Starting January 1, 2004, the Joint Commission on Healthcare Accreditation requires that all health care providers avoid using certain abbreviations which can be misread or misunderstood easily, including "qd", "U", and others. It also requires health care organizations to choose additional abbreviations to forbid by April 1, 2004 (from a list including things like "ug", "hs", "sq", "cc", and others).

Welford Chart Notes makes it easy to comply with this requirement (and any future such requirements, should they come to pass) using a new feature called the Medication Instruction Abbreviation Replacer. It lets you set up a table of forbidden abbreviations and their permitted counterparts. It then replaces any instance of the forbidden abbreviation with its permitted meaning in the last dosing instruction for each medication in your database. It also fixes any improper use of doses involving decimals, e.g. by converting ".125" to "0.125" and converting "2.0" to "2" (both of which are now forbidden by JCAHO). It also can add these abbreviations and their meanings to your list of Contractions, so that in the future, whenever you type one of these forbidden abbreviations (into a note, a prescription, the Prescription Log, or the Medication Editor) they are automatically replaced with the permitted meaning, thus avoiding any inadvertent use of the forbidden abbreviation. Finally, if a year from now the JCAHO comes up with a new list of forbidden abbreviations, you can easily edit the list inside the Medication Instruction Abbreviation Replacer to maintain compliance.

Let's see how this works:

6. Then, press Scan. This quickly goes through your previous dosing instructions in the Medication Editor and changes the most recent one to match the abbreviations you have selected and fix any decimal problems if you checked Fix decimals. (It does not fix dosing instructions older than the most recent one. These older instructions are not likely to ever appear in your future notes. Scanning to change every old instruction would tie up the computer for a much longer period of time).

When a patient refuses to ever perform a recommended procedure, such as a mammogram or influenza vaccination, you will want to add this patient as an Exception to the particular Rule Reminder that pertains to this procedure, so that you aren't incessantly reminded to ask the patient to have the procedure. Starting with version 4.5, you can also record the reason WHY the patient is refusing the perform the procedure, and when the patient stated this refusal. Such documentation is helpful if you are ever questioned as to why you haven't ordered the procedure. (Of course, you can also document the refusal somewhere in a patient note using the Writer, but it is handy to be able to look it up directly in the Rule Reminders).

7. Type in the reason for the Exception (and perhaps when the patient stated the reason) and press Ok; or press Cancel or <ESC> if you don't want to record a reason.

Note that you can also record a reason when you are being reminded about a Rule Reminder. When the reminder appears and you feel this patient should be considered an exception, press the Except button. The Reason for Exception window appears, allowing you to record your reason at that time.

We are currently planning version 4.6, and have added a number of new enhancements already. If you have suggestions for features you would like to see in version 4.6, please let us know.