Horrible Handwriting: Horrible Mistakes

Posted on April 20, 2007
Filed Under News, Pharmacy (PharmD), Medical (MD, DO)

Horrible MistakesThe longstanding joke is that doctors have horrible handwriting. But it’s no laughing matter.

While handwriting doesn’t play a major role in most peoples’ careers, in the medical field, it can mean the difference between life and death. Whether it’s a mix-up between Lamisil and Lamictal, Cerebyx and Celebrex, Zyrtec and Zantac, or Sarafem and Serophene, confusion over drugs with similar spellings and similar sounds accounted for 15 percent of all errors reported to the United States Pharmacopeia Medication Errors Reporting Program from 1996 to 2001. In fact, it’s such a problem that the Food and Drug Administration even appointed a panel of experts to review proprietary drug names—just to try to alleviate such confusion in the future.

But beyond drug name mix-ups, poor penmanship also accounts for many other errors. From 1993 to 1998, a total of 52 deaths resulting from drug name errors were reported. And according to the Institute for Safe Medical Practices (ISMP), in the year 2000, indecipherable or unclear prescriptions resulted in more than 150 million calls from pharmacists to physicians asking for clarification—a time-consuming process that could delay important treatments, as well as lead to injury or even death.

These mistakes could also cost those involved. In 1999 in Texas, a jury awarded a woman $450,000 because her husband died from taking the wrong medication due to his doctor’s poor penmanship and the pharmacist mistakenly giving him the incorrect medication as a result.

“Reading prescriber handwriting is an acquired art,” explains Anna Peck, who is both a pharmacy student and worker. “Much of the ability to decipher prescriptions comes from pre-exiting knowledge of drug names and sig (shorthand) codes. Someone who practices in a retail setting may not be able to read messy hospital orders and vice versa.”

Peck says that last year, her state legislature (Wash.) passed legislation stating that cursive prescriptions are deemed illegible and must be verified by phone or fax, or simply rewritten.

“In the two weeks between the passage of the law and when word came around that the Board of Pharmacy was not enforcing it, I learned that forcing prescribers to write in block letters does not make crappy handwriting any better,” she added. “In fact, cursive is usually easier to read.”

At Cedars-Sinai Medical Center, the powers that be have offered special classes in handwriting for members of their medical staff. After contacting a firm that specialized in teaching people good penmanship, nurses and administrative staff were asked to help identify physicians who would most benefit from the class. The three-hour course was self-instructional and emphasized a cursive italic handwriting style, with tips on the correct position of the paper, the size of letters, the length of strokes, and how to hold the writing instrument.

Beyond penmanship pointers, the ISMP advocates the use of electronic prescribing tools that computerize the process of ordering prescriptions, which has been shown to reduce potentially harmful prescription errors, allergic drug reactions and excessive drug dosages. These computers also check for drug side effects, drug interactions and inappropriate dosages, among other errors.

But if a physician is planning to stick with pad and pen, experts recommend using caution when writing prescriptions or orders for drug products with brand names similar to other brand named drug products, generic names similar to other generic named products, or brand names similar to other generic named products.

While Peck has heard of one guy in Everett, Wash., whose handwriting was so bad that the state board restricted his prescriptive authority to typewritten or electronically generated prescriptions, she says, “Honestly, most of the prescriptions we get are ultimately legible, even if they appear messy.”

“I’d venture to guess that quite a few more mis-fills are blamed on ‘illegibility’ than are actually caused by it. Often, bad handwriting is used as an excuse for sloppy eyesight or other errors. A truly illegible prescription usually cannot be read at all and the prescriber must be contacted for clarification. Only rarely do we find that we truly misread one drug as another, one dose as another, or one sig as another, because the item was really ambiguous and that fact eluded us.”

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2 Responses to “Horrible Handwriting: Horrible Mistakes”

  1. Handwriting: better penmanship = better doctor « Medliorate on May 9th, 2007 3:45 pm

    […] by wupz on May 9th, 2007 In the medical field, bad handwriting results in errors. Student Doctor Network outlines some motivating reasons to improve your handwriting. confusion over drugs with similar […]

  2. Horrible handwriting:Horrible Mistakes - xenoMED on May 10th, 2007 10:08 am

    […] careers, in the medical field, it can mean the difference between life and death. Whether it?s.. Horrible Handwriting: Horrible Mistakes : The Student Doctor Network i take life […]

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