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Several years ago, a relatively inexperienced evening pharmacist received an order for "Black and White, 30 ml hs prn." The only black and white the pharmacist knew of was Scotch whisky. The whisky had been stored by the pharmacy for some time and was dispensed occasionally by doctor's order. This is what was dispensed. No complaint was voiced by the patient. The doctor who wrote the order claimed that "everybody knows that Black and White is a laxative mixture containing the equivalent of 5 ml of aromatic cascara fluid extract and 30 ml of milk of magnesia." Everyone, of course, except people who've never heard of a black and white! It is easy to understand how coined names and abbreviations evolve.
Obviously, everyone does not know what these unique "nicknames" mean, thus errors occur. Health professionals waste time clarifying orders and therapy is delayed as a result. Community pharmacists are particularly vulnerable when they receive prescriptions for coined-name drugs that are familiar to only those who work within the institution where the doctor practices. For example, a dermatologist routinely prescribed "T.M.C.," an abbreviation for triamcinolone. Several calls from community practitioners were made asking what this was.
In another example, when a topical solution mixture of three antibiotics was being used in hip surgery, a lazy doctor ordered "chicken soup" rather than spelling out the lengthy formula. Nurses and pharmacists knew what the orthopedist wanted. But' can you envision this medical record being used in a court case, or even worse, chicken soup being used? Other such orders have included "pink lady" (tincture of belladonna, Maalox, and phenobarbital elixir) or "dynamite" (Dulcolax).
Most Pharmacy and Therapeutics Committees have rules on the books stating that no chemical symbols be used in writing orders and that there be an approved list of abbreviations (this is a JCAHO requirement). When a complex formula is consistently prescribed, a descriptive name for this product should be approved by the Pharmacy and Therapeutics Committee for use only within the institution. The name and exact formula must appear in the formulary and on container labels. Every effort must be made to resist creating unofficial names.