Strategy Submission

This clinical learning activity is appropriate for early clinical courses in a pre-licensure curriculum. In Colorado, where this strategy was developed, there is a long term care rotation in Fundamentals of Nursing. This learning activity is used in that rotation. The activity would also fit well for a junior Med/Surg clinical rotation.

Before class, I assign the students the following homework:

Go to the website for The Institute for Safe Medication Practices (www.ismp.org). Under the “Medication Safety Tools and Resources,” print out the “Error Prone Abbreviation List.” Review the list and be sure that you are familiar with the abbreviations to avoid, the misinterpretations that have been reported, and the potential danger in their continued use.

During class I lead a discussion on ISMP’s Error Prone Abbreviation List. We talk about the evolution of this list, the overlap of ISMP’s work with The Joint Commission’s National Patient Safety Goal that focused on abbreviations to avoid. I ensure during this class that all students have printed off the list and have a strong working knowledge of the list’s implementation in the practice setting. During this class I also review The Health Insurance Portability and Privacy Act (HIPPA), and have the students review the nature of deidentified patient data.

The students then receive this assignment for a day at their clinical rotation:

During your clinical rotation, as you review patient charts to prepare for patient care, keep a running list of all of the “error prone abbreviations” that you come across. Do not include any patient identifying information in your notes – all of your notes must be deidentified patient data. Keep record of the following information: • Copy down the error prone abbreviation in the context of the order or documentation, as it is written • If the error prone abbreviation is repeated in a set of orders or documentation, keep track of its recurrence. • Keep track of recurrence of error prone abbreviations by provider (e.g. LIP #1, LIP #2, RN #1, RN#2 etc…)

Type up the inclusive list of error prone abbreviations that you found in charts. Create a two column table where for every use of an error prone abbreviation, you write how the order or documentation should have been correctly written, without the error prone abbreviation. See the example below:

Error Prone Abbreviation as found in chart Correction for Order “give 10u regular insulin now” Give 10 units of regular insulin now “5,000u of heparin SC qd” 5,000 units of heparin subcutaneously daily

After you have typed up your table, choose 3 examples of incorrectly written orders or incorrect documentatoin, and explicate what might have been a patient outcome if each of these 3 error prone abbreviations had been misinterpreted. What might be the dosage calculation error? Would the error result in underdosing a patient, or potentially overdosing a patient? Look up the normal limits for that medication and infer possible patient outcomes. What are other ways that patient care might be compromised by the misinterpretation of these 3 orders or pieces of documentation?

Please conclude this write-up with a summary of what you learned from this data mining exercise. Were there any patterns to what you found (e.g. recurring offenders, recurring circumstances around the incorrect documentation, etc…). How will this exercise impact your nursing practice (please stretch for an insight beyond, “I will not use error prone abbreviations.”)