ISMP List V2 [Official] Flashcards
Q: Why do healthcare professionals use abbreviations, symbols, and dose designations?
A: They save time, fit information into smaller spaces, and help avoid misspellings. However, they can also lead to confusion, misinterpretation, and even harm to patients when misunderstood.
Visual Example: A prescription label with abbreviations (e.g., “q.d.” for daily) alongside a crossed-out warning sign for potential errors.
Q: What problems can arise from using abbreviations or symbols in healthcare?
A: Misunderstanding or misreading abbreviations and symbols can result in medication errors, harm to patients, and delays in care due to time spent clarifying meanings.
Visual Example: A confused healthcare provider holding a prescription with unclear symbols, showing a delay in care.
Q: Where are abbreviations and symbols not allowed in healthcare?
A: They should not be used in verbal, electronic, or handwritten communications. This includes medication labels, drug storage labels, prescriptions, infusion pumps, and other medication-related technologies.
Visual Example: A red “No” symbol over a medication label with handwritten abbreviations.
Q: What is the purpose of the ISMP MERP?
A: It reports and tracks harmful errors caused by misunderstood abbreviations, symbols, and dose designations to help improve medication safety.
Visual Example: A flowchart showing an error reported to ISMP and leading to a “Do Not Use” recommendation.
Q: What is the purpose of the “Do Not Use” list in healthcare?
A: The “Do Not Use” list identifies abbreviations, symbols, and dose designations that are error-prone and banned by The Joint Commission to improve safety. These are marked with a double asterisk (**) for required exclusions.
Visual Example: A list of abbreviations with a bold “Do Not Use” heading, highlighting common mistakes like “U” for units.
Q: How can medical professionals reduce errors related to abbreviations?
A: By avoiding abbreviations and symbols in written and verbal communications, using clear language, and adhering to the “Do Not Use” list to prevent misunderstandings.
Visual Example: A prescription written out in full, clearly stating “once daily” instead of “q.d.”
Q: Why do they use abbreviations and symbols in medicine?
A: They use them to save time and fit information into small spaces, like writing “q.d.” instead of “every day.” But sometimes, these shortcuts can be tricky and lead to mix-ups that might confuse people or even cause harm.
Visual Example: A happy doctor writing “q.d.” on a small space, but a question mark appears above someone reading it.
Q: Can abbreviations and symbols ever cause problems?
A: Oh yes! If someone doesn’t understand them or reads them the wrong way, it can cause mistakes with medicine or treatment. That’s why being clear is so important in healthcare.
Visual Example: A confused nurse looking at a prescription with abbreviations and a clock ticking, showing a delay in patient care.
Q: Are there places where they shouldn’t be used?
A: Yes! They shouldn’t be used in handwritten notes, medicine labels, or electronic records because it’s too easy for people to get confused. Clear words are much better in those cases!
Visual Example: A crossed-out handwritten prescription with abbreviations and a big checkmark next to a prescription written in full.
Q: What does the ISMP MERP do?
A: It’s like a team of detectives! They collect reports about medicine mistakes caused by confusing abbreviations and symbols. Then, they figure out how to make things safer for everyone.
Visual Example: A detective-style magnifying glass over a prescription error, with a “Problem Solved!” badge next to it.
Q: What’s the “Do Not Use” list all about?
A: It’s a special list of abbreviations and symbols that can cause mistakes, like writing “U” instead of “units.” Doctors and pharmacists aren’t allowed to use these anymore to keep patients safe.
Visual Example: A glowing “Do Not Use” sign with examples like “U” crossed out and replaced with the full word “units.”
Q: How can they make medicine safer to understand?
A: By writing things out fully instead of using shortcuts, like saying “once daily” instead of “q.d.” It might take a little longer, but it helps everyone understand and keeps people safe.
Visual Example: A clear prescription showing “Take once daily,” with a happy patient and a big smiley face next to it.
Q: Why shouldn’t “cc” be used in medical settings?
A: “cc” (cubic centimeters) can be misread as “u” (units), which may cause medication errors.
Best Practice: Use mL instead to avoid confusion.
Visual Example: A label with “cc” crossed out and replaced with “mL” in bold, ensuring clarity.
Q: Why is “IU” problematic in medical communication?
A: “IU” can be misinterpreted as “IV” (intravenous) or the number 10, leading to dangerous dosing errors.
