Newsletter and Grammar Coach

People routinely encounter and use abbreviations, which in most cases are intended to save time or space. Abbreviations can be perplexing to people who are unfamiliar with them. Use of obscure abbreviations may not necessarily cause harm other than alienating readers or audiences. In a worst-case scenario, though, misinterpretation of an abbreviation can lead to serious error and even potentially imperil health.

 

Instructions in medical and health-related prescriptions and hospital orders traditionally are expressed using abbreviated Latin terms such as “b.i.d.,” “h.s.” and “q.h.s.” Such encoded terms are part of the lingo of physicians, nurse practitioners, physician assistants, registered nurses, dentists, optometrists and other health care professionals who are authorized to write prescriptions. They’re often perplexing, however, to most lay people — patients and health care consumers. Pharmacists, nurses and other health care professionals are entrusted with understanding and fulfilling prescription orders, but errors in reading or deciphering abbreviations can occur. Misinterpretation of brief abbreviations that are similar but have drastically different meanings can have deleterious implications.

 

An article on a patient advocacy website illustrated one such example. An alert customer who had been taking the diuretic Lasix once daily for some time asked the pharmacist why the label on his medication refill read, “Take 1 tablet 4 times a day.” The pharmacist retrieved the actual prescription form, on which the physician had scrawled “1 QD” (Latin for 1 tablet daily), but he inadvertently inserted periods after the “Q” and the “D.” To the pharmacy intern who filled the prescription, the period after the ‘Q’ appeared to be a lowercase “i.” Thinking that the physician had written “1 QiD” the intern typed the instructions for that three-letter abbreviation: “1 tablet 4 times per day” — quadruple the amount of medication that the physician intended to prescribe. “Such an overdose could have had grave consequences if the customer had not questioned us,” the pharmacist wrote.

 

The word “prescription” itself has long been expressed as “Rx” — abbreviation of the Latin word “recipe,” meaning “take.” Even though more than a decade has passed since the Joint Commission health system accreditation agency and other organizations began discouraging Latin abbreviations in prescriptions and hospital orders, their use persists.

 

The patient’s best strategy to avoid errors is to understand the meaning of prescriptive abbreviations, and to review them carefully and discuss them with the prescribing health care professional before the prescription or therapy order is initiated. This is an important facet of what we have long advocated: clarity in communication.

 

If your doctor writes “AAA” on your prescription, that’s not a reference to the American Automobile Association. In medical shorthand, that stands for “apply to affected area.” The notation “ad lib.” is not an invitation for the pharmacist to speak extemporaneously or crack jokes; it signifies “use freely, as much as desired (it’s a contraction of the Latin words “ad libitum,” meaning “according to pleasure”). You want to make sure that “p.r.n.” (which means “as needed”) is not mistaken for the instruction “p.r.” (which means “by the rectum”). In addition to medication name and strength, prescription orders indicate the quantity, frequency and method of administration for medications. Here is a selective list of other commonly used combinations of initials used in prescription orders.

 

FORM OF MEDICATION

• cap. — capsule (but CAP signifies “cancer of the prostate”)
• CR — controlled release
• cr or crm — cream
• DR — delayed release
• EC — enteric-coated
• ER — extended release (also stands for “emergency room”)
• gtt or gtts — drop or drops (abbreviation for gutta; but GTT sands for “glucose tolerance test”)
• IR — immediate release
• MDI — metered-dose inhaler
• pulv — powder
• XL or XR or XT — extended release

 

ROUTE OF ADMINISTRATION

• a.d. or AD — right ear (abbreviation for Latin aurio dextra; but “ad.” in lowercase followed by a period means “up to” a specific amount)
• a.l. or a.s. or AS — left ear (for Latin aurio laeva or aurio sinister)
• a.u. or AU — each ear, or both ears
• NAS — intranasal
• o.d. or OD — right eye (abbreviation for oculus dexter; but “OD” also can indicate “overdose,” and “o.d.” also can mean “once per day”)
• o.s. or OS — left eye (abbreviation for oculus sinister)
• o.u. or OU or o_2 or o 2 — both eyes (oculus uterque)
• per os or PO or po or p.o. — orally (per os)
• PR or p.r. — by the rectum

 

