Abbreviation Use Habits in Nurses’ Work

1 Slađana Režić

2 Kristina Hanžek

1 Department for Health Care Quality Assurance and Improvement, University Hospital Centre Zagreb, Zagreb, Croatia

2 Clinic for Neurology, University Hospital Centre Zagreb, Zagreb, Croatia

Article received: 02.05.2023.

Article accepted: 13.06.2023

Author for correspondence:

Slađana Režić

Department for Health Care Quality Assurance and Impro- vement

University Hospital Centre Zagreb, Zagreb, Croatia E-mail: srezic@kbc-zagreb.hr

https://doi.org/10.24141/2/7/1/4

Keywords: abbreviation, nursing documentation, medical terminology, patient safety

Abstract

Introduction. The use of abbreviations in nursing practice is common and frequent. Abbreviations are considered a time saver but can lead to omissions in work due to misinterpretation.

Aim. To collect data on the attitudes and habits of using abbreviations in nursing practice, and to de- termine whether there is a difference with regard to professional education, place of work and years of service.

Methods. A cross-sectional study was conducted during September 2020. A questionnaire implement- ed by Koh et al. in their research was used; permission was obtained to adapt the questionnaire according to our needs. The study was conducted at three Clinics at the UHC Zagreb. A total of 50 questionnaires were distributed on every clinic. The study was approved by the UHC Zagreb’s Ethics commission.

Results. The use of abbreviations is common in nurs- ing practice. Nurses most often learn abbreviations from nurses with longer work experience and re- gard the use of abbreviations as acceptable. Nurses with 16 or more years of service use abbreviations significantly more often in order to save time, than respondents with up to 15 years of service. Nurses with up to 15 years of service significantly more of- ten report incorrect application of therapy as a result of misinterpretation of abbreviations compared to nurses with longer working experience.

Conclusion. The study showed that abbreviations are often used in nursing practice. Standard abbre- viations are most often used, although non-standard abbreviations are also increasingly present. Abbre- viations are acceptable in nursing practice, although nurses must be made aware that the use of abbrevia- tions can lead to omissions in the work. For this rea- son, other researchers who have studied the use of abbreviations suggest that lists of permitted abbre- viations should be created at the institutional level and that they should be regularly updated.

Introduction

An abbreviation is a shortened word or several words in written form; as a rule, it is written in lowercase letters and is not declined through cases (1). In the language of the medical profession, abbreviations are frequent, especially in written texts, and with the progress of science and technology, their use is becoming more frequent. Abbreviating terms means saving time while simultaneously achieving commu- nication. A large influx of abbreviations, especially of foreign origin, can cause interference in communica- tion due to the ambiguity of their meaning (2).

Medical terminology is the basic instrument for trans- mitting information between healthcare profession- als and patients, but also between healthcare pro- fessionals. Every terminology, including those used in the medical profession, strives for standardization, which implies harmonization according to the princi- ple of unequivocalness, systematicity and integration

the meaning of an abbreviation. Both groups agreed that abbreviations are acceptable in everyday work (6). The Australian Health System has collected data on abbreviations used in health care settings and produced a detailed list of abbreviations that are al- lowed to be used (7). The initiative was started on the national level and is regulated by law. It is the responsibility of the healthcare staff to know which abbreviations are allowed, as well as the obligation to educate each newly hired healthcare worker. The list is updated once a year and is available to all healthcare workers (7). The Nursing and Midwifery Council also gives similar advice regarding the use of abbreviations in nursing practice (8). They believe that every healthcare institution should pay atten- tion to how abbreviations are used and how many of them are used, to have a list of dangerous abbrevia- tions and to conduct education. The focus is on ex- pert professional societies that can create a nation- ally standardized list of permitted abbreviations (8).

into the Croatian language system. Unequivocalness                                                                           

is an important characteristic of the language of sci-

ence. Identical terms often have different meanings in different branches of science. Such non-uniformity in terminology leads to incomprehensible content, its misinterpretation and misunderstanding (3). Bru- netti et al. in their study on the impact of the use of abbreviations on patient safety proved that the use of abbreviations bears risks for patient safety (4). Using the MEDMARX program, which collects and analyzes medication errors, he found that 30,000 of the 600,000 reported errors were attributed to er- rors caused by the use of abbreviations (4). Given that the program collects medication errors, the most common errors are related to the drug name, drug dosage, and the wrong route of drug administration (4). The Joint Commission created a ‘Do not use list’, i.e., a list of abbreviations that should not be used in medical documentation, so every institution in the USA that wants to be accredited must have this list implemented in its daily practice (5). The aim is to reduce the use of dangerous abbreviations that could jeopardize patient safety. In a study on the frequency of abbreviation use among physicians and nurses in Malaysia, the authors state that the main reason for using abbreviations is to avoid writing sentences en- tirely and thus save time. In the results of their study, they state that nurses are more prone to guessing

Aim

To collect data on the habits of using abbreviations in nursing practice.