Best Practice: Write unit(s) in full instead of “IU.”
Visual Example: A prescription with “IU” crossed out and “unit(s)” written clearly in its place, highlighted for emphasis.
Q: How can “l” and “ml” cause errors?
A: The lowercase letter “l” can look like the number “1,” and “ml” may be misinterpreted without proper capitalization.
Best Practice: Write L (uppercase) for liter and mL (lowercase “m,” uppercase “L”) for milliliter.
Visual Example: A comparison of “l” and “L,” with “L” highlighted as the safer option alongside proper use of “mL.”
Q: What problems can arise with abbreviations for “million”?
A: “MM” or “M” can be mistaken for “thousand,” and “M” can be interpreted as either million (modern) or thousand (Roman numeral).
Best Practice: Write million and thousand in full to avoid any confusion.
Visual Example: A side-by-side comparison of “M” for million vs. thousand, with the full words “million” and “thousand” highlighted as clear options.
Q: How can healthcare professionals reduce errors caused by these abbreviations?
A: Use clear and standardized terms, such as “mL,” “unit(s),” “L,” “million,” and “thousand.” Avoid shorthand that could be misread or misinterpreted.
Visual Example: A checklist of safe terms (e.g., “mL,” “unit(s),” “L”) with a big green checkmark and error-prone terms crossed out.
Q: Why shouldn’t we use “cc” for medicine?
A: “cc” stands for cubic centimeters, but it can look like “u” (units), which might confuse someone and cause a mistake. Instead, we write mL because it’s much clearer and safer!
Visual Example: A cheerful medicine bottle saying “Use mL, not cc!” with “mL” written brightly.
Q: Why don’t we use “IU” in prescriptions?
A: “IU” can be mixed up with “IV” (for intravenous) or even the number 10! That could cause big problems. Instead, we write unit(s) so there’s no confusion.
Visual Example: A smiling nurse pointing to “unit(s)” written clearly, with “IU” crossed out next to it.
Q: Why do we have to write “L” and “mL” in a special way?
A: A lowercase “l” can look like the number “1,” which might make someone give the wrong dose. To be super clear, we write L (for liters) and mL (for milliliters).
Visual Example: A cartoon letter “L” holding a sign that says, “I’m NOT a number!” next to a friendly “mL” label.
Q: Why don’t we just use “M” for million?
A: “M” can mean “million” today, but in Roman numerals, it means “thousand”! That’s super confusing. Instead, we write million or thousand in full so everyone understands.
Visual Example: A treasure map with the word “million” written clearly, showing it’s better than a mysterious “M.”
Q: How do we make sure medicine instructions are easy to understand?
A: By writing everything clearly! Instead of shortcuts like “cc” or “IU,” we use clear words like “mL” and “unit(s)” to keep everyone safe.
Visual Example: A glowing prescription label with “mL” and “unit(s)” written clearly, and a happy patient holding their medicine.
Q: Why shouldn’t “ng” be used for nanograms?
A: “ng” can be misread as “mg” (milligrams) or even as “nasogastric,” leading to serious dosing errors.
Best Practice: Write nanogram in full.
Visual Example: A chart comparing “ng” and “mg,” with “ng” crossed out and “nanogram” written clearly.
Q: What’s wrong with using “U” or “u” to represent units?
A: “U” can be mistaken for a zero or the number 4, causing significant overdoses (e.g., 4U read as 40 or 44).
Best Practice: Write unit(s) in full.
Visual Example: A prescription label with “U” crossed out and “unit(s)” highlighted for clarity.
Q: Why is “μg” not safe to use for micrograms?
A: “μg” can be misread as “mg” (milligrams), leading to a thousand-fold overdose.
Best Practice: Write mcg instead of “μg.”
Visual Example: A magnified view of “μg” and “mg” showing how easily they can be confused, with “mcg” highlighted as the safe option.
Q: Why shouldn’t we use AD, AS, and AU for the right ear, left ear, and both ears?
A: These can be confused with OD, OS, and OU (eye-related abbreviations), leading to medication being given in the wrong place.
Best Practice: Write right ear, left ear, or each ear in full.
Visual Example: A diagram showing “AD” mistakenly applied to the eye, with “right ear” written clearly on a correct label.
Q: Why can’t “o.d.” or “OD” be used for daily?
