JCAHO Guidelines

CHAPTER 3B – JCAHO RULES

WHAT ARE JCAHO GUIDELINES??
Commission on Accreditation of Healthcare Organizations (JCAHO) — a private, nonprofit
organization dedicated to improve the quality of care in organized healthcare settings.

Joint Commission standards are the basis of an objective evaluation process that can help
health care organizations measure, assess and improve performance. The standards focus
on important patient, individual, or resident care and organization functions that are
essential to providing safe, high quality care.

To meet this JCAHO goal, organizations must standardize the abbreviations, acronyms, and
symbols used throughout their organization. This includes developing a “Do Not Use” list of
abbreviations, acronyms, and symbols. Beginning January 1, 2004, JCAHO requires the
following dangerous abbreviations, acronyms and symbols be included on each accredited
organization’s “Do not use” list.

JCAHO FORBIDDEN ABBREVIATIONS

Abbreviations Potential Problem Preferred Term
U Mistaken for zero, four or Write “unit”
(for unit) cc
IU Mistaken for IV Write “international unit”
(for International Unit) (Intravenous) or 10 (ten).
Q.D., Q.O.D. Mistaken for each other. Write “daily” or “every
(Latin abbreviation for once The period after then Q can other day”
daily and every other day) be mistaken for an “I” and
the O can be mistaken for Never write a zero by itself
Trailing zero (X.0 mg), “I” after a decimal point (X
lacking of leading zero (.X Decimal point is missed. mg), and always use a zero
mg) before a decimal point (0.X
Confused for one and mg)
MS another. Can mean Write “morphine sulfate”
MSO4 morphine sulfate or or “magnesium sulfate”
MgSo4 magnesium sulfate

In addition, effective from April 1, 2004, each organization must add at least another three
“do not use” abbreviations, acronyms and symbols to the organization’s “Do Not Use” list.
The JCAHO suggests selecting from the following:

OTHER NOT TO BE USED ABBREVIATIONS, ACRONYMS ND SYMBOLS

Abbreviations Potential Problem Preferred Term
µg
Mistaken for mg (milligram) Write “mcg”

resulting in one

H.S. (For half-strength or thousandfold dosing Write out “half-strength” or
Latin abbreviation for overdose “at bedtime”
bedtime) Mistaken for either half-
T.I.W strength or hour of sleep Write “3 times weekly” or
(for three times a week) (at bedtime) “three times weekly”
Mistaken for threentimes a
S.C. or S.Q. day or twice weekly Write “Sub-Q”, “subQ” or
(for subcutaneous) resulting in an overdose subcutaneously
D/C Mistaken for SL for Write discharge.
(For discharge) sublingual or “5 every”
Interpreted as discontinue Write “ml” for “milliliters”
c.c. whatever medications
(for cubic centimeter) follow (typically discharge Write “left ear,” “right ear”
A.S., A.D., A.U. (Latin meds). or “both ears;”, “left eye,”
abbreviation for left, right Mistaken for U (units when “right eye” or “both eyes”
or both ears), O.S., O.D., poorly written)
O.U. (Latin abbreviation for Mistaken for each other
left, right or both eyes ) (e.g., AS for OS, AD for OD,
AU for OU, etc.)

The Institution Of Same Medication Practices (ISMP) has also published a list of dangerous
abbreviations relating to medications use. This list is available at www.ismp.org.
Examples for this list are:

Abbreviations Potential Problem Preferred Term
> and < Mistakenly used opposite Use “greater than” or “less
of intended than”
/ (slash mark) Misunderstood as the Do not use a slash mark to
number 1 (“25 units/10 separate doses. Use “Per”
units” read as “110 units”)

Whenever any prohibited item has been used in an order, there must be written evidence of
confirmation of the intended meaning before the order is carried out. If, in the judgment of
the people providing care to the patient (e.g., the registered nurse and pharmacist), the
order is clear and complete and the delay to obtain confirmation from the prescriber prior
to execution of the order would place the patient at greater risk, then the order should be
carried out and the confirmation obtained as soon as possible thereafter.1 Through the end
of 2004, JCAHO will limit the survey and score of this requirement to all handwritten,
patient-specific documentation, not just orders. As of 2005, the requirement will also apply
to preprinted forms and software that contain the prohibited items.