Safe use of symbols in handover documentation for medical teams

Concern has been reported about the safe use of medical abbreviations in documents such as handover sheets and medical notes, especially when information is being communicated between staff of different specialties (BBC 2008, Sheppard et al. 2008). This article describes a study to investigate whether the use of symbols in handover documentation that is shared within and between multidisciplinary teams (MDTs) has similar safety implications. We asked 19 healthcare professionals from a range of specialties to identify 45 different combinations of 38 individual symbols. The symbols and combinations of symbols were extracted from 102 handover sheets taken from 6 different healthcare contexts in 4 London hospitals. Three symbols proposed in Microsoft's Common User Interface guidelines for alert symbols were also included. Results reveal that while some symbols are well understood, many others are either ambiguous or unknown. These results have implications for the safe use of symbols in medical documents, including paper and electronic handover documents and Electronic Patient Records (EPRs), especially where teams comprise individuals from different professional backgrounds, i.e. MDTs. We offer initial suggestions for standardisation and further research.