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The abysmal handwriting of physicians is the stuff of legend among nurses and pharmacists. But the result - frequent medication errors due to drug names and dosages misread from doctors' chicken scratch - is deadly serious.

New research has driven home just how harmful badly written prescriptions and other transcription errors can be.

The study, published in the journal Health Services Research, shows that having doctors write electronic prescriptions - by typing them into a computer rather than writing them by hand - reduces medication errors by a staggering 66 per cent.

"These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake," said Tatyana Shamliyan, a research associate at the University of Minnesota School of Public Health, and the lead author of the paper.

While poor handwriting is a major issue, it is not the only one, she said. Medication errors can occur because of transcription problems, poor communication, incomplete medical records and drug reactions.What is clear, though, is that a computerized physician order entry (CPOE) system dramatically reduces mistakes.

"With CPOE, handwriting and transcription errors should drop to almost zero; that's our experience," said Matthew Anderson, vice-president and chief information officer at University Health Network in Toronto.

He said almost 95 per cent of prescriptions at UHN, one of Canada's largest hospitals with 698 beds, are now done electronically.

"This is the right thing to do for the safety of patients," Mr. Anderson said.

The new study noted, however, that only 9 per cent of U.S. hospitals have CPOE systems. In Canada, the rate is even lower, and varies dramatically by province. In Alberta, for example, about seven in 10 hospitals now have CPOE.

The new study is a meta-analysis, a compilation and analysis of research that has already been published. In this case, the research team led by Dr. Shamliyan examined 12 studies that compared medication errors that occurred with handwritten and computerized prescriptions from in-hospital doctors.The research study found that prescribing by computer:

Cut total prescribing errors by 66 per cent;

Reduced dosing errors by 43 per cent;

Reduced instances in which patients were harmed by 37 per cent.

The improvements are welcome, the study said, because nearly one in four patients experienced a medication error.

Robert Kane, a professor in the school of public health at the University of Minnesota and co-author of the study, said that "most errors typically go undetected unless they led to an adverse" - meaning a serious illness or death.

In Canada, it is estimated that there are up to 12,000 deaths annually due to drug-related adverse events. These include administering the wrong drug, the wrong dosage, drug interactions and reactions.

The study listed some examples of common errors that occur when prescriptions are handwritten or dictated and transcribed. For example, the pain medication Celebrex can be confused with the antidepressant Celexa, and the tranquilizer Zyprexa with the antihistamine Zyrtec.

Similarly, a simple mistake such as putting a decimal point in the wrong place can result in a patient being given 10 times the recommended dosage of a drug.

"Often physicians are writing prescriptions under pressures of time, and they can make careless errors, like writing 50 milligrams instead of 5 milligrams," Dr. Kane said.

He said that most people also don't realize that, from writing a prescription to filling an order, the document can pass through five sets of hands, multiplying the risk for errors.

In the hospital setting, prescriptions can be extremely complex because they include four variables: the drug, the dosage, the frequency and the route of administration, all of which can change over a period of hours.

"It's a complex order and requires a sophisticated electronic system," Mr. Anderson said.

He said that while computerization is a great benefit, it is not a panacea. "This doesn't take the place of good care and good communication between doctors, nurses and pharmacists; it enhances it."

Arthur Levin, director of the Center for Medical Consumers in New York, said the switch to electronic prescribing is long overdue.

He said that, in the 21st Century, doctors' prescribing pads are as outdated and flawed as bloodletting in the 19th Century.

"Written and verbal orders should be a no-no," Mr. Levin said.