Computers may help fix doctors’ handwriting

MINOT, N.D. (AP) — Hospitals are trying to cut down on the potential for mistakes caused by hard-to-read handwriting. One answer — computers — is costly.

USA Today

The price tag on electronic systems has been outside the reach of many of the state’s rural hospitals until now, said Mary Wakefield, director of the University of North Dakota Center for Rural Health in Grand Forks.

"The federal government has made $26 million in grants available this fall to help rural hospitals with information technology to improve patient safety, which can include computerized drug-order systems," she said.

Computers eliminate potential handwriting problems, and also can red-flag an abnormal dose or a potential for interaction with a patient’s other drugs, Wakefield said.

Even when poor handwriting does not lead to error, it can cause delays when nurses or pharmacists have to track down a doctor to verify information.

"We call and clarify a prescription at least a couple times a day," said Lance Mohl, a pharmacist with Keycare Pharmacy in Minot.

A 1997 Texas study involving six experienced nurses reading medication orders written by 36 doctors found that 20% of the medication orders and 78% of the signatures were illegible or legible with effort. Another Texas study in 2000 found 10% of one hospital’s physician orders and 15% of the prescriptions at a community pharmacy were illegible.

Health care systems around the country have gone to different lengths to address handwriting problems. Some hold penmanship classes for doctors or ban drug abbreviations, and some provide doctors with hand-held computers that beam data to printers.

Some Minot physicians and dentists have acquired computer software capable of printing out prescriptions.

Donna Wahl, president of the National Association of Boards of Pharmacy, has targeted the elimination of handwritten prescriptions as one of her goals.

"Nationally, its an issue and in North Dakota as well," said Howard Anderson, executive director of the North Dakota Board of Pharmacy.

Trinity Hospital in Minot has a new automated pharmacy system that could be expanded to include electronic prescription orders.

"As we move forward with technology, Trinity will go to this system, which should eliminate most legibility problems," said Jeffrey Verhey, chief of medical staff. Currently, the staff is very careful to decipher some handwriting, and to call doctors with any questions.

Trinity pharmacy manager Doug Gietzen said problems can occur when a new pharmacist or a new doctor comes on board with unfamiliar handwriting.

"Once pharmacists become accustomed to a doctor’s handwriting, the problem of reading the orders usually takes care of itself," he said.

"You do get used to some of the worst handwriting in the world," he said. "You learn and you adjust to the physician."

Trinity’s pharmacy also posts doctors’ signatures so pharmacists can identify those that are unclear.

Gietzen, who spent 35 years reading doctors’ handwriting, said the script hasn’t gotten any worse. The difference is that there are more drugs and more similarly named drugs to cause confusion, he said.

On the other hand, he said, "There are a lot more safety checks that we didn’t have many years ago.

The hospital pharmacy knows the patient’s diagnosis, so if the prescription doesn’t track with the illness, it sends up a red flag, he said.

Pharmacists also counsel customers on their prescriptions so they are more likely to catch errors, he said.
Copyright 2003 The Associated Press. All rights reserved.

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