Pharmacology Medical Abbreviations
Abbreviations
Abbreviations should be written without periods.
Common abbreviations:
BID: Twice a day.
AC: Before meals; ensure the patient understands the timing relative to their meal schedule.
AM/PM: Morning/evening. Clarify the specific times for medication administration.
Cap: Capsule. Explain what a capsule is and how to swallow it properly.
AC (with a line above): With. Often used to indicate 'with food'.
DC: Discharge or discontinue. Important for medication reconciliation upon patient discharge or when a medication is stopped.
D5W: Dextrose 5% in water (5% sugar in water), an IV solution. Used for patients needing hydration and a source of glucose.
DS: Double strength. Indicates a higher concentration of the drug.
ER: Extended release. Medications formulated to release slowly over time; patients should not crush or chew these.
mg: Milligram.
g: Gram.
gtt: Drop (lowercase). Used for liquid medications, often eye drops or ear drops.
IM: Intramuscular. Injection given into a muscle.
IV: Intravenous. Medication given directly into a vein.
HS: At bedtime. Ensure patient understands this means just before going to sleep.
IVPB: Intravenous piggyback. A secondary IV bag connected to the main IV line.
MCG: Microgram.
NPO: Nothing by mouth. Important to clarify before administering oral medications.
ML: Milliliter.
PC: After meals. Instruct patients to take the medication shortly after eating.
PO: By mouth. Orally administered medication.
PRN: As needed. Explain when and how often the medication can be taken.
Q2H: Every two hours. Requires careful scheduling and documentation.
QH: Every hour. Typically used in critical care settings, requires vigilant monitoring.
QID: Four times a day. Space the doses evenly throughout the day.
SubQ: Subcutaneous. Injection given under the skin.
SL: Sublingual. Medication placed under the tongue to dissolve.
Stat: Immediately. Administer without delay.
Error-Prone Abbreviations
Joint Commission (JCO) has a list of dangerous abbreviations not to be used due to potential for error. Familiarize yourself with this list to avoid mistakes.
Institute for Safe Medication Practices (ISMP) identifies practices contributing to medication errors. Implement their recommendations to improve medication safety.
Safety practice: Avoid periods in medical abbreviations to prevent misinterpretation (e.g., mistaking a period for the number one). Always write clearly and double-check.
Medication Orders
Medication orders contain six parts:
Date and time the order was taken. Crucial for tracking and verifying the order's validity.
Patient's name. Verify against the patient's medical record to ensure accuracy.
Medication name. Use both brand and generic names to clarify, especially for high-alert medications.
Dose and amount. Specify the exact quantity and units (e.g., mg, mL).
Route (e.g., PO, rectally, injection). Ensure the route is appropriate for the patient and medication.
Directions for use, including time and frequency. Be precise to avoid ambiguity and patient confusion.
Medication orders must be written and signed by a physician. Verbal orders should be minimized and followed up with written confirmation.
In emergencies, verbal orders (VO) are allowed but must be read back and confirmed by the healthcare professional before administration. Always document the read-back verification.
Document the medication, amount, and time of administration immediately. Timely documentation is essential for patient safety and legal compliance.
The physician signs the order after the emergency. Ensures accountability and validation of the order.
High-Alert Medications and Abbreviations
SC, SQ, or SubQ (subcutaneous) should be written out to avoid confusion with SL (sublingual). This prevents potential administration errors.
SubQ injections release medication slowly due to absorption in fat, while sublingual administration allows rapid absorption through mucous membranes. Understanding these differences is vital for choosing the correct route.
The abbreviation "q" can be mistaken as "every". Avoid using "q" alone; instead, write out "every".
Example: Heparin doses ordered two hours before surgery could be misinterpreted as every two hours before surgery. Clear communication prevents dangerous dosing errors.
Telephone orders (TO) require specific procedures:
Determine the agency's policy on who can take telephone orders (e.g., registered nurse, licensed practical nurse). Follow institutional guidelines to ensure compliance.
Record the caller's name and time of the call. Essential for documentation and verification.
Repeat all details (medication, dosage, frequency) to confirm accuracy. Read-back is a critical safety step.
Document as TO/RV (telephone order/read back) with the read back statement. This confirms that the order was accurately received and verified.
Electronic Orders and Prescriptions
Computerized Physician Order Entry (CPOE) involves typing prescriptions into the system, printing them, and either signing them or sending them directly to the pharmacy. Improves legibility and reduces transcription errors.
This process is also known as e-prescribing or e-scribing. Streamlines the prescription process and enhances communication.
Electronic Medication Administration Record (EMAR) is commonly used in hospitals. Allows for real-time tracking of medication administration.
Prescription Details
Prescription blank includes date, patient name, age, address, medication name, dose, route, frequency, refills, and the physician's Drug Enforcement Administration (DEA) registration number (if the medication is controlled). This information is necessary for legal and safety reasons.
Dispense as Written: If the provider wants to prescribe a specific brand and not allow generic substitution, it must be indicated, and they will sign on the “dispense as written” line. This ensures the patient receives the exact medication intended.
The Sig refers to how to take the meds. This section contains instructions for the patient and must be clear and concise.
Systems of Measurement
Apothecary System:
Obsolete; historically used by pharmacists/druggists. Understanding its context can be helpful for historical records.
Required conversions to metric, which was complex. This complexity contributed to medication errors.
Metric System:
The current standard. Universally used in healthcare for prescribing and administering medications.
Household System:
Least accurate. Use should be discouraged due to variability in measurements.
Uses common household measurements like teaspoons and tablespoons, which vary in size. This can lead to significant dosing errors.
Metric System Details
Invented by the French, the international standard. Promotes standardization and reduces confusion.
Based on three basic units:
Liter (L) for volume.
Meter (m) for length.
Gram (g) for weight.
Metric Conversions:
1 \text{ gram} = 1000 \text{ milligrams} = 1,000,000 \text{ micrograms}
Move the decimal point three places for each conversion step (e.g., grams to milligrams). Provides a simple method for converting between units.
Examples:
0.5 \text{ grams} = 500 \text{ milligrams}
0.05 \text{ liters} = 50 \text{ milliliters}
1000 \text{ milligrams} = 1 \text{ gram}
1 \text{ gram} = 0.001 \text{ kilograms}
Household Measurements
Household measurements are imprecise due to variations in spoon sizes. Emphasize the importance of using standardized measuring devices.
Approximate Equivalents:
5 \text{ milliliters} = 1 \text{ teaspoon}
15 \text{ milliliters} = 1 \text{ tablespoon}
30 \text{ milliliters} = 1 \text{ ounce}
240 \text{ milliliters} = 1 \text{ cup}
473 \text{ milliliters} = 1 \text{ pint}
Medical equipment used includes medicine cups and syringes. These provide more accurate measurements than household items.
Common Medical Conversions
Kilograms to Pounds: Multiply kilograms by 2.2.
Example: 10 \text{ kg} \times 2.2 = 22 \text{ pounds}
Pounds to Kilograms: Divide pounds by 2.2.
Example: 150 \text{ pounds} / 2.2 = 68.18 \text{ kg}
Caution: Accurate weight conversion is crucial for children's dosages, often calculated using the body surface area rule. Small errors in weight can lead to significant dosing discrepancies.
Patient Education
Speak directly to the patient and observe their comprehension when explaining dosage preparation. Tailor your explanation to their level of understanding.
Older patients may hesitate to admit they don't understand, so encourage them to repeat the directions. Use open-ended questions to assess their understanding.
Ensure patients can explain how they will take the medication. This confirms their ability to follow the prescribed regimen.