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The Joint Commission’s “Do Not Use” list is short on purpose. It names exactly six abbreviation patterns that every accredited hospital must prohibit in handwritten and free-text orders, plus a separate, longer list the Joint Commission itself flags only as material for possible future inclusion. Neither of those is the Institute for Safe Medication Practices’ (ISMP) own list, which is voluntary, far longer, and frequently confused with the Joint Commission’s mandatory one. This page separates the two, walks through each required entry and the documented failure mode behind it, and covers where the requirement applies and where it doesn’t — the part accreditation survey teams check most closely.
Audience note: this is written for the people who own compliance with this requirement inside a hospital — infection preventionists building order-set audits into their surveillance work, patient-safety officers, quality directors, and risk managers preparing for a Joint Commission or CMS-deemed survey. It is not a clinical-documentation style guide for individual prescribers, and it is not lab-bench or clinical-trial documentation practice — both of those live in CASRAI’s separate lab-operations and clinical-research content, not here.
The six required “Do Not Use” entries
These are the only entries an organization is required to prohibit to meet the Joint Commission’s own minimum. Each one has a documented, well-established failure mode — not a single reported incident, but a recurring, textbook-level error pattern that is exactly why the abbreviation was banned rather than merely discouraged.
| Do not use | Potential problem | Use instead |
|---|---|---|
| U, u (unit) | Misread as the number “0” (zero), the number “4” (four), or as “cc” — a handwritten “4U” of insulin has been misread as “40” units, a tenfold overdose | Write “unit” |
| IU (International Unit) | Misread as “IV” (intravenous) or as the number “10” — either misreading changes the route or the dose | Write “International Unit” |
| Q.D., QD, q.d., qd (daily) and Q.O.D., QOD, q.o.d, qod (every other day) | Mistaken for one another — the period after the “Q” can be misread as an “I,” and the “O” can be misread as an “I,” turning “daily” into “every other day” or the reverse | Write “daily” and “every other day” |
| Trailing zero: X.0 mg Lack of leading zero: .X mg |
The decimal point is missed entirely on a fax, photocopy, or hurried read — “1.0 mg” read as “10 mg” is a tenfold overdose; “.5 mg” read as “5 mg” is the same error in the other direction | Write “X mg” (no trailing zero); write “0.X mg” (always a leading zero) |
| MS | Can mean either morphine sulfate or magnesium sulfate — two different drugs with different indications, doses, and risk profiles | Write “morphine sulfate” or “magnesium sulfate” in full |
| MSO4 and MgSO4 | Confused for one another for the same reason as “MS” — the abbreviated forms still look alike enough at speed to be misread | Write “morphine sulfate” or “magnesium sulfate” in full |
Note that the trailing-zero and leading-zero rule is really two rules bundled into one list entry, and that “MS” and “MSO4/MgSO4” are two entries addressing the same underlying morphine/magnesium confusion in two different abbreviated forms. Counted by row as the Joint Commission itself presents them, this is a six-item list; counted by distinct abbreviated string, it covers closer to nine or ten forms.
Where the requirement applies — and where it doesn’t
This is the detail accreditation survey teams check and the one organizations most often get wrong in practice. The “Do Not Use” list applies to:
- All handwritten orders and medication-related documentation
- Free-text entry into a computer system (typing “5U” into a text field is still handwritten in every sense that matters to this rule)
- Pre-printed forms
It does not apply, under the Joint Commission’s own exemption, to:
- Preprogrammed health information technology systems that limit the choices available to the user to standard, non-prohibited terminology (a dropdown or structured order set that physically cannot generate “4U” is compliant by design, not by the individual clinician remembering the rule)
- Medication references, drug information resources, and manufacturer labeling
- Pharmacy purchasing, inventory, and storage documentation
This exemption is the reason a hospital’s electronic health record and CPOE build matter as much to this requirement as staff education does: a well-built order set enforces the list structurally, where a policy alone only asks people to remember it under time pressure. Survey teams tracing a medication-use process (see Joint Commission tracer methodology) will pull actual handwritten orders and free-text fields, not just ask whether a policy exists.
Where this requirement lives in accreditation
The “Do Not Use” list began as a National Patient Safety Goal in 2004, at a time when dangerous abbreviations were a well-documented and frequently cited contributor to medication errors nationally. It has since been folded into the Joint Commission’s ongoing accreditation requirements as a standing expectation rather than a standalone goal — organizations are expected to maintain, apply, and monitor compliance with the list as part of routine practice, not as a goal that gets retired once addressed. (For the mechanics of how a goal or standard becomes something a survey team actually checks, see National Patient Safety Goals, including the January 2026 chapter restructuring for hospital and critical-access-hospital programs.) A finding against this requirement during a survey is handled the same way any other standards finding is — through the Requirement for Improvement process rather than automatically as a sentinel event, unless an actual error traced back to a prohibited abbreviation caused patient harm.
