In October 2004 I became ill with what I thought was the flu. After a week of escalating temperatures, horrible chills, and nausea, I was dehydrated, exhausted, and scared-scared because I realized that it was not the flu. When I called the primary care practice I use, the physician on call recommended that I go to an ED. But I didn't want to go. Besides dreading what could be hours of waiting and misery in an ED, I was actually afraid someone might unintentionally kill me. No, I wasn't being paranoid; I simply know too much. I know that, according to the Institute of Medicine, errors in health care are the eighth-leading cause of death in this country.
That experience shows me that I no longer trust hospitals to ensure my safety. And I'm not alone. In 2004 the Henry J. Kaiser Family Foundation announced the findings of the National Survey on Consumers' Experiences with Patient Safety and Quality Information. Fifty-five percent of those surveyed said they no longer had confidence in the quality of health care; 34% said they or a family member had experienced a medical error. While most of the respondents (72%) said physicians had "a lot" of the responsibility for the error, 28% said nurses did.
We must do something to change the public's trust in health care-and I don't mean by telling patients and families that all is well when it's not. Since most people go to hospitals because they need nursing care (and since many feel nurses are responsible for errors), it's incumbent upon nurses to lead the way in creating places that are safe for the people we serve.
In July 2004 AJN helped bring together nurses, pharmacists, physicians, and others to talk about how to make medication administration by nurses safer, since medication errors are the most frequent type of error in health care. At an invitational symposium, the participants identified barriers to safer medication administration and priorities for future research and recommended changes in practice, education, administration, and policy to address the barriers. This month's AJN includes the executive summary of the report from this symposium (page 73). The full report is available at http://www.nursingcenter.com/AJNmedsafety. And this month we're publishing "State of the Science on Safe Medication Administration," a 56-page supplement to AJN and the Journal of Infusion Nursing that details the urgency of this issue.
In keeping with the idea of supporting safety, we're changing our policy on the use of abbreviations in the journal. In 2003 the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) responded to the fact that many medication errors occur because of errors in writing, transcribing, or reading abbreviations. For example, because U for "unit" can be mistaken for a 0, it said that unit must be spelled out. This should not be news to most nurses working in facilities that seek JCAHO accreditation. JCAHO now requires facilities that wish to retain accreditation to create a "do not use" abbreviation list and identified some abbreviations that had to be on it as of January 1, 2004.
The editorial staff debated the merits of adopting this more cumbersome approach to writing in a field that thrives on abbreviations and acronyms. But participants in the medication safety symposium listed several excellent reasons for adopting the new rules.
* AJN should model the best practices in health care.
* Future generations of nurses will not be taught the abbreviations.
* The new rules are even being used in computerized record systems because misreading is not only a result of poor handwriting. Our brains can deceive us-we think we see a 0 instead of a U when our brain expects a 0.
As of this issue, AJN will adopt JCAHO's rules. So no trailing zeros after decimal points, no using QD or QOD. As new restrictions on abbreviations arise, we'll adopt them and encourage you to do the same.