National Academies Press: OpenBook

Preventing Medication Errors (2007)

Chapter: Appendix B Glossary of Terms and Acronyms

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Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
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B
Glossary of Terms and Acronyms

TERMS

ACE inhibitor. Angiotensin-converting enzyme inhibitor.

Adverse drug event. Any injury due to medication (Bates et al., 1995b).

Adverse event. An event that results in unintended harm to the patient due to an act of commission or omission rather than the underlying disease or condition of the patient (IOM, 2004).

Ambulatory care. For the purposes of this study, care given in (1) the ambulatory clinic, (2) the community pharmacy, (3) the home care setting, (4) the self-care setting, or (5) the school setting.

Biologics (including vaccines, blood, and blood products). A subset of drug products. Biologics are distinguished from other drugs by their manufacturing process—biological as opposed to chemical.

Clinician. An individual who uses a recognized scientific knowledge base and has the authority to deliver health care services to patients (IOM, 1996). The term encompasses prescribers, nurses, and pharmacists.

Dietary supplement. A product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin; a mineral; an herb or other botanical; an amino acid; a dietary substance for use by man to supplement the diet by increasing the dietary intake; or a concentrate, metabolite, constituent, extract or combination of any ingredient described above (Dietary Supplement Health and Education Act of 1994 [P.L. 103-147]).

Drug. A substance that is recognized by an official pharmacopoeia or formulary; intended for use in the diagnosis, cure, mitigation, treatment, or

Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×

prevention of disease; intended to affect the structure or any function of the body (other than food); intended for use as a component of a medicine but not a device or a component, or a part or accessory of a device (FDA, 2004). Drugs are divided into those that require a prescription and those that do not. Nonprescription drugs are usually called “over-the-counter” (OTC) drugs (see below).

Error. The failure of a planned action to be completed as intended (i.e., error of execution) or the use of a wrong plan to achieve an aim (i.e., error of planning). An error may be an act of commission or an act of omission (IOM, 2004).

Formulary. A schedule of prescription drugs that will be paid for by a health insurance plan and dispensed through participating pharmacies. A formulary can be an important safety tool since it can eliminate (for example, in hospitals) the use of drug products considered to be unsafe.

Hand-off. The process of moving patients and their information from one provider or site to another.

Health care professional. See clinician.

Managed Care Organization. A health care provider that attempts to manage the access, cost, and quality of health care.

Medication. See drug.

Medication error. Any error occurring in the medication-use process (Bates et al., 1995a).

Medication therapy management. A service or group of services that optimize therapeutic outcomes for individual patients to help ensure that the goals of drug therapy are achieved. These services can be provided in conjunction with or independently of the provision of a medication product by pharmacists or other qualified health care providers.

Nonformulary drug. A medication that has a preferred alternative listed in the drug formulary.

Off-label use. The Food and Drug Administration (FDA) permits the prescribing of approved medications for other than their intended indications. This practice is known as off-label use.

Orphan drug. A product that is used in the diagnosis or treatment of diseases or conditions that are considered rare in the United States.

OTC (“over-the-counter”) drug. A drug sold without a prescription. The product’s potential for misuse and abuse is low, consumers are successfully able to use it for self-diagnosable conditions, it can be adequately labeled for ease and accuracy of use, and oversight by health practitioners is not needed to ensure its safe and effective use (FDA, 2005).

Potential adverse drug event (ADE). An event in which an error occurred but did not cause injury (for example, the error was intercepted before the patient was affected, or the patient received a wrong dose, but no harm occurred) (Gandhi et al., 2000).

Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×

Practicing clinician. See clinician.

Practitioner. See clinician.

Preventable adverse drug event (ADE). An adverse drug event arising because of an error.

Primary care. The provision health care services by clinicians who are accountable for addressing a large majority of a patient’s health care needs, developing a sustained partnership with patients, and practicing in the context of family and community (IOM, 1996).

Provider. See clinician.

Reconciliation. Comparison of the medications a person is taking in one care setting with those being provided in another setting.