The “Additional Abbreviations, Acronyms and Symbols” list
Beyond the six required entries, the Joint Commission separately publishes a longer set of abbreviations “for possible future inclusion” in the official list. These are not currently required, but organizations are encouraged to consider prohibiting them as part of their own internal list. Commonly included items:
| Abbreviation | Intended meaning | Potential problem |
|---|---|---|
| µg | Microgram | Misread as “mg” (milligram), a thousandfold dosing error |
| H.S. | Half-strength, or “hour of sleep” | Mistaken for the other meaning; can also be confused with “hs” for bedtime dosing |
| T.I.W. | Three times a week | Mistaken for “three times a day” or “twice weekly” |
| S.C. or S.Q. | Subcutaneous | “SC” mistaken for “SL” (sublingual); “SQ” mistaken for “5 every” |
| D/C | Discharge, or discontinue | Medications interpreted as discontinued when the intent was to note discharge planning, or vice versa |
| c.c. | Cubic centimeter | Mistaken for “U” (units) |
| A.S., A.D., A.U. / O.S., O.D., O.U. | Left/right/each ear; left/right/each eye | Mistaken for one another, misdirecting a route to the wrong ear or eye |
This is the point where the Joint Commission’s own supplementary list and ISMP’s separate list start to visually resemble each other — both are longer, both are voluntary, and both cover overlapping abbreviated forms. They are still two different documents from two different organizations, and conflating them is the single most common mistake in how hospitals communicate this requirement internally.
The Joint Commission’s list vs. ISMP’s list: not the same document
This distinction matters because only one of these lists is an accreditation requirement.
- The Joint Commission’s “Do Not Use” list is a formal accreditation requirement. Its six required entries must be prohibited in the scope described above for an organization to remain in compliance. Its “Additional Abbreviations” set is explicitly non-mandatory.
- ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations is a separate document maintained independently by the Institute for Safe Medication Practices. It is substantially longer than either Joint Commission list, is intended for voluntary adoption by healthcare organizations, drug information vendors, and medication technology vendors, and carries no accreditation weight on its own. ISMP states this explicitly on its own materials — it does not present its list as Joint Commission-approved or -required.
The two organizations take the same general approach elsewhere in medication safety, and the relationship is structurally similar to how the FDA’s and ISMP’s separate tall man lettering lists relate to each other: a shorter, narrower, mandatory or regulator-published list, and a longer, voluntary list an organization can choose to adopt on top of it. See tall man lettering: two different lists, the CD3 rule, and making it hold across every screen for the closely analogous FDA/ISMP relationship in that convention.
Practically, most hospital pharmacy and therapeutics committees adopt ISMP’s longer list as internal policy anyway — there’s no rule against exceeding the Joint Commission’s minimum, and many medication-safety programs do exactly that. What matters for survey readiness is knowing which entries are the actual accreditation floor (the six required items) versus which are voluntary additions your own P&T committee chose to adopt. A surveyor citing a finding will cite it against the required list, not against however far past it your internal policy happens to go.
Building it into survey readiness, not just a poster on the wall
A “Do Not Use” list taped to a nursing station wall satisfies nothing on its own. What a survey team actually looks for:
- Order-set and EHR build audits confirming free-text fields and pre-printed forms don’t silently allow a prohibited entry through, and that structured/dropdown fields are genuinely constrained rather than accepting arbitrary text.
- A documented, current internal policy that states the six required entries explicitly, states whether and how far the organization has extended the list (Joint Commission’s additional set, ISMP’s list, or both), and states the scope exemptions correctly — getting the electronic-system exemption wrong in either direction (claiming an exemption a build doesn’t actually meet, or failing to claim one it does) is a common documentation gap.
- Ongoing monitoring, not a one-time rollout — medication-error reporting and chart audits that specifically flag prohibited-abbreviation occurrences, feeding back into staff education and, where the root cause is a system gap rather than an individual lapse, into order-set redesign.
- Staff education tied to onboarding and ongoing competency, not a single memo sent once when the policy was adopted.
Frequently asked questions
Is the Joint Commission’s “Do Not Use” list the same as ISMP’s list of error-prone abbreviations?
No. They are two separate documents from two separate organizations. The Joint Commission’s list is a formal accreditation requirement, limited to six required entries, plus a separate non-mandatory “Additional Abbreviations” set the Joint Commission itself publishes. ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations is a longer, independently maintained, voluntary list with no accreditation weight of its own.
Does the “Do Not Use” list apply to electronic health records?
It applies to free-text entry into an electronic system, since a typed prohibited abbreviation is still the same error a handwritten one would be. It does not apply to preprogrammed systems that constrain the user’s choices to standard, non-prohibited terminology — a genuinely structured order set or dropdown is exempt because the abbreviation physically can’t be entered, not because it’s electronic.
How many abbreviations are actually required, not just recommended?
Six required entries: U/u, IU, Q.D./Q.O.D. (and their variants), the trailing-zero/naked-decimal-point rule, MS, and MSO4/MgSO4. Everything else — the Joint Commission’s own “Additional Abbreviations” set and all of ISMP’s separate list — is voluntary, however widely adopted it is in practice.
What happens if a survey team finds a prohibited abbreviation in use?
It’s handled as a standards finding through the ordinary Requirement for Improvement process, the same as any other cited deficiency — it does not automatically escalate to a sentinel event unless an actual patient-harm event is traced back to it.
This page reflects the Joint Commission’s official “Do Not Use” list as a widely documented, long-standing accreditation requirement. jointcommission.org itself returns an access error to automated verification tools as of this writing; the specific standard/element-of-performance citation for where the requirement currently sits in the accreditation manual is not independently pinned here and should be confirmed against your organization’s current accreditation manual before citing a specific standard number in policy documentation.
