1
Revista Ecuatoriana de Ciencia, Tecnología e
Innovación en Salud Pública
Código ISSN 2588-0551
Bonifaz-Valverde M., Arbeláez-
Rodríguez G., Ochoa-Andrade
M., Barberán-Torres P.
Characterization and evaluation
of the use of dangerous
abbreviations in a hospital in
Quito, Ecuador Original Article.
INSPILIP. 2023; Vol. 7, Num.
23.
Scientic magazine INSPILIP.
Volume 7, Number 23,
September - December de 2023.
The author declares to be free of any
personal or commercial association
that may involve a conict of interest
in connection with the article, as
well as having respected the ethical
principles of research, such as having
requested authorizations from the
institution where the study was
conducted, permission to use the data,
informed consents and in the case of
observational studies and clinical
trials, authorization from a CEISH,
ARCSA, Environment, among
others, according to the category. In
addition, the license to publish images
of the person or persons appearing in
the manuscript. Therefore, INSPILIP
is not responsible for any aectation
to third parties, neither INSPI as
publishing entity, nor the Editor, the
responsibility of the publication is of
absolute responsibility of the authors.
Patricio Vega Luzuriaga
EDITOR-IN-CHIEF
iD
Bonifaz-Valverde Marco
a
, marbonval987@hotmail.com
iD
Arbeláez-Rodríguez Gloria
a
, gloria.arbelaez@iess.gob.ec
iD
Ochoa-Andrade Miguel
a,b
, * a8_miguel@hotmail.com
iD
Barberán-Torres Pedro
c
, jbarberan@uide.edu.ec
a. General Hospital of the South of Quito, Ecuadorian Institute of Social Security (EISS), Quito,
Ecuador.
b. Central University of Ecuador, Quito, Ecuador.
c. International University of Ecuador, Quito, Ecuador.
*Correspondence: Miguel Jacob Ochoa Andrade Email: a8_miguel@hotmail.com
Identication of the responsibility and contribution of the authors: The authors declare
having contributed to the original idea (MOA), study design (MOA, GAR, MBV), data
collection (MOA, GAR, MBV), data analysis (MOA, MBV, GAR, PBT), writing of the draft and
writing of the article (MOA, MBV, GAR, PBT).
Date of Entry: 7/7/2023.
Date of Aproval: 12/7/2023.
Date of Publication: 5/9/2023.
Characterization and evaluation of the use of dangerous abbreviations in a hospital in Quito,
Ecuador
Caracterización y evaluación del uso de abreviaturas peligrosas en un hospital de Quito, Ecuador
Original Article
Open Access
Abstract
Citation
Introduction. The dangerous abbreviations not allowed used in the record of
the Clinical History, due to an erroneous interpretation, could trigger associated
adverse events in health care. Methods. Cross-sectional descriptive study, 15 786
cases registered in the Medical Records of Hospital General del Sur de Quito of
42 clinical and surgical units were reviewed, the use of dangerous abbreviations
was included, the acronyms allowed according to the regulations of the Ministry
of Public Health of Ecuador were excluded. The information was consolidated in a
database in Excel 2017 format and the compliance and frequencies of abbreviations
used with the SPSS Version 22.0 program were analyzed. Results. 69,84% (n=11
026 services) complied with the proper use of allowed abbreviations, the clinical
area with 74,9% and the surgical area with 62,62%. 6 199 dangerous abbreviations
were found, the most frequent being “(…) FR, FC, LPM, RPM, TA, TAM, RX,
GSRN, CD4, M2, CD8, ASC, ECG, AQX, NPO, VIH, BH, FUM, HTA, RHB, SAT,
GSM, TAC, RHA, DH, RP, APP, AM, TTO, IDG (…)”. Conclusions. Percentages
of higher compliance were determined in the clinical units, followed by the surgical
ones. The abbreviations used in the records of the Clinical Histories are not included
in Ministerial Agreement 00000115, Patient Safety Manual - User, of the Ministry of
Public Health of Ecuador.
Keywords: Abbreviations as Topic; Systematized Nomenclature of Medicine;
Patient safety; Accident prevention; Health Care Quality Assurance; Health Care
Quality Indicators.
DOI: 10.31790/inspilip.v7i23.545
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Revista Ecuatoriana de Ciencia, Tecnología e
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Resumen
Introducción. Las abreviaturas peligrosas no
permitidas empleadas en el registro de la Historia
Clínica, por una interpretación errónea, podrían
desencadenar en eventos adversos asociados
en la atención de salud. Objetivo. Caracterizar
y evaluar el uso de Abreviaturas Peligrosas en
los servicios clínicos y quirúrgicos del Hospital
General del Sur de Quito, período del 01 de
enero al 31 de diciembre del 2021 Métodos.
