In January this year a hospital pharmacist contacted us after a colleague had questioned a prescription for amlodipine 10 mg four times a day for migraine. She contacted the prescriber, who said he had got the dose from this clinical review about pharmacological prevention of migraine published in The BMJ.
The article had specified amlodipine 5-10 mg QD in a table, with an explanation at the bottom of the table which clarified the abbreviation QD to mean once daily.
Our policy in such circumstances is to issue a correction and attach it to the article, which we promptly did. Because of the potential patient safety risk, we also amended the table and republished the article. The correction reminded readers not to confuse QD with QDS, which means four times a day.
The journal’s managing editor then reminded the editorial team to avoid dosing abbreviations such as QD. On this occasion it was used to save space, and, although its meaning was clearly defined in the footnote, it nearly led a busy clinician to prescribe four times the correct dose.
An added complication is that acronyms are not used consistently between the UK and US, and as an international journal we need to be mindful of this. Lastly, she urged the team to always ask authors to clarify what they mean, and that our policy is to minimise the use of abbreviations.
The incident recounted above was in my mind this week at a meeting to discuss a company-wide project to establish some policies and principles for protecting patient safety. We tend not to think of The BMJ as a point-of-care resource, unlike some of our other products such as Best Practice, but our education content (clinical reviews and practice articles), frequently contain dosage information, and they have to be unambiguous.
The project team has suggested a range of principles about empowering us all to raise patient safety concerns and issues, and including the issue in our induction programme when we join the company, and in our training.
Readers also need to be aware of the channels they can use to raise patient safety concerns. The issue described above was flagged via our complaints inbox (firstname.lastname@example.org). Readers can also contact our customer services team (email@example.com), and respond to a specific article if they feel it contains misleading information. Responses are monitored seven days a week. You can find out more about our complaints inbox at this link
It goes without saying that we are extremely grateful to the pharmacist for alerting us to this problem, and to all readers who contact us with patient safety concerns related to articles in The BMJ.
David Payne is editor, bmj.com, and readers’ editor