ACRONYMS

AADA Abbreviated Antibiotic Drug Application

AAFP American Academy of Family Physicians

AAMC Association of American Medical Colleges

ACE angiotensin converting enzyme

ACGME Accreditation Council on Graduate Medical Education

ADE adverse drug event

ADWE adverse drug withdrawal event

AFB American Foundation for the Blind

AGS American Geriatrics Society

AHA American Hospital Association

AHCA American Health Care Association

AHRQ Agency for Healthcare Research and Quality

ALLHAT Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

AMA American Medical Association

ANDA Abbreviated New Drug Application

ANSI American National Standards Institute

APA American Psychiatric Association

ASHP American Society of Health-System Pharmacists

ASTM American Society for Testing and Materials

BLA Biologic Licensing Application

BTE Bridges to Excellence

CC Cochrane Collaboration

CCR Continuity of Care Record

CDC Centers for Disease Control and Prevention

CDER Center for Drug Evaluation and Research, Food and Drug Administration

Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×

CDSS clinical decision support system

CERTS Centers for Education and Research on Therapeutics

CGMP Current Good Manufacturing Practices

CME continuing medical education

CMS Centers for Medicare and Medicaid Services

CMWF The Commonwealth Fund

CoSI Commission for Systemic Interoperability

COX-2 cyclooxygenase-2

CPOE computerized provider (physician) order entry

CTFPHC Canadian Task Force on Preventive Health Care

DCRI Duke Clinical Research Institute

DDMAC Division of Drug Marketing, Advertising and Communications, Food and Drug Administration

DHA Australian Department of Health and Ageing

DHHS Department of Health and Human Services dl deciliter

DMETS Division of Medication Errors and Technical Support, Food and Drug Administration

DTC direct-to-consumer

EAN/UCC European Article Number/Uniform Code Council

eHI eHealth Initiative

EHR electronic health record

FACCT Foundation for Accountability

FDA U.S. Food and Drug Administration

FMEA failure modes and effects analysis

FPIN Family Physicians Inquiries Network

FR Federal Register

GAO U.S. Government Accountability Office

GMP Good Manufacturing Practices

GRAM Geriatric Risk Assessment MedGuide

H2 histamine-2

HEDIS Health Plan Employer Data and Information Set

HHS (Department of) Health and Human Services

HI Harris Interactive

HIBCC Health Industry Business Communications Council

HIRO Hospital Incident Reporting Ontology

HL7 Health Level 7

Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×

HMO health maintenance organization

HOPE Health Outcomes and PharmacoEconomic

HPA Health Policy Alternatives, Inc.

HRSA Health Resources and Services Administration

ICU intensive care unit

IHI Institute for Healthcare Improvement

IM intramuscularly

IND Investigational New Drug Application

INR international normalized ratio

IOM Institute of Medicine

ISMP Institute for Safe Medication Practices

IV intravenous

JAMIA Journal of the American Informatics Association

JCAHO Joint Commission on Accreditation of Healthcare Organizations

JFP Journal of Family Practice

JKF Josie King Foundation

KFF Kaiser Family Foundation

kg kilogram

LDL low-density lipoprotein

m2 square meter

MAO monamine oxidase

MAR medication administration record

MBRP Massachusetts Board of Registration in Pharmacy

MCPME Massachusetts Coalition for the Prevention of Medical Errors

MDS Minimum Data Set

MERP Medication Error Reporting Program

mg milligrams

MHA Massachusetts Hospital Association

ml milliliters

MMA Medicare Prescription Drug Improvement and Modernization Act of 2003 (P.L. 108-173)

MoA mechanism(s) of action

NABP National Association of Boards of Pharmacy

NACDS National Association of Chain Drug Stores

Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×

NCCAM National Center for Complementary and Alternative Medicine

NCCMERP National Coordinating Council for Medication Error Reporting and Prevention

NCHM National Center for Health Marketing

NCHS National Center for Health Statistics

NCPDP National Council for Prescription Drug Programs

NCPIE National Council on Patient Information and Education

NCQA National Committee for Quality Assurance

NCVHS National Committee on Vital and Health Statistics

NDA New Drug Application

NDF-RT National Drug File Reference Terminology

NEISS-CADES National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance

NHS National Health Service

NICHQ National Initiative for Children’s Healthcare Quality

NIH National Institutes of Health

NIHCMREF National Institute for Health Care Management and Research and Educational Foundation