Estudio descriptivo transversal, se revisó 15 786
atenciones registradas en las Historias Clínicas
del Hospital General del Sur de Quito de 42
dependencias clínicas y quirúrgicas, se incluyó
el uso de abreviaturas peligrosas, se excluyó
las siglas permitidas acorde a la normativa del
Ministerio de Salud Pública del Ecuador. Se
consolidó la información en una base de datos en
formato Excel 2017 y se analizó el cumplimiento
y frecuencias de abreviaturas empleadas con
el programa SPSS Versión 22.0. Resultados. El
69,84% (n=11 026 atenciones) cumplió con el
uso adecuado de abreviaturas permitidas, el área
clínica con el 74,9% y el área quirúrgica con
el 62,62%. Se encontraron 6 199 abreviaturas
peligrosas, con mayor frecuencia fueron “(…)
FR, FC, LPM, RPM, TA, TAM, RX, GSRN, CD4,
M2, CD8, ASC, ECG, AQX, NPO, VIH, BH,
FUM, HTA, RHB, SAT, GSM, TAC, RHA, DH,
RP, APP, AM, TTO, IDG (…)”. Conclusiones. Se
determinaron porcentajes de mayor cumplimiento
en las dependencias clínicas, seguidas de las
quirúrgicas. Las abreviaturas empleadas en los
registros de las Historias Clínicas no constan
en el Acuerdo Ministerial 00000115, Manual de
Seguridad del paciente – usuario, del Ministerio
de Salud Pública del Ecuador.
Palabras clave: Abreviaturas como Asunto;
Nomenclatura Médica Sistematizada; Seguridad
del Paciente; Prevención de Accidentes; Garantía
de la Calidad de Atención de Salud; Indicadores
de Calidad de la Atención de Salud.
Introduction
The danger posed by drafting and communicating
medical actions in components of dierent
documents that make up the Clinical History,
with the use and abuse of certain abbreviations,
concerned organizations worldwide. Organizations
such as the World Health Organization, the Agency
for Healthcare Research and Quality, the National
Quality Forum, the Joint Commission International,
and Accreditation Canada International, among
others, are vigilant about patient safety. The risk of
error is higher in handwritten texts, but it can also
occur in printed or electronic materials such as an
electronic medical record (EMR). Therefore, the
use of dangerous abbreviations should be avoided
in all cases (1-4).
Physicians document issues, needs, diagnoses,
treatments, and follow-ups that can lead to errors
in various phases, such as physical or electronic
prescription errors related to dose designation
or administration route (5,6). The consequences
include extended hospital stays, additional medical
interventions, severe injuries in patients with
increased morbidity and mortality, and increased
costs in healthcare systems (7). Contributing
factors include patient overcrowding, eorts
to reduce patient waiting times, shift changes,
extreme conditions within a very short period,
simultaneous care of multiple patients with
dierent complications, a high load of administered
medications, and a lack of knowledge of patient's
complete medical history, including allergies,
concurrent medications, underlying conditions,
patients with multiple prescriptions, etc. (8).
In Ecuador, several second-level public and
private hospitals (9-14) developed a Ministerial
Agreement 00000115 "Manual de Seguridad
del Paciente - usuario," 2016, from the Ministry
of Public Health (MSP). This manual includes
a description of safe practices following the
standards set by the regulatory body. One of
these practices is the safe care practice known as
"Control of Dangerous Abbreviations." Failure to
comply with this provision could lead to adverse
events associated with healthcare. Drafting the
Clinical History with dangerous abbreviations
may promote insecurity in the care provided to the
patient or user.
The method for controlling the record of
dangerous abbreviations ensures greater legibility
and standardization of parameters. It is crucial
to avoid the special use of abbreviations that
may lead to confusion, for example, AZT
(zidovudine, azathioprine, azithromycin); DFH
(diphenhydramine, diphenylhydantoin). Each
country has lists of authorized abbreviations (15).
The integration of electronic prescriptions and
decision support tools into patient care presents
a good opportunity to reduce the use of confusing
abbreviations. There is a plan to standardize the
use of permissible abbreviations in care processes
to prevent confusion and errors that may impact
patients. To achieve this, it is necessary to establish
and share a list of authorized abbreviations and
symbols for healthcare facilities.
This study aims to characterize and assess the
use of dangerous abbreviations in the clinical and
surgical services of the “Hospital General del Sur
de Quito”, during the period from January 1 to
DOI: 10.31790/inspilip.v7i23.545
Scientific magazine INSPILIP - Volume 7 - Number 23 - September - December 2023
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Revista Ecuatoriana de Ciencia, Tecnología e
Innovación en Salud Pública
Código ISSN 2588-0551
December 31, 2021.
