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Illegible Handwriting, Physician's Penmanship, Chicken Scratch, Direct Patient Care

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See also: Medication Errors, Nursing Malpractice Cases

Brilliant Communication or Chicken Scratch? How to Read a Doctor's Prescription, Ask Your Pharmacist!:"Q. What does all that doctor's scribble on my prescription mean? Is there a trick to help me read prescriptions? A. Just like the English speak English, French speak French and the Vietnamese speak Vietnamese, doctors, nurses and pharmacists speak the language of medicine. It takes years of training to understand what might be spoken amongst health care professionals in your local hospital or the dense pages of information written in your own medical chart. Your prescription is an extension of this medical terminology. It contains key information and directions regarding your medication including the name, the dose, how to take it, when to take it, how frequently it should be ingested, and when the medication should be stopped, if it is to be taken for a definite duration."
http://www.askyourpharmacist.ca/how_to_read_prescriptions.html

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Death By Handwriting, By Maureen Glabman, Trustee Magazine :"Most Americans don't receive any formal handwriting instruction beyond the third grade, so how we learned to write then is more or less what we are stuck with for the rest of our lives. It's a worn joke that when someone writes poorly, we tell him he could be a doctor. But a medical error due to misinterpretation of illegible writing is no laughing matter--and for physicians it is a major threat to patient safety. The Joint Commission does not know precisely how often hospitals are reproached for handwriting deficiencies, but the problem is believed to be substantial. "The Joint Commission almost always finds instances where handwriting is of poor quality," says Peter Angood, M.D., JCAHO vice president and chief patient safety officer. The standard that encompasses handwriting legibility also includes stipulations that medical records be dated, that patients be identified and that diagnoses are supported, among other requirements, so it is difficult to sort out individual deficiencies."
http://www.trusteemag.com/trusteemag_app/jsp/articledisplay.jsp?dcrpath=TRUSTEEMAG/PubsNewsArticleGen/data/2005/0510TRU_FEA_Handwriting

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Doctor, is your writing legible? Animesh Jain, Prateek Rastogi, Indian Journal of Medical Ethics:"Today, computers are used in every field of work including medicine. Despite the computer revolution, however, a great deal of information in clinical records in hospitals continues to be handwritten. The doctor may understand what he/she has written, but difficulties arise when other parties are involved. The handwriting of healthcare professionals in general and doctors in particular has been known to be illegible and difficult to decipher (1). In India, as in most other parts of the world, it is generally accepted that doctors have handwriting which needs some skill to decipher. Yet the importance of a doctor`s handwriting cannot be overemphasised. Pharmacists and nurses have to read the physician`s prescription to dispense and administer the correct medication to patients. Patients need to understand the prescription to take proper and timely treatment. In one study, 117 case notes were examined and 18 (15%) were so illegible that the meaning was unclear (1). Another study suggests that doctors, even when asked to be as neat as possible, produce handwriting that is worse than that of other professionals (2). This provides supportive evidence for the commonly held belief that the legibility of doctors` handwriting is unusually poor."
Department of Community Medicine, Kasturba Medical College
Mangalore 575 001 INDIA
email: animesh_j@yahoo.com
Department of Forensic Medicine and Toxicology,
Kasturba Medical College, Mangalore 575 001 INDIA
http://www.issuesinmedicalethics.org/171co42

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Electronic Prescriptions Save Lives and Money, MichiganToday.net:"To combat growing quality and safety concerns, a bi-partisan coalition led by Debbie Stabenow, U.S. Senator (Michigan) is trying to pass legislation aimed at expediting the use of electronic prescribing. “E-prescribing” is when a physician uses a computer or hand-held computing device to electronically generate and send a prescription to a pharmacist's computer. The benefits of this technology include reducing potentially harmful drug interactions by alerting physicians of possible risks, eliminating illegible physician hand-written prescriptions and cutting patient wait time at the pharmacy. Less paperwork and more information for the physician equal more convenience and lower cost for the patient."
MichiganToday.net
P. O. Box 700112
Plymouth,, MI 48170
(734) 223-9645
http://www.michigantoday.net/living.electronicprescriptions.html

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Electronic Prescriptions Save Lives and Money, VIDEO from Medialink and General Motors:"Four out of every five adults take at least one medication or dietary supplement every day, according to the Institute of Medicine. Every year, hundreds of thousands of prescription drug errors are made due to handwritten prescriptions. These errors often lead to drug mix-ups, wrong dosages, dangerous drug interactions and allergic reactions."
http://www.advfn.com/news_VIDEO-from-Medialink-and-General-Motors-Electronic-Prescriptions-Save-Lives-and_25165842.html

