When Writing Prescriptions, Are You Dotting Your Ps and Crossing Your Eyes? 5/8/2000  Dentists and physicians are notorious for bad handwriting. Reading some doctors' prescription orders has been likened to deciphering hieroglyphics or interpreting the Rosetta Stone. But though society once made light of their indiscernible scratches and scrawls, doctors' bad handwriting is no longer a laughing matter. According to Paul Hackmeyer, MD, chief of the medical staff at Cedars-Sinai Medical Center, Los Angeles, poor handwriting can be dangerous -- if not deadly. "Bad handwriting can lead to dramatic medication errors," explains Dr. Hackmeyer, "while clear, easy-to-read handwriting can help protect patients from the consequences of taking the wrong medicine. On Tuesday, May 9, we are offering a special class in handwriting for members of our medical staff. Though Cedars-Sinai medical staff consistently rates high in customer satisfaction, we realize that many of our physicians don't write legibly and we wanted to take the initiative and address this concern." Dr. Hackmeyer says that the medical staff decided to offer this class in response to recent national studies, like that of the Institute of Medicine, which highlight the need to reduce medical errors. He cites a widely publicized 1999 case in Texas where a jury awarded a woman $450,000 because her husband died from taking the wrong medication. "Because of the doctor's poor penmanship, the pharmacist mistakenly gave him a different medication," says Dr. Hackmeyer. "This tragic situation is certainly a cautionary tale for everyone in the medical profession." In order to create interest in the handwriting class, Dr. Hackmeyer borrowed basic techniques from Madison Avenue. He had the Medical Center create posters and flyers featuring a photo likeness -- and cryptic penmanship -- of Marshal Fichman, MD, a longtime kidney specialist at Cedars-Sinai. "Dr. Fichman is our poster child for the handwriting challenged," says Dr. Hackmeyer. "He's been such a good sport about this. In addition, we're currently featuring a contest where our doctors have to decipher the handwriting of two anonymous colleagues. The grand prize is Sunday Brunch for two at the Four Seasons Hotel in Beverly Hills." The strategy worked. Dr. Hackmeyer says that Cedars-Sinai physicians have responded enthusiastically to the class and contest and already, more than 50 have signed up. "We contacted a firm that specializes in teaching people good penmanship," he says. "Then, we asked nurses and administrative staff to help us target those physicians who would most benefit from this class. The three-hour course will be a self-instructional one that emphasizes a cursive italic handwriting style, with tips on the correct position of the paper, the size of letters, the length of strokes, and how one should hold the writing instrument." Though he's had fun promoting the class, Dr. Hackmeyer takes the project very seriously. "By offering this innovative handwriting course for our physicians and making the reduction of medical errors one of the medical staff's top strategic goals, we believe that Cedars-Sinai is raising the bar for other medical institutions," he says. "So that we can measure the effectiveness of our efforts, we are currently conducting a survey to determine how many calls our doctors' offices receive from pharmacists who cannot read their prescriptions. After the class, we will do follow up to see if the numbers have decreased. At Cedars-Sinai, we have a whole network of interdisciplinary committees that work to improve, not just maintain, our already high levels of excellence." Another organization is taking a different approach to the handwriting issue. The Institute for Safe Medication Practices says the healthcare system should eliminate handwritten prescriptions by the year 2003. In fact, the organization contends that new systems that computerize the prescribing process are coming on line and hold the potential for eliminating the problems associated with poor handwriting skills. “Prescription writing is perhaps the most important paper transaction remaining in our increasingly digital society; it seems simplistic to note that electronic prescribing tools could minimize medication errors related to handwriting,” the nonprofit ISMP (Huntingdon Valley, PA) says in a white paper. “Yet even though such devices are available for use in hospitals, ISMP estimates that less than 5% of U.S. physicians currently ‘write’ prescriptions electronically.” The paper quotes studies that find a dramatic decrease in medication errors with the use of technology. One study, ISMP says, found a 55% reduction in errors with potential for harm when physicians used a computer order entry program. Another study of intensive care patients found that a computerized system helped dentists and physicians reduce the incidence of allergic drug reactions and excessive drug doses by more than 75%. The paper points out a number of benefits that come from integrating patient and drug information for electronic prescribing: Computers can maintain accurate, unbiased, and up-to-date drug databases, which constitute essential tools as the number of approved medications continues to increase. Prescribers can receive on-screen prompts for drug-specific dosage information, with reminders to ensure that look-alikes and sound-alikes are not confused. Vital patient-specific information, such as overdose warnings, drug interactions, and allergy alerts, can be presented in the course of prescribing, so that potential ADEs that would otherwise go unrecognized can easily be avoided Computers can reduce, even eliminate, the margin for error by flagging pre-existing medical conditions or concurrent medications that would preclude use of certain drugs in individual patients. Electronic prescribing can expedite refill requests, once patients are entered into the system. Computers can facilitate data exchange to enhance teamwork between clinicians and professionals who represent other parts of the medication management system, such as pharmacists in retail, hospital, and online environments; pharmacy benefit managers; and health plans. Computers can enable practitioners to stay abreast of changes in formularies and insurance coverage. The use of computers can reduce healthcare costs through time and efficiency savings and by encouraging prescribers to consider lower-cost drug options. “Put simply, handwritten prescriptions ought to be a thing of the past,” the white paper goes on to say. “Healthcare practitioners and providers across the nation should rapidly and aggressively take advantage of the electronic prescribing technology that can help prevent medication errors today.” Edited by Chris Smith

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