This will contribute to managerial decision-making,
establish projects for continuous improvement,
provide solutions for the management of
appropriate terminology use, and enhance
clinical documentation workows, analysis, and
population health management. The main goal is to
implement safe practices at all levels of healthcare
provision (16).
Methodology
Design, Study Population, Sample, and Data
Source
The study employed a descriptive, cross-sectional,
analytical design utilizing data from patient care
recorded in the “MIS AS-400” System of the
Hospital General del Sur de Quito, part of the
Instituto Ecuatoriano de Seguridad Social (IESS),
during the period from January 1 to December 31,
2021. The known population consisted of 920,695
recorded patient care instances throughout 2021
across 42 clinical and surgical departments. From
this population, a random sample of 15,786 patient
care instances was selected with a condence level
of 99.9%.
Inclusion criteria
The inclusion criteria for the study involved the
use of dangerous abbreviations in the patient care
instances recorded in the Clinical Histories within
the “MIS AS-400” System of the 42 clinical and
surgical departments of the Hospital General del
Sur de Quito.
Exclusion Criteria
The exclusion criteria for the study involved
instances where permitted abbreviations, as
outlined in Ministerial Agreement 00000115
"Manual de Seguridad del Paciente - usuario” 2016
from the Ministry of Public Health (MSP), were
used and recorded. Additionally, Clinical Histories
from other hospitals or outside the specied period
were excluded. Histories containing duplicated,
blank, or mistakenly recorded care instances were
also excluded from the analysis.
Data Collection and Analysis
The research support team consisted of seven
General Practitioners in Hospital Functions from
the Medical Audit Subdirectorate of the hospital,
led by the principal investigator. The collected data
were coded and anonymized to ensure privacy.
The databases were requested from the Planning
and Statistics Subdirectorate, and a consolidated
matrix was created with monthly reviews of the
identication of Dangerous Abbreviations.
A database was developed using Microsoft Excel
2017, and compliance with the use of dangerous
abbreviations was analyzed using the SPSS
Version 22.0 program.
Ethical Considerations
This study received approval from the Research
Ethics Committee on Human Subjects at General
San Francisco Hospital (CEISH-HGSF) on
November 1, 2022, with the assigned code
CEISH-HGSF-2022-033. Exoneration from
Specic Informed Consent was requested
considering the use of data from Clinical Histories.
This was due to circumstances such as the patient
being deceased, missing (with no located family
or representative), unconscious, or lacking the
cognitive capacity to give informed consent.
The study ensured the protection of sensitive
data, whether the individuals were considered
vulnerable patients.
Results
Data from 15,786 patient care instances recorded
in Clinical Histories was collected. Adequate
use of abbreviations was achieved at 69.84%
(n=11,026 instances) for the year 2021. The
frequency and compliance regarding the use of
permitted dangerous abbreviations on a monthly
and quarterly basis are detailed in Table 1.
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It was observed that in 4,760 patient care instances
recorded in the Clinical Histories during the period
from January 1 to December 31, 2021, dangerous
abbreviations were used. On average, there were
one to two abbreviations per provided care, with
397 instances per month containing some record
of abbreviations not permitted by the Ministry of
Public Health of Ecuador.
Regarding the use of dangerous abbreviations
by services, it was found that the Clinical Area
reported a compliance rate of 74.9%, with Pediatric
Infectious Disease and Dermatology with the
highest scores at 98.8% and 97.72%, respectively.
The compliance of the Surgical Area was 62.62%,
with Obstetrics, Orthopedics & Traumatology
scoring the highest at 89.75% and 75.75% (Table
2). The service with the lowest compliance was the
Adult Emergency Department at 34.56%, where
there is a high demand for patients.
After a thorough review of dangerous abbreviations
not permitted by the regulatory body in Ecuador,
a total of 6,199 abbreviations were identied. The
frequency of their use in writing and recording in
clinical records is detailed in Table 3.
According to the number of repetitions for each
dangerous abbreviation used in dierent Clinical
Histories, the most representative ones by group
were: (40 to 358 repetitions) "(...) FR, FC, LPM,
RPM, TA, TAM, RX, GSRN, CD4, M2, CD8
(...)"; (20 to 39 repetitions) "(...) APF, FRX, ORF,
RN, EA, GR, PM, VMI, AA, ETCO2 (...)"; (5 to
19 repetitions) "(...) FAV, UDS, A, APQX, ENE,
EF, MSI, MT2, NA, ACT, DISH (...)"; and (Less
than 5 repetitions) "(...) ASA, BT, C/8, CD, CSPS,
FA, FX, GS, HGB, ILA, LCR, LQ (...)"
Out of all the abbreviations found, none of them
is allowed in Ministerial Agreement 00000115
"Manual de Seguridad del Paciente – usuario”
2016, of the Ministry of Public Health of Ecuador.