SCHEDULE AND OTHER INSTRUCTIONS

• ac or a.c. — before meals (abbreviation for the Latin ante cibum)
• ap — before dinner
• ATC — around the clock
• bid or b.i.d. or BID — twice a day (abbreviation for Latin bis in die)
• BT — bedtime
• cc or cf — with food (for cum cibos)
• dieb. alt. — every other day (for diebus alternis)
• Ex aq — in water (ex aqua)
• h or hr. — hour
• hs or h.s. or HS — at bedtime or hours of sleep (abbreviation for hora somni; but HS also can refer to “half-strength”)
• mane — in the morning
• noct. — at night (nocte)
• noct. maneq. — night and morning
• pc or p.c. — after meals (abbreviation for post cibum)
• p.r.n. or prn — as needed (pro re nata)
• q.a.d. or q.o.d. — every other day (for quoque alternis die)
• qam — every morning
• qd or QD or q1d — every day (quaque die)
• qh or q.h. or qhr — every hour (quaque hora)
• qhs or q.h.s. — every night at bedtime (quaque hora somni)
• qid or q.i.d. — four times per day (quater in die)
• qs — every shift
• q2h — every 2 hours (quaque 2 hora)
• TID or t.i.d. or t.d.s. — three times per day (ter in die or ter die sumendum)

 

OTHER ABBREVIATIONS

• ASA — aspirin (acetylsalicylic acid)
• DX — diagnosis
• HCT — hydrocortisone (but HCTZ indicates hydrochlorothiazide)
• NKA or NKDA — no known (drug) allergies
• NPO or n.p.o. — nothing by mouth
• NTE — not to exceed
• q — every (for Latin quaque)

 

The abbreviation “SOB” on a prescription order is not a criticism of an irritable patient. It stands for “shortness of breath.”

 

When physicians submit medical orders electronically, patients may not actually be able to read the encoded orders — which underscores the importance of reviewing instructions before you leave the doctor’s office. Understanding medical abbreviations is an important part of a prescription for avoiding medical errors and assuring that you understand therapeutic directions. We can think of no more persuasive argument for insisting on clarity in communication..

Two decades have passed since pre-press work was under way for Echoes of the Sixties, the first book by EditPros partners Marti Smiley Childs and Jeff March. Twenty years ago this month, we were busy checking layout proofs for the 320-page book, for which Amazon had been accepting advance orders since July. As our New York-based publisher, Billboard Books, prepared for a November 1 release date, we were immersed in planning with the publisher’s publicity department.

 

Echoes of the Sixties explored the personal, off-stage lives of a dozen recording acts — soloists, duos and members of musical groups who recorded top-selling national hit songs primarily during the 1960s.

 

We had begun work on the project one day in 1997 after hearing a oldie of the 1960s playing on the radio while we were returning from a meeting with a client. Realizing that most of the artists of that era were then in their 50s or early 60s, we wondered whatever happened to the members of the band who recorded that song. Had they remained in some facet of the music industry or entered other fields? How had fame affected their personal lives? How did they cope with the pressures of recording and touring, and with the uncertainties of shifting musical tastes and public popularity? We checked with local and on-line book sellers to see if any existing books covered the topic as we envisioned it. After we determined the lack of any such books, we began making calls.

 

Among the first people we contacted were 1960s pop stars Peter Asher and Donnie Brooks. Asher, formerly of the "British invasion" pop duo of Peter and Gordon, has been a music producer of enormous influence during the prior three decades and by 1997 was senior vice president at Sony Music Entertainment, the New York conglomerate encompassing Columbia Records, Epic Records, and other labels. Brooks, who recorded the 1960 top-10 hit "Mission Bell," was in the late ’90s producing touring oldies music revues in which he and other artists of the 1960s performed. Asher and Brooks opened many doors for us, and the artists and agents with whom they put us in contact in turn helped us reach other performers.

 

Deciding against use of a literary agent, we prepared a tightly focused, marketing-oriented proposal and sent it to only five book publishers. Among them was Billboard Books, an imprint of Watson-Guptill Publications of New York. To our delight, Billboard offered us a contract, which we signed.

 

The advent of print-on-demand technology encouraged us to publish subsequent titles under the EditPros imprint, including three more musical biography books, under the title Where Have All the Pop Stars Gone? That venture evolved into Book Prep, our service for authors who wish to self-publish books and thereby retain all rights and royalties for their books.

 

In November 2011, EditPros reissued Echoes of the Sixties in digital form. Preserving the original 1999 book manuscript, the e-book version consists of 12 chapters, each focusing on a musical group or solo artist who first achieved popularity in the 1960s. Featured performers are:

• The Fireballs
• Gary "U.S." Bonds
• The Tokens
• The Angels
• Peter and Gordon
• Mike Pinder of the Moody Blues
• The Beau Brummels
• Sam The Sham and the Pharaohs
• The Lovin' Spoonful
• Gary Puckett and the Union Gap
• Country Joe and the Fish
• Iron Butterfly

  

LEARN MORE about Echoes of the Sixties.

Dave K. wrote:

The grammar coach replies:

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