To determine whether there is a difference in the way nurses use abbreviations, depending on their level of education, place of work and years of service.

Methods

A cross-sectional study was conducted during Sep- tember 2020. An anonymous questionnaire was used, consisting of four areas. The first area con- tained questions related to the level of education, place of work and years of service; the second area consisted of questions about the habits of using ab- breviations (e.g. how often you use abbreviations in your work); the third area consisted of questions about the perception of abbreviations in nursing

practice (e.g. do you have problems interpreting ab- breviations) through a series of statements to which respondents answered using a Likert scale where 1 meant ‘I completely agree’ and 5 meant ‘I completely disagree’; the fourth area contained a list of abbre- viations used in nursing practice in the departments where the research was conducted (e.g. EKG, BG, CT).

In the UHC Zagreb there is a document named DUI

– List of abbreviations that may be used in nursing practice, which was used as the source for abbrevia- tions in the fourth area. Koh et al. used a similar ques- tionnaire (6), from whom permission was obtained to adapt the questionnaire according to our needs.

The study was conducted at three Clinics at the UHC Zagreb: the Clinic for respiratory diseases (KPB), the Clinic for heart and circulatory diseases (SKŽ) and the Clinic for neurology (NRL). At each clinic, 50 question- naires were distributed, representing a total of 150 questionnaires; 136 questionnaires were filled out and returned to the researcher. The questionnaires were filled out by female nurses, with their average age being 35.3 (20 - 63 years of age). A convenience sample was used. Anonymity was ensured in such a way that each nurse received a questionnaire and

filled it out in a separate room and then put it in an envelope which she sealed. The study was approved by the UHC Zagreb’s Ethics commission.

Descriptive analysis was used to display demograph- ic data, as well as data related to the meaning of ab- breviations. Differences in the perception of abbre- viations with regard to the level of education, place of work and years of service were analyzed using the chi-square test, with a value of p<0.05 being consid- ered significant.

Results

The questionnaire was filled out by 136 respondents. The respondents were nurses from three clinics at the UHC Zagreb. At the clinic for respiratory diseases the questionnaire was filled out by 50 nurses, at the clinic for neurology by 44 nurses, and at the clinic for heart diseases by 42 nurses. The questionnaire was

filled out by female nurses. The largest number of respondents were Bachelors of Nursing, who mostly worked on wards, and mostly had less than five years of work experience. The data is shown in table 1.

Half of the respondents use abbreviations often, and an additional 36.8% use them occasionally, with time saving as the dominant reason for using them (64.7% of respondents). Coworkers are the source of information about abbreviations for half of the respondents (50%), 33.8% learn about them from professional literature. The most frequent problem caused by the misinterpretation of abbreviations are missed tests, as mentioned by 39% of respondents, followed by incorrect application of therapy (28.7% of respondents).

The highest level of agreement is with the state- ment ‘I often encounter abbreviations in my work’ (77.9% of respondents agree), followed by a high level of agreement that abbreviations are acceptable (72.1%), while 61.8% of respondents agree that they are necessary (61.8%). A fifth of respondents agree that they feel frustrated when interpreting abbrevia- tions (21.3%) and that the interpretation of abbrevia- tions interferes with their work (19.9%).

Nurses with 16 or more years of service use abbrevi- ations significantly more often in order to save time, than respondents with up to 15 years of service.

Nurses with up to 15 years of service significantly more often report incorrect application of therapy as

a result of misinterpretation of abbreviations com- pared to nurses with longer working experience.

Nurses with up to 15 years of service significantly more often agree with the statement ‘I often en- counter abbreviations in my work’, than nurses with 16 or more years of service.

The interpretation of abbreviations causes signifi- cantly more frustration in nurses with 16 or more years of service, than nurses with up to 15 years of service.

In the last part of the questionnaire, abbreviations that are most often used at all three UHC Zagreb clinics were shown. Abbreviations were divided into standard abbreviations and non-standard ab- breviations. Standard abbreviations were such ab- breviations that appear in short form in professional literature and are used in the majority of professional literature in the same way. Non-standard abbrevia- tions were such abbreviations that are used on the three clinics, but that do not have the same abbrevi- ated meaning in professional literature.

From the data presented in Table 6, it is evident that nurses more accurately recognized the meaning of standard abbreviations compared to non-standard abbreviations. The abbreviation EKG was correctly interpreted by 98% of nurses, while FT was correctly interpreted by only 13% of nurses.

