Endgames Christmas 2022: Brain Stew

Misspelling of antimicrobials by healthcare professionals

Daniel Weiand, Joanna Lumb

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2946 (Published 19 December 2022)Cite this as: BMJ 2022;379:o2946

Although electronic health records have widely reduced medication errors, and computerised hospital orders are an undeniable step-up in clarity from illegible handwritten orders,1234 they are not a patient safety panacea. Interpreting free text clinical information of any kind is far from straightforward, especially when it comes to antimicrobials. For starters, hundreds of antimicrobials exist, many have similar sounding names (looking at you, cephalosporins), and each antimicrobial can be referred to variously by brand name, generic name, or drug class.567 With 80 antimicrobials beginning with “ceph-” or “cef-” and 54 antimicrobials ending in “-mycin,” 7 it’s no wonder that many healthcare workers struggle to spell each one correctly.

When healthcare teams submit patient samples for microscopy and culture, microbiology laboratories use clinical information included in the request to inform specimen preparation and analysis as well as result interpretation.89Misspelling the names of common antimicrobials could, on occasion, create confusion for those interpreting clinical details included in investigation requests. On a more lighthearted note, we often come across amusing misspellings of commonly used antimicrobials.

As part of a project aiming to improve the quality and quantity of clinical information included with microbiology requests, we interrogated our laboratory information management system for free text data submitted using the computerised provider order entry module of Cerner Millennium.31011 The Department of Microbiology and Virology at the Freeman Hospital offers one of the most comprehensive test portfolios in the UK and is fully accredited by the UK Accreditation Service. Over two 10 week periods, the clinical details included with 10 760 culture requests specified 13 838 antimicrobials purported to have been used in the treatment of patients at the Newcastle upon Tyne Hospitals NHS Foundation Trust. Of these, 1395 antimicrobials (10%) were misspelt.

Meropenem was the most commonly misspelt agent (207 times), usually as meropenum (n=114), followed by the cephalosporins (n=136), piperacillin-tazobactam (n=106), usually as tazosin (n=21), and gentamicin (n=73), usually as gentamycin (n=55) (see supplementary table online).

We found many unusual and insightful misspellings, some alluding to seemingly novel compounds (table 1). Drug researchers and drug companies might want to take inspiration from our findings when deciding on the names of yet-to-be released antimicrobials.

Table 1 Novel misspellings