A: These can be mistaken for “OD” (right eye), potentially leading to the wrong administration method.
Best Practice: Write daily in full.
Visual Example: A prescription with “OD” mistakenly applied to eye drops, corrected to “daily” for clarity.
Q: What’s the safest way to abbreviate subcutaneous injections?
A: Avoid “SC,” “SQ,” or “sub q,” as they can be mistaken for “SL” (sublingual) or “5 every.”
Best Practice: Use SUBQ (in all uppercase) or write subcutaneously in full.
Visual Example: A prescription with “SC” crossed out and replaced by “SUBQ” in bold uppercase letters.
Q: What makes “Q.D.” or “QD” unsafe to use?
A: They can be misinterpreted as “q.i.d.” (four times daily), especially when handwritten.
Best Practice: Write daily instead of using abbreviations.
Visual Example: A comparison of “QD” and “daily,” with “daily” highlighted as the safer choice.
Q: What’s the safest way to write nightly doses?
A: Avoid “Qhs” or “Qnt,” as they can be confused with hourly instructions like “qhr.”
Best Practice: Write QHS (in uppercase) or at bedtime in full.
Visual Example: A label with “Qhs” crossed out and replaced with “at bedtime,” ensuring clarity.
Q: Why isn’t “ng” a good way to write nanograms?
A: “ng” is tricky because it can look like “mg” (milligrams), which is a much bigger amount, or even like “nasogastric,” which has nothing to do with nanograms! Instead, we write the whole word, nanogram, to keep it clear.
Visual Example: A tiny nanogram standing proudly with a sign saying, “I’m not mg! Write nanogram!”
Q: Why don’t we use “U” to mean units anymore?
A: “U” can be a little sneaky—it might look like a zero or even the number 4, which could make someone give too much medicine by accident. Writing unit(s) instead keeps everyone safe!
Visual Example: A superhero “unit(s)” flying over a scribbled-out “U,” saving the day.
Q: Why shouldn’t we write “μg” for micrograms?
A: “μg” can look a lot like “mg” (milligrams), which is a thousand times bigger! That could be a huge mistake, so we write mcg instead.
Visual Example: A magnifying glass showing “mcg” written clearly, with “μg” and “mg” looking way too similar.
Q: Why don’t we use AD, AS, or AU for ears anymore?
A: These letters are tricky because they can be mixed up with OD, OS, or OU, which are for eyes! To be safe, we write right ear, left ear, or each ear instead.
Visual Example: A cartoon ear saying, “I’m not an eye!” with the words “right ear” written clearly beside it.
Q: Why don’t we write “o.d.” or “OD” for daily?
A: “o.d.” can be mistaken for “OD,” which means “right eye.” Instead of confusing anyone, we just write daily to make it crystal clear!
Visual Example: A glowing label with “Take daily” written in big, easy-to-read letters.
Q: What’s the best way to write subcutaneous injections?
A: Abbreviations like “SC” or “sub q” can be confusing—they might look like “SL” (under the tongue) or even “5 every.” To be super clear, we write SUBQ or subcutaneously instead.
Visual Example: A friendly syringe with “SUBQ” written clearly and a happy patient nearby.
Q: Why don’t we use “Q.D.” for every day?
A: It can look like “q.i.d.,” which means four times a day! To keep things safe, we just write daily so no one gets confused.
Visual Example: A checklist with “daily” written neatly and “Q.D.” crossed out to avoid mix-ups.
Q: What’s the best way to write medicine instructions for nighttime?
A: Instead of using “Qhs” or “Qnt,” which could mean “every hour,” we write QHS or at bedtime so it’s super clear.
Visual Example: A cute bedtime scene with “Take at bedtime” written on a glowing prescription label.
Q: Why shouldn’t we use “Q.O.D.” or “qod” for every other day?
A: It can look like “qd” (daily) or “q.i.d.” (four times daily), especially if handwritten poorly.
Best Practice: Write every other day in full.
Visual Example: A comparison of “qod” with a handwritten version that looks like “qd,” replaced with “every other day” written clearly.
Q: What’s wrong with writing “q6PM”?
A: It can be misread as “every 6 hours” instead of at 6 PM daily.
Best Practice: Write daily at 6 PM or 6 PM daily.