The selection of abbreviations was made by the au- thors in such a way that when reviewing the nurs- ing documentation, they noticed the most frequently used abbreviations and then made a list of abbrevia- tions that are present in all clinics and a list of ab- breviations that are present to a significant extent in certain clinics. For example, FOB as an abbreviation was frequent at the Clinic for Respiratory Diseases, which can be linked to the fact that 86% of the nurs- es of that clinic correctly interpreted it, while at the other two clinics, only 14% of the nurses correctly interpreted the meaning of this abbreviation.

Statistical significance related to table 5 was not analyzed due to the small number of individual re- sponses that could affect the results.

1Pearson chi-squared test

1Pearson chi-squared test

*Key: NRL (Clinic for neurology), SKŽ (Clinic for heart diseases), KPB (Clinic for respiratory diseases)

Discussion

Nursing documentation in hospital healthcare insti- tutions in the Republic of Croatia is used in electronic form. By reviewing nursing documentation, it was observed that abbreviations are often used in nurs- ing documentation. Respondents stated that they often use abbreviations in documentation, and 72% of them believe that abbreviations are acceptable in documentation. Although the use of abbreviations is considered common, respondents state that they have problems interpreting the abbreviations and that this can result in errors in nursing care (missed tests or incorrect application of therapy).

Koh obtained similar results (6). He included physi- cians and nurses in his research on abbreviations, and the results showed that abbreviations are used frequently and are acceptable in documentation. Also, their research shows that nurses have difficul- ties in interpreting abbreviations used by physicians, which can affect patient safety (6).

The Institute for Safe Medication Practices Canada monitors, records and analyzes reports of medication errors due to abbreviations, symbols, or acronyms. Thus, in their regular report (bulletin), they cite ex- amples of errors such as a physician instructing a patient to take a medicine first 2/7, then 1/7, which meant that the patient should take one dose for two days, and then another dose for one day. The patient misunderstood the instructions and took one dose for two weeks, and then another dose for one week, causing side effects that required hospitalization (9). Such examples help the said Institute to revise the instructions for the use of abbreviations and issue a ‘Do not use’ sheet that is recommended for use in Canadian hospitals.

Research shows that interpreting abbreviations is a challenge for healthcare professionals. Thus, Sinha et al. conducted a survey of surgical wards using medi- cal records to derive the abbreviations used in them. They used these abbreviations in a questionnaire that aimed to determine how many healthcare work- ers understood the meaning of the abbreviations. A total of 209 healthcare professionals filled out the questionnaire and only 43% of them correctly inter- preted the abbreviations (10).

Tsima et al. also conducted a cross-sectional study aimed at determining the understanding of the meaning of abbreviations. They examined 57 patient records in which they found 1,683 abbreviations, symbols and/or acronyms. They used these abbrevia- tions in the form of a questionnaire and had health professionals write the meaning. A total of 73% of healthcare professionals correctly interpreted the abbreviations. What is interesting in this research is that the respondents (58%) suggested alternative meanings of abbreviations (11).

Nakayama analyzed data in electronic patient records to track health outcomes of treatment and it was the presence of abbreviations that made the analysis of health outcomes difficult (12). The authors did not monitor health outcomes, but the data obtained could indicate that nurses’ work experience has an influence on the interpretation of the meaning of ab- breviations. This particularly applies to nurses who have been working for less than 5 years.

Tariq states that the use of abbreviations in medi- cine is becoming even more frequent. He mentions how the US Institute of Safe Medication Practices monitors adverse events, including adverse events associated with misinterpretation of abbreviations in medical records (13). Thus, the author states that increasingly hospitals are forming hospital commis- sions that monitor the use of abbreviations in medi- cal documentation, and provide mandatory education of health workers about abbreviations, as well as regular updating of the list of abbreviations (13).

The quasi-experimental study conducted by Thachaparambil et al. showed how certain interven- tions can reduce the frequency of errors caused by the use of abbreviations. The authors conducted trainings for healthcare workers and created post- ers related to the use of abbreviations they put up in the wards. They compared the errors they observed before the aforementioned interventions and four months after the intervention and proved that the frequency of errors decreased by 8% (14).

According to the obtained data, standard abbre- viations are more familiar to the respondents, but knowledge of abbreviations also depends on the workplace where they are used. So, Gomes states that non-standard abbreviations are used by 30% of respondents in his research (15). He recommends the use of software that would highlight abbreviations in medical documentation and thus enable regular

observation of new abbreviations, which also include non-standard abbreviations (15).

This study has certain limitations. A small number of respondents and only one institution were included. The study is cross-sectional, and we believe that some future longitudinal type of research could mon- itor abbreviations over time and show the change in the habits of using abbreviations as well as the speed of introduction of new abbreviations.

