WINNIPEG — Along with the stethoscope and the white coat, bad handwriting is central to the popular image of the physician.
But the Winnipeg Regional Health Authority has launched a campaign to stamp out hastily scrawled prescriptions after an audit revealed a third of the orders issued in its hospitals could have compromised patient safety, either because they were illegible or contained banned abbreviations.
“We know from the literature that there are certainly medical errors that result from miscommunication,” said pharmacist Lora Jaye Gray medication safety co-ordinator for the WRHA. “There are continually reports throughout Canada of patients who have been harmed and killed through medication errors. We also know from the Canadian Adverse Events Study in 2004 that 7.5 per cent of patients admitted to Canadian hospitals had at least one adverse event. Not all were medications, but medications were a big part of that.”
The audit found that 1 per cent of prescriptions were unreadable and required a phone call to the prescribing physician or nurse to clarify. Approximately 30 per cent of all orders contained abbreviations and symbols that can be easily misinterpreted.
Some of the posters that will be used to counter what Winnipeg health officials view as dangerously poor penmanship among the medical profession.
The new policy explicitly bans the use of abbreviations such as QD, which means to be taken every day, because it can be mistaken for QOD, every other day, or even OD, which means right eye. Leading with a decimal point instead of a zero, as in .5 grams, can lead to a 10-fold increase in the administered dose. Drug names, which are often quite similar, can be confused by a pharmacist struggling to read an illegible squiggle or an unclear abbreviation, often with disastrous results.
Dr. Bill Pope, registrar of the College of Physicians and Surgeons of Manitoba, said he supports the new policy, which will be publicized by way of a poster campaign in hospitals.
A study in the British Medical Journal in 1998 found that physicians, even when asked to produce neat writing, could not write as clearly as those in other professions. But Dr. Pope said it's not as bad as it once was.
“The concept that a physician's terrible handwriting is part of the ambience of being a good doc ... I think that truly has changed,” he said. “But it still happens when they're dashing off prescriptions, of course.”
Dr. Pope said if a pharmacist is having difficulty interpreting the doctor's writing, college policy requires the doctor to immediately clarify the issue.
He can recall only one instance where the college had to take action against a physician with poor penmanship, but said the situation was resolved quickly and didn't require disciplinary measures.
In future, hospitals will strive to remove penmanship from the equation by adopting electronic records and prescriptions. A recent study in the journal Health Services Research found that having doctors write electronic prescriptions reduced medication errors by 66 per cent.
Dr. Pope said the move to electronic records, which is expensive and has been held up by legal and privacy issues, is still in its infancy in Canada.
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