohibiting abbreviations may save lives." Maybe not many, but every one is important. And it's one of those small, simple changes.