NIMH National Institute of Mental Health

NLM National Library of Medicine

NMBP New Mexico Board of Pharmacy

NME new molecular entity

NPSF National Patient Safety Foundation

NQF National Quality Forum

NRC National Research Council

NSAID nonsteroidal anti-inflammatory drug

OBRA Omnibus Budget Reconciliation Act

OIG Office of Inspector General

OSCAR Online Survey Certification and Reporting

OTC over-the-counter

PACE Program of All-Inclusive Care for the Elederly

PBM Pharmacy Benefits Manager

PCA patient-controlled analgesia

PCM pharmaceutical case management

PCSEPMBBR President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research

PD pharmacodynamics

PDA personal digital assistant

PHR personal health record

PhRMA Pharmaceutical Research and Manufacturers of America

Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×

PICC peripherally inserted central catheter

PK pharmacokinetics

PMS Pathways for Medication Safety

POCA Phonetic Orthographic Computer Analysis

POL Physician Office Link

PPAG Pediatric Pharmacy Advocacy Group

PSET Patient Safety Event Taxonomy

PSI Premier Safety Institute

QSHC Quality and Safety in Healthcare

R&D research and development

RFID radio frequency identification

RHIO Regional Health Information Organization

RoA route of administration

RSW Roper Starch Worldwide

RWJF The Robert Wood Johnson Foundation

SAGE Systematic Assessment of Geriatric drug use via Epidemiology

SPL Structured Product Label

TGA Therapeutic Goods Administration

UNC University of North Carolina

USAN United States Adopted Name Council

USP U.S. Pharmacopeia

USP-ISMP MERP United States Pharmacopeia-Institute for Safe Medication Practices Medication Errors Reporting Program

VA (Department of) Veterans Affairs

VAERS Vaccine Adverse Event Reporting System

VHA Veterans Health Administration

VistA Veterans Health Information Systems and Technology Architecture

VSD Vaccine Safety Datalink

WHI Women’s Health Initiative

WHO World Health Organization

Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×

REFERENCES

Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L. 1995a. Relationship between medication errors and adverse drug events. Journal of General Internal Medicine 10(4): 100–205.

Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R, Vander Vliet M, Nemeskal R, Leape LL. 1995b. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. Journal of the American Medical Association 274:29–34.

FDA (U.S. Food and Drug Administration). 2004. Drugs @ FDA: Glossary of Terms. [Online]. Available: http://www.fda.gov/cder/drugsatfda/glossary.htm [accessed June 7, 2005].

FDA. 2005. Office of Nonprescription Drugs. [Online]. Available: http://www.fda.gov/cder/ offices/otc/default.htm [accessed June 7, 2005].

Gandhi TK, Seger DL, Bates DW. 2000. Identifying drug safety issues: From research to practice. International Journal for Quality in Health Care 12(1):69–76.

IOM (Institute of Medicine). 1996. Primary Care: America’s Health in a New Era. Washington, DC: National Academy Press.

IOM. 2004. Patient Safety: Achieving a New Standard for Care. Washington, DC: The National Academies Press.

Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×
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Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×
Page 360
Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×
Page 361
Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×
Page 362
Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×
Page 363
Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×
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Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×
Page 365
Suggested Citation:"Appendix B Glossary of Terms and Acronyms ." Institute of Medicine. 2007. Preventing Medication Errors. Washington, DC: The National Academies Press. doi: 10.17226/11623.
×
Page 366
Next: Appendix C Medication Errors: Incidence Rates »
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In 1996 the Institute of Medicine launched the Quality Chasm Series, a series of reports focused on assessing and improving the nation’s quality of health care. Preventing Medication Errors is the newest volume in the series. Responding to the key messages in earlier volumes of the series—To Err Is Human (2000), Crossing the Quality Chasm (2001), and Patient Safety (2004)—this book sets forth an agenda for improving the safety of medication use. It begins by providing an overview of the system for drug development, regulation, distribution, and use. Preventing Medication Errors also examines the peer-reviewed literature on the incidence and the cost of medication errors and the effectiveness of error prevention strategies. Presenting data that will foster the reduction of medication errors, the book provides action agendas detailing the measures needed to improve the safety of medication use in both the short- and long-term. Patients, primary health care providers, health care organizations, purchasers of group health care, legislators, and those affiliated with providing medications and medication- related products and services will benefit from this guide to reducing medication errors.

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