Joint Commission do not use abbreviations: how nurses spot them on Mac, 2026

What the Joint Commission Do Not Use list asks of you

The Joint Commission's Do Not Use list names abbreviations you should not write in medical orders or notes. ISMP publishes a separate list of error-prone abbreviations, symbols, and dose designations. ISMP marks the items that also appear on the Joint Commission list. Knowing the list is only half the job. The other half is checking your own text before it leaves your hands.

ISMP released its 2024 list on April 18, 2024. The rule covers more than typed text. ISMP says its items should not appear in verbal, handwritten, or electronic communication. They also should not appear on medication labels, administration records, or order-entry or dispensing screens. That means a form that looks fine in a chart note can still fail on a label.

What prohibited abbreviations cost patients and staff

Start with the largest figure you can source. WHO says the cost associated with medication errors has been estimated at $42 billion USD annually. The page does not name the year or the method behind that estimate. Treat it as an old, global figure. It does not isolate prohibited abbreviations, so do not quote it as a number for abbreviations.

WHO describes medication errors as causing severe harm, disability and even death. It sets a goal to reduce severe avoidable medication-related harm by 50% globally within five years. Clear written orders are one practical part of that goal. This page cannot tell you how much of that harm comes from abbreviations.

No verified source here gives a count of patients harmed by items on the ISMP list. ISMP says every item was reported through its voluntary error reporting program. It also says each item has been involved in harmful or potentially harmful medication errors. The page gives no error counts or rates. So the list tells you which forms are risky. It does not tell you how often they hurt someone on your unit.

Your own costs are harder to measure, and no verified figure exists for them. A clarification call takes time. A dose can wait while someone asks what an abbreviation means. An incident report takes more time still. For a week, keep a tally. Write down each call to ask what a term means. That gives you a number for your unit that no national study can give you.

Why prohibited abbreviations keep showing up

• Paper habits carry over. Handwritten shorthand often ends up in typed notes, even when you know the rule.
• Templates and copy-paste keep old text alive. A template built before ISMP's 2024 update may still hold older forms.
• Channels follow different rules. A form that passes in a chart note can fail on a label or in a verbal order.
• Spell check does not know the list. It checks spelling against dictionaries, not against a safety rule.
• Busy shifts push you toward shortcuts. No source on this page measures that effect on a unit, so treat it as a common pattern.
• Memory fills the gap. Once a term feels familiar, you stop checking the current list.

The 2024 update changed some items that experienced nurses still use. ISMP asks you to spell out nanog. It asks you to spell out intranasal instead of NAS. It asks you to use QHS instead of nightly or HS for bedtime. It also asks you to avoid reduced-size fractions for half tablets, and to use and instead of per as a slash.

Electronic order entry is one control that helps. In a 2014 systematic review of 16 studies, computerized provider order entry (CPOE) was linked to fewer medication errors than paper orders. The pooled risk ratio was 0.46, with a 95% confidence interval of 0.35 to 0.60. The authors called the study designs weak, and the results varied widely. Read that number as a direction, not a promise about your screen.

Check your notes for prohibited abbreviations, step by step

Use this routine before you sign, hand off, or print a label. A short note takes only a few minutes once the habit sticks. Keep the current list open in Chrome while you work, and keep your cheat sheet in Word.

1. Open the current ISMP list in Chrome and keep the tab open. Save a PDF copy with ⌘P for offline use.
2. Open your draft in Word, or the charting page in Chrome.
3. Press ⌘F and search for one item from your cheat sheet at a time.
4. Read each hit. Decide whether it sits in a dose, a label, a handoff, or a plain phrase.
5. Replace each prohibited form with the spelled-out term your facility approves.
6. Ask pharmacy or your charge nurse when a term is unclear. Do not guess.

Find only works on text you can see on the screen. It does not read scanned forms, photos, or handwriting. Check those by eye, against the same list.

Run the check again for labels and verbal orders. ISMP covers those channels too. A note that passes Find can still fail on a printed label.

Free fixes you can set up on your Mac today

You do not need to buy anything to start. Apple and Microsoft already include the tools you need. Start with two settings: Text Replacements in macOS, and the custom dictionary in Word.

Set up Text Replacements

Open Apple menu > System Settings > Keyboard > Text Replacements. Click Add. Type the short text you type and the full text it should become. Click Done. Apple's Mac Help says text replacements are not available in all apps, so test each app where you chart.

Pick triggers you never type by accident. For example, bedt could expand to at bedtime. Avoid triggers that match real words. Avoid any trigger that expands into a prohibited form. Test each shortcut once in Word and once in your charting app before you rely on it.

Teach Word your approved terms

Word checks spelling against dictionaries. If it flags an approved term such as intranasal, add that term to a custom dictionary. Go to Word > Preferences > Authoring and Proofing Tools > Spelling & Grammar > Dictionaries. Select the dictionary, click Edit, and add the word. Microsoft says this works in Word 2016 through Microsoft 365 for Mac.

Do not mistake the dictionary for a safety check. Adding a term only clears a red underline. It does not stop a prohibited form, which can be a real short string that spell check accepts without comment.

Set a quarterly list check

Open Apple Reminders and create a reminder titled Check the Do Not Use list. Set it to repeat every quarter. Put the ISMP link in the notes field. When it fires, check the publication date of each source and update your cheat sheet. An old printout can quietly mislead you for a long time.

Worked example: fixing a note line by line

Say your draft reads: NAS spray given nightly. Press ⌘F and search for NAS. The hit is a prohibited form, so replace it with intranasal. Search for nightly next. Replace it with QHS, as ISMP suggests, or with the spelled-out bedtime wording your facility approves. Your facility decides which of those goes into the final note. Read the line once more before you sign it.

Mistakes people make with prohibited abbreviations

• Trusting memory. A term you learned years ago may have changed in the 2024 update.
• Treating the list as the whole rule. Your facility policy can be stricter than the list. Follow the stricter rule.
• Using spell check as a safety net. It checks spelling, not safety.
• Forgetting the other channels. Verbal orders, handwritten notes, labels, and screens all count.
• Swapping one abbreviation for another. Spell the term out unless your policy names a replacement.
• Fixing a template once and forgetting it. Old templates bring back old forms.

Where Lazur helps, and where it does not

Lazur is a voice assistant for the Mac. It lives in the notch. Hold Option and Command to ask about anything on screen, and Lazur answers out loud. Hold fn to dictate clean, formatted text at the cursor in any app.

Use it for the parts that need a second pair of eyes or a faster hand. Ask what a term means while you chart, and Lazur answers from what it sees on screen. Ask where Text Replacements is, and Lazur draws a circle and a label around it. Ask how to add a shortcut, and Lazur guides you one click at a time, waiting for each click.

Lazur does not click buttons, edit files, or operate other apps for you. It is not a plugin or add-in for any app, and it has no partnership with any app maker. It does not check your notes against the Joint Commission list. Confirm each term against the current list and your facility policy.

Lazur listens and looks at the screen only while you hold the shortcut. Content is never used to train AI models. Those are Lazur's stated terms. They do not replace your employer's rules, and your facility can still say no. If it does, follow that answer.

Dictate and draft safer text without typing the banned forms

Dictation can help you write spelled-out text faster. Hold fn and speak. The text lands at the cursor in any app. Snippets and a personal dictionary can hold the approved wording, so you do not retype it each shift.

Read the dictated text after every run. Speech tools can mishear terms, and a word that sounds like a short code may come out wrong. Check each term that matters before you sign or send. Use drafts for generic text, such as your cheat sheet, not for patient notes unless your employer allows it.