Patient safety

Campaign targets poor penmanship by docs

WINNIPEG – The Winnipeg Regional Health Authority has launched a campaign that aims to improve the legibility of prescriptions that are hand-written by physicians.

As reported by the Globe and Mail newspaper, the move comes after an audit revealed nearly a third of the orders issued in WRHA hospitals could have threatened patient safety, either because they were illegible or contained banned abbreviations.

In future, the WRHA intends to remove penmanship from the equation by adopting electronic records and medication ordering.

According to the Globe and Mail article, a recent study in the journal Health Services Research found that having doctors write electronic prescriptions reduced medication errors by 66 percent.

In the meantime, measures like cracking down on sloppy handwriting will have to do.

“We know from the literature that there are certainly medical errors that result from miscommunication,” said pharmacist Lora Jaye Gray,medication safety co-ordinator for the WRHA. “There are continually reports throughout Canada of patients who have been harmed and killed through medication errors. We also know from the Canadian Adverse Events Study in 2004 that 7.5 percent of patients admitted to Canadian hospitals had at least one adverse event. Not all were medications, but medications were a big part of that.”

The WRHA audit found that 1 percent of prescriptions were unreadable and required a phone call to the prescribing physician or nurse to clarify. Approximately 30 percent of all orders contained abbreviations and symbols that can be easily misinterpreted.

The new policy explicitly bans the use of abbreviations such as QD, which means to be taken every day, because it can be mistaken for QOD, every other day, or even OD, which means right eye. An error in the position of a decimal point, as in ).5 grams, can lead to a 10-fold increase in the administered dose.

Drug names, which are often quite similar, can be confused by a pharmacist struggling to read an illegible script – often with disastrous results.

Dr. Bill Pope, registrar of the College of Physicians and Surgeons of Manitoba, said he supports the new policy, which will be publicized through a poster campaign in hospitals.

A study in the British Medical Journal in 1998 found that physicians, even when asked to produce neat writing, could not write as clearly as those in other professions. But Dr. Pope said it’s not as bad as it once was.

“The concept that a physician’s terrible handwriting is part of the ambience of being a good doc ... I think that truly has changed,” h esaid. “But it still happens when they’re dashing off prescriptions, of course.”

Dr. Pope said if a pharmacist is having difficulty interpreting the doctor’s writing, college policy requires the doctor to immediately clarify the issue.