JCAHO (I refuse to refer to them as THE JOINT COMMISSION as they now wish to be called) has spent God only knows how much time and how many millions of dollars developing a list of abbreviations which must never be used.
Never mind that the whole point would be moot if doctors all had to use computerized order entry so you took their crappy hand writing out of the equation. How many times have you seen a group of nurses clustered around a chart asking each other "what do you think that says" and hazarding guesses? Multiple times every day.
Some do make sense for instance trailing zero's. why write 1.0 mg? the zero is completely unnecessary and if the period is overlooked a ten time over dose will occur. Why would anyone write a number like that? It happens all the time. Or .5 instead of 0.5 - a hastily written decimal could be mistaken for a one. Those make sense.
For eons medical personnel have used the abbreviation MS for morphine sulfate. JCAHO has determined we must never do so. Foolish staff may mistake it for Magnesium Sulfate. Never-mind that we abbreviate that MgSO4. Never mind that the dosing is different - if a doctor was to write MS 1 gram (meaning Magnesium Sulfate 1 gm) I would certainly question the order. But JCAHO fears some one would administer 1 gram of morphine. In my ER that would require I pull out 100 vials!
Now doesn't that make sense? Now we have a whole contingent of people who used to do bedside nursing who's job is to look through all the charts for the unapproved abbreviations and chase down and chastise the offender. And every shift for the last 3 months we have been short at least one nurse. Perfect.
Tuesday, March 25, 2008
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11 comments:
The hospital I work for sent out a list of approved abbreviations--all 24,000.
love it!
As a nursing student we get sheet of abbreviations to avoid and those to use and it changes every freaking semster and the hospital here used all the no-no ones. I agree with the how to write your numbers part, those are a problem and easy to fix. I stole your post about the how to call patients, don't worry I linked to you, because i find the whole thing so assinine! I swear these people have nothing better to do than sit around with their thumbs, or each other's thumbs up their asses, or somebody else's ass, however that works out.... and make up stupid regulations and rules. I worked in the ARMY child care system and they were the same way. "you must play music at nap time, but the player must be out of reach, but not so high that the children can pull it down" and "all blinds must be at the same level with other classrooms for a look of consistence and visual appeal" WTF??!!! How bout backing me when I report a case of physical and sexual abuse.. nope can't do that, in fact we will tell the father who turned him in so he will like us and keep his child here because we need the money and you as a staff member are replaceable if he kills you in a homicidal rage. Ok, thats logical to me! I understand! (don't worry i had their job for it, my boss, her boss and her boss were all fired!)
Back on topic, JCAHO sucks!
maybe I can shed some light on why someone might write 1.0 instead of 1. I am a chemist turned nursing student, and in the hard sciences we are always taught to be precise with our numbers. 1.0 is more precise than 1 because it shows that we know the value to the tenth rather than just to the nearest one. After a few years of working in a lab, it feels weird to write 1 instead of 1.0. So these docs, many of whom have degrees in the hard sciences, may have a similar mind-set, and old habits are hard to break
Ah Bradley, good old significant figures. Gotta love them. I had a hard time with this originally too, which my only chemistry history being a 200 level chem class.
I refuse to stop writing MSo4. I trust my nurses will not give 5 subtherapeutic milligrams of magnesium sulphate to someone.
From my residency experiences, I will forever think of JCAHO inspection week as the time we temporarily had to remove all candy and cookie jars from the nurses station and get the microwave and coffee maker out of the residents' room. All in the name of improved patient safety.
We call them JCAHoff because it seems they all just sit in their nicely insulated offices wearing their K-Mart Jaclyn Smith Collection power suits mentally diddling away the hours thinking up shit for other people to do. Talk about creating a niche for yourself.
I'm on a patient satisfaction committee, along with our DON and a bunch of career sycophants and clipboard jockeys. When I suggested the key to patient satisfaction was better nurse/patient ratios and plenty of (working) equipment, our DON actually closed her eyes and shook her head, and said "No no no... that's NOT what we want to hear - that has NOTHING to do whatsoever with the nurse's attitude and with patient satisfaction. WE are a Magnet Hospital!" I resigned from the committee and my manager put me on a Level I disciplinary status. I'm going to talk with HR tomorrow, more offices, more clipboards more poster-therapy... I can't take much more.
One of our resident once wrote for 80 gm of Gent for a post op joint replacement with a UTI. The nurse who picked up the order was a friend. I went by to say hi and watched in astonishment as she stacked the boxes of vials of gent to be emptied into an IV bag.
While I do not agree with all the Joint Commish has to say, some of their efforts are reasonable. While most of us perform admirably and are careful, alert, etc. Not all docs and RNs can function well autonomously.
Howard:
Cardinal rule: if you need to use more than three of anything (tabs/vials/syringes), call pharmacy!
We're "forbidden" to write MgSO4 for magnesium sulfate, MS or MSO4 for morphine, U for units, trailing 0's, etc. There is a sticker on every single patient chart with these biggies as "no-no's".
You call it foolish staff !!! No wonder when such arrogant creatures like you know nothing about patient safety! It takes only one person who is not familiar with the abbreviation to harm a patient. You are lazy to write Morphine ... is it that long? You arrogant don't know that morphine comes only as Sulfate, so no need to write SO4
You super busy creature wanna save time regardless to outcome. Stop silly bla bla and go get some classes in improving handwriting. Silly
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