Discussion
Medical prescription is a complex act that requires
updated scientic knowledge, professional
experience, specic skills, necessary expertise,
a sense of responsibility, and an ethical attitude.
The prescriber assumes legal responsibility for
the respective implications, providing quality
services that include the application of clinical
guidelines, medical protocols, instructions, and
procedures. These should allow for accurate
diagnosis, timely care, a therapeutic regimen, and
eective, ecient, and appropriate follow-up for
the patient. All of this entails accurate, rigorous,
and careful documentary writing, as well as
acquiring standardized technical language in the
healthcare professional context (17,18).
In clinical practice, communicative intent through
writing may fail because the written product has a
high degree of specialization, and the codes used,
both verbal and non-verbal, are often exclusive
to those within this scientic community. This
includes the omission of non-pharmacological
measures when relevant and the use of
pharmaceutical products. In the latter case, the
medical professional prescribes a treatment that
includes the type of medication, the duration,
and the frequency of use, to achieve a therapeutic
eect.
There can be a healthcare risk, referring to
the possibility of something happening during
healthcare that harms the patient. It is measured in
terms of consequences and probability. Therefore,
patient safety is crucial, as it denotes the absence of
accidents, injuries, or preventable complications
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Revista Ecuatoriana de Ciencia, Tecnología e
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resulting from received healthcare. The
consequences of using and abusing dangerous
abbreviations include extended hospital stays,
additional medical interventions, serious injuries
in patients with increased morbidity and mortality,
and increased healthcare system expenses.
Several contributing factors to the use and abuse
of dangerous abbreviations exist, such as patient
overcrowding, eorts to reduce patient waiting
times, shift changes, extreme conditions in a
very short period, simultaneous care of multiple
patients with dierent complications, a high
load of administered medications, and a lack of
knowledge of patient's complete medical history,
including allergies, concurrent medications,
underlying conditions, and patients with multiple
prescriptions. These factors may lead to the use
of dangerous abbreviations. Various types of
unsafe abbreviations (abbreviations, signs, and
symbols) correspond to the use or abuse in writing
and communicating acronyms for medications,
supplies, or other products used in healthcare that
may lead to errors. They can be confused with
others with dierent actions and pose a danger to
physiological function, causing pathological harm,
and even the patient's death when misinterpreted
by the reader. In Ecuador, regulations for the use
of dangerous abbreviations were established by
the health regulatory body, outlined in Ministerial
Agreement 00000115 "Manual de Seguridad del
Paciente - usuario" 2016. Scientic evidence in
Ecuador veries problems in the use and abuse of
dangerous abbreviations.
Ponce & Velasteguí (2019) demonstrated the
widespread use of acronyms in almost all the
540 Clinical Histories reviewed, amounting to
89.4%. The treating pediatrician utilized them,
and resident doctors employed at least one
acronym, with an average of 49 acronyms per
Clinical History, ranging from a minimum of 0
to a maximum of 414. This study was conducted
in Neonatology and Pediatrics at the Hospital
Metropolitano de Quito in Ecuador. The analysis
of scientic evidence revealed that specic
acronyms are used based on the services/areas of
a hospital, emphasizing the necessity for training
across various healthcare branches in managing
clinical records and medication. Knowledge of
the standards and protocols helps raise awareness
of the importance of notication and increased
reporting of events (5).
At the Hospital General del Sur de Quito, there was
a lack of knowledge about the characterization and
assessment of the use of Dangerous Abbreviations,
demonstrating their frequency in hospital
departments, and clinical and surgical services.
The literature review conrmed agreement on
the inappropriate use and recording of such
abbreviations.
The study successfully characterized and evaluated
the use of dangerous abbreviations, revealing
a high percentage of their inclusion in Clinical
Records, with higher compliance rates in clinical
departments followed by surgical ones. It was
evident, based on the literature review, that the use
of such abbreviations can lead to errors, resulting
in adverse events for patients due to imprecise
interpretations, potentially even leading to fatal
outcomes. Adequate management for the use of
appropriate terminology is crucial, implemented
through workows and strategies that incorporate
safe practices at all levels of healthcare provision.
This aims to enhance knowledge about recording
and reporting possible incidents and preventing
them. Additionally, continuous updating of
manuals based on ndings related to the use of
dangerous abbreviations in our country is essential.
Peer Review
The manuscript underwent blind peer review and
was promptly approved by the Editorial Team of
the INSPILIP journal.
Availability of data and materials
The data supporting this manuscript is available
upon request to the corresponding author.
Acknowledgments
The authors express their gratitude for the
collaboration of the “Hospital General del Sur de
Quito” where the current study was conducted.
Additionally, thanks to the sta who contributed
to the review of the medical records.
Funding
Self-funded.
Conicts of Interest
None declared by the authors.
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Revista Ecuatoriana de Ciencia, Tecnología e
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