Visual Example: A clock showing 6 PM with “daily at 6 PM” written clearly beside it, while “q6PM” is crossed out.
Q: Why shouldn’t we use “TIW” (three times a week) or “BIW” (twice a week)?
A: These abbreviations can be misinterpreted as “three times a day” or “twice in a week.”
Best Practice: Write 3 times weekly or 2 times weekly instead.
Visual Example: A weekly calendar showing three medication doses with “3 times weekly” written clearly.
Q: Why avoid using “UD” for “as directed”?
A: “UD” can be mistaken as “unit dose” and lead to incorrect dosing, such as giving a bolus dose instead of following instructions.
Best Practice: Write as directed in full.
Visual Example: A prescription with “UD” crossed out, replaced by “as directed,” with a patient following the instructions correctly.
Q: Why are “BBA” and “BGB” for newborn twins confusing?
A: These can be mistaken for genders (boy/girl) instead of indicating twins (e.g., twin A or twin B).
Best Practice: Use the mother’s last name with a gender identifier (e.g., Smith boy A, Smith girl B).
Visual Example: Two labeled bassinets, one reading “Smith boy A” and the other “Smith girl B.”
Q: What’s the problem with using “D/C”?
A: It can be mistaken as discontinuing medication instead of discharge, leading to unintended stoppages of treatment.
Best Practice: Write discharge or discontinue in full.
Visual Example: A label with “D/C” crossed out, replaced by “discharge,” showing clarity in the instruction.
Q: Why is “OJ” unsafe to use for orange juice?
A: It can be mistaken for “OS” (left eye) or “OD” (right eye), leading to dangerous errors.
Best Practice: Write orange juice in full.
Visual Example: A bottle of orange juice labeled clearly, with “OJ” crossed out.
Q: What’s wrong with using periods after abbreviations like “mg.”?
A: The period can be misread as a number (e.g., “mg.” mistaken as “mg1”).
Best Practice: Write mg, mL, or similar terms without a terminal period.
Visual Example: A comparison of “mg.” and “mg,” with the latter highlighted as the safer choice.
Q: Why don’t we write “Q.O.D.” for every other day?
A: It’s tricky because it can look like “qd” (daily) or “q.i.d.” (four times daily) if someone’s handwriting isn’t clear. That could be a big mistake! Instead, we just write every other day to make it super easy to understand.
Visual Example: A calendar with every other day highlighted and the words “every other day” glowing brightly.
Q: Why don’t we say “q6PM” when medicine is for 6 PM?
A: Because it might be read as “every 6 hours,” which is totally different from just taking it at 6 PM daily. Instead, we write daily at 6 PM to be extra clear.
Visual Example: A big clock showing 6 PM with the words “Take daily at 6 PM” next to it, while “q6PM” is crossed out.
Q: Why don’t we use “TIW” for three times a week?
A: “TIW” might look like “three times a day,” and “BIW” could confuse someone into thinking it means twice in one week. Instead, we write 3 times weekly or 2 times weekly so it’s crystal clear.
Visual Example: A weekly planner with “3 times weekly” written on three highlighted days and “TIW” crossed out.
Q: Why don’t we use “UD” for as directed?
A: “UD” can look like “unit dose,” which might make someone give the wrong amount. To be safe, we write as directed so everyone knows exactly what to do.
Visual Example: A smiling patient holding medicine labeled “Take as directed,” with “UD” scribbled out for safety.
Q: Why is “BBA” or “BGB” tricky for twins?
A: People might think it’s about gender (boy or girl) instead of identifying twins. To avoid mix-ups, we use the family name and labels like Smith boy A or Smith girl B.
Visual Example: Two baby cribs, one labeled “Smith boy A” and the other “Smith girl B,” with the abbreviations crossed out.
Q: Why don’t we write “D/C”?
A: “D/C” could mean “discontinue” instead of “discharge,” which might stop someone’s medicine by mistake. Instead, we write discharge or discontinue clearly.
Visual Example: A doctor’s note with “discharge” written clearly, while “D/C” is scribbled out to avoid confusion.
Q: What’s wrong with “OJ” for orange juice?
A: “OJ” can look like “OD” (right eye) or “OS” (left eye), which could cause a dangerous mistake. Instead, we write orange juice in full.
Visual Example: A big orange juice bottle with “orange juice” written clearly and “OJ” crossed out.
