Barbara M. Cook
HCA 375: Continuous Quality Monitoring & Accreditation
Illegible Physicians Handwriting
August 31, 2009
Illegible handwriting and transcription errors are responsible for as much as 61 percent of medication errors in hospitals. A simple mistake such as putting the decimal point in the wrong place can have serious consequences causing a patient's dosage to be 10 times the recommended amount. This is a serious problem. Bad handwriting is the cause for many delays due the time spent in trying to decipher the Doctor’s order. This is a subject that has to be taken seriously to ensure continuous quality improvement. Failure to do so could eventually lead to death. So let us examine this topic of illegible handwriting; why is it an accepted practice to expect physician’s handwriting to be terrible? Is there an unwritten code-a self righteous chicken scratch that is decipherable only by experienced pharmacists and, with luck, by each other? The question of doctors' handwriting has a serious side with implications concerning the quality and safety of health care. We often joke that if people have poor handwriting we may say “you write like a doctor.” This all may sound funny, but there is nothing funny about death resulting from poor penmanship or cacography. It is an issue that should have a federal mandate to ensure all medical personnel should be required to take a course in legible handwriting. In this paper I will explore some cases that resulted in death due to poor penmanship. We will also look at the positive effects of electronic charting verses handwriting, and in an effort to improve quality and safety. The current concern with medical error and patient safety has created a sense of urgency about information technology and for electronic charting. (Kaluzny & McLaughlin (2006).
Physicians’ orders can be confusing, especially if you have to spend time trying to interpret them rather than quickly carrying them out. They could be as confusing as trying to decipher hieroglyphics. Looking at the issue of poor penmanship as decreasing quality, safety and eventually causing fatalities, we must research what guidelines should be put in place to regulate such. Most Americans don't receive any formal handwriting instruction beyond what they learn in grade school; how we learned to write then is what we are stuck with for the rest of our lives. Because of this, illegible handwriting becomes the norm. The question is why this has been so accepted? The money and time it would cost to provide additional training in handwriting does not equal the amount of money spent in poor quality, adverse drug events and lawsuits. As a whole, adverse drug events in hospitals, caused by handwriting errors, missed dosages, duplicate therapy, drug-drug interactions and more, cost up to $5.6 million per hospital due to prolonged hospitalizations, according to the Agency for Healthcare Research and Quality's March 2001 report. (quality.chcf.org). This is why there should be some type of federally mandated stipulation in place that require physicians to use electronic charting. In my research I looked at 12 studies conducted by researches from the University of Minnesota, they compared medication errors with handwritten and computerized prescriptions from in-hospital doctors. According to the study there was a 5% increase in errors caused by poor handwriting. "Most errors typically go undetected unless they led to an adverse event," said review co-author Robert Kane. (Science Daily 2007) Oftentimes that adverse event is death. This is exactly why I feel there should be a big
push for computerized systems. Simply put, it improves patient safety. This should be the driving force behind all healthcare that is provided, safety and continuous quality improvement (CQI). If you are not able to read or understand orders and you have to constantly...
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