Conclusion

The study showed that abbreviations are often used in nursing practice. Standard abbreviations are most often used, although non-standard abbreviations are also increasingly present. Nurses most often learn about abbreviations from their coworkers and feel that abbreviations save time. Nurses with 16 or more years of service use abbreviations significantly more often to save time than respondents with up to 15 years of service. Nurses with up to 15 years of ser- vice report a significantly higher number of cases of incorrect application of therapy as a result of mis- interpretation of abbreviations compared to nurses with a longer working experience. Abbreviations are acceptable in nursing practice, although nurses must be made aware that the use of abbreviations can lead to omissions in the work. For this reason, other researchers who have studied the use of abbrevia- tions suggest that lists of permitted abbreviations should be created at the institutional level and that they should be regularly updated. Also, education of healthcare workers on how to use abbreviations should be mandatory.

References

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2. Gjuran-Coha A, Bosnar-Valković B. Lingvistička analiza medicinskoga diskursa. JAHR. 2013;4(1):107-28. Cro- atian.

3. Gjuran-Coh, A. Terminologizacija jezika medicinske struke. Med Flum. 2011;47(1):4-14. Croatian.

4. Brunetti L, Santell JP, Hicks RW. The impact of abbre- viations on patient safety. Jt Comm J Qual Patient Saf. 2007;33(9):576-83.

5. The Joint Commission. Do not use list. Available from: https://www.jointcommission.org/-/media/tjc/docu- ments/resources/patient-safety-topics/patient-safe- ty/ do_not_use_list_9_14_18.pdf?db= web&hash=0 9CFD4A3A80CE0B555C9660070D4C098 Accessed: 10.04.2023.

6. Koh KC, Lau KM, Yusof SA, Mohamad AI, Shahabud- din FS, Ahmat NH, et al. A study on the use of ab- breviations among doctors and nurses in the medical department of a tertiary hospital in Malaysia. Med J Malaysia. 2015;70(6):334-40.

7. Australian Commission on Safety and Quality in Health Care. Recommendations for terminology, ab- breviations and symbols used in medicines documen- tation. ACSQHC, Sydney. Available from: https://www. safetyandquality.gov.au/sites/default/files/migrated/ Recommendations-for-terminology-abbreviations- and-symbols-used-in-medicines-December-2016.pdf Accessed: 13.04.2023.

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14. Thachaparambil A, Kausar M, R M, Dk S. Impact of ‘Never Use’ Abbreviations (Error-Prone Abbreviations- EPA’s) List on the Incidence of EPAs in Inpatient Medi- cal Prescriptions in Apex Tertiary Care Public Hospital in India. Curr Drug Saf. 2023;18(3):318-22.

15. Gomes DC, Cubas MR, Pleis LE, Shmeil MA, Peluci AP. Terms used by nurses in the documentation of patient progress. Rev Gaucha Enferm. 2016;37(1):e53927.

NAVIKE U UPOTREBI KRATICA U RADU MEDICINSKIH SESTARA

Sažetak

Uvod. Upotreba kratica u sestrinskoj praksi uobičajena je i učestala. Smatra se kako kratice štede vrijeme, ali mogu dovesti do propusta u radu zbog pogrešnog tumačenja.

Cilj. Cilj je ovog rada prikupiti podatke o stavovima i navikama upotrebe kratica u sestrinskoj praksi te ut- vrditi postoji li razlika s obzirom na stručnu spremu, mjesto rada i radni staž medicinskih sestara.

Metode. Provedeno je presječno istraživanje tijekom rujna 2020. Primijenjen je upitnik koji su upotrijebili Koh i suradnici u svojem istraživanju te je od autora dobiveno dopuštenje za prilagodbu upitnika našim potrebama. Istraživanje je provedeno na tri klinike KBC-a Zagreb. Na svakoj klinici podijeljeno je 50 up- itnika. Istraživanje je odobrilo Etičko povjerenstvo KBC-a Zagreb.

Rezultati. Primjena kratica učestala je u sestrinskoj praksi. Medicinske sestre najčešće uče kratice od medicinskih sestara s dužim radnim stažem te sma- traju primjenu kratica prihvatljivom. Nije pronađena statistička značajna razlika s obzirom na stručnu spre- mu i radno mjesto. Pronađena je statistički značajna razlika s obzirom na radni staž. Medicinske sestre s radnim stažem manjim od pet godina zbog pogrešne interpretacije kratica daju pogrešnu terapiju.

Zaključak. Istraživanje je pokazalo da je upotre- ba kratica učestalo prisutna u sestrinskoj praksi. Najčešće se upotrebljavaju standardne kratice, iako je sve učestalija prisutnost nestandardnih kratica.

Kratice su prihvatljive u sestrinskoj praksi, iako tre- ba osvijestiti kako upotreba kratica može dovesti do propusta u radu. Zbog toga i drugi istraživači koji su istraživali upotrebu kratica predlažu da se na razina- ma ustanovama izrade popisi dopuštenih kratica te da se redovito ažuriraju.

Ključne riječi: kratice, sestrinska dokumentacija, medicin- ska terminologija, sigurnost pacijenta