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Introduction
An acronym (sometimes called an initialism) is simply a word formed by taking letters (usually the first) of each word in a phrase; on the other hand, an abbreviation is a shortened form of a word or phrase. Acronyms and abbreviations are commonly used in medical records to simplify and facilitate communication, and to save time, space and effort. 1 The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) found that nearly 5% of all medical errors were attributable to inappropriate use of acronyms and abbreviations. 2
Use of error-prone medical abbreviations is common. A study that reviewed paediatric handover sheets and medical notes found that paediatricians were able to accurately recognise 56-94% of abbreviations, and only about half of the abbreviations were understood by healthcare professionals from other disciplines. 3
Many acronyms stand for more than one word and can be easily misinterpreted. For example, the acronym 'CP' can be used for 'cleft palate' or 'cerebral palsy', two completely different conditions. 4 Likewise, 'PE' might mean 'pericardial effusion' to a cardiologist but 'pulmonary embolism' to a pulmonologist. 5 Interpretation of acronyms in a medical note is dependent on the knowledge and expertise of the person reading it. Incorrect interpretation may lead to the failure of health professionals to work together or communicate as a team, potentially ending up in a major catastrophe in patient outcome.
Some acronyms are prone to misinterpretation, such as 'U' for unit, which can be mistaken for a zero, leading to a 10-fold overdose in a medication dosed in units. 6 For example, medications ordered 'Q.D.' (once a day) can be misread and administered 'Q.I.D.' (four times a day). The National Coordinating Council for Medication Error Reporting and Prevention published the first list of error-prone abbreviations in 1996. 7 Since then, more extensive lists have been released by the Institute of Safe Medication Practices 8 and the JCAHO. 9
In an Australian study it was revealed that a total of 694 (8.4%) medication orders contained 1162 error-prone abbreviations. 10 The overall rate was 2.4 error-prone abbreviations per patient, and 77% had at least one error-prone abbreviation on their medication chart. Of the 1162 error-prone abbreviations, 344 (30%) were considered high risk. 10
In Pakistan, there are no data on...