Illegible Handwriting, Physician's Penmanship, Chicken Scratch, Direct Patient Care, http://www.nursefriendly.com/nursing/directpatientcare/illegible.handwriting.physicians.penmanship.htm

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The handwriting is on the wall for nation's doctors. Penmanship classes helping to make prescriptions legible:"He's a veteran physician who works as a trauma surgeon. Just don't ask Dr. Sheldon Brotman to write a legible prescription. That's why he's here, sitting in a handwriting class at Atlantic City Medical Center, learning how to hold his pen, position his paper and put a sharp angle on his "z" so it doesn't look like an "s." "My signature is always a problem down at the pharmacy," Brotman said."
http://www.seattlepi.com/national/docs05.shtml

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Illegible handwriting in medical records, F Javier Rodríguez-Vera MD:"In clinical records many items are handwritten and difficult to read. We examined clinical histories in a representative sample of case notes from a Spanish general hospital. Two independent observers assigned legibility scores, and a third adjudicated in case of disagreement. Defects of legibility such that the whole was unclear were present in 18 (15%) of 117 reports, and were particularly frequent in records from surgical departments."
http://jrsm.rsmjournals.com/cgi/content/abstract/95/11/545

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Implementing a Legible Handwriting Policy, By Lewis Zulick, MD, MMM, FACS and Maura Farmer, American College of Physician Executives:"Legibility of chart notations and physician orders has become a topic of increasing concern since the health care industry began its prolonged introspection regarding patient safety first prompted by the Institute of Medicine report “To Err is Human” in 2000. Our hospital set out to create a medical staff policy to address this problem. Previously, the frequent illegibility of physician handwriting had been considered an unavoidable fact of life and even a source of wry amusement. There is an increasing realization that the poor communication that results from illegible chart entries is not an acceptable standard for the profession. As with many traditional practices viewed from a fresh perspective, it appears incredible that the present standard was ever considered acceptable. Still, there is a sense that illegible physician handwriting will be difficult to eliminate because of ingrained work habits and a lack of central authority with which to address the problem."
The American College of Physician Executives
400 N. Ashley Drive
Suite 400
Tampa, Fl 33602
Toll Free Phone Number: 800-562-8088
Outside the U.S. 813-287-2000
Fax: 813-287-8993
For general inquiries, please email: acpe@acpe.org
http://www.acpe.org/Publications/LeadingEdge/2006/Winter/cmu.aspx

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In the long run, penmanship classes for doctors won't do much for patient safety, Institute for Safe Medication Practices (ISMP):"With the nation's attention now focused on patient safety issues, television and print journalists frequently cover stories about medical errors. Often, medication errors caused by poor physician handwriting are a common theme. While jokes and cartoons still flourish about illegible prescriptions, the public is personally familiar with this problem, and it is no longer considered a joking matter. Recently, national television networks and wire services have reported a number of efforts that are underway at hospitals across the country to bring doctors back to the classroom for courses in basic penmanship. While we applaud hospitals that seek to improve handwriting through these courses, we fear that such actions will achieve only marginal improvement at first and even less sustained improvement over time."
Institute for Safe Medication Practices (ISMP)
1800 Byberry Rd., Suite 810 Huntingdon Valley, Pa. 19006
Voice: 215.947.7797 Fax: 215.914.1492
E-Mail: ismpinfo@ismp.org
http://www.ismp.org/newsletters/acutecare/articles/20010110.asp

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Nurse Perceptions of Medication Errors: What We Need to Know for Patient Safety, Journal of Nursing Care Quality:"This study describes nurse perceptions about medication errors. Findings reveal that there are differences in the perceptions of nurses about the causes and reporting of medication errors. Causes include illegible physician handwriting and distracted, tired, and exhausted nurses. Only 45.6% of the 983 nurses believed that all drug errors are reported, and reasons for not reporting include fear of manager and peer reactions. The study findings can be used in programs designed to promote medication error recognition and reduce or eliminate barriers to reporting."
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=514523

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Physicians Barred From Cursive Writing For RX, By Stephen A. Frew JD, Medlaw.com:"In a move that caught physicians and pharmacists off-guard, a new Washington state law went into effect this month that requires prescriptions to be printed, typed or electronically entered in order to be filed and filled. The law bans cursive writing."
http://www.medlaw.com/healthlaw/MEDMAL/physicians-barred-from-cu.shtml

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What can we do about illegible physician handwriting? HCPro, Inc.:"As part of our ongoing record review, we are monitoring legibility of handwritten entries in medical records. What would be the appropriate process to follow when addressing legibility of a physician's handwriting? I would like to have some options for corrective action when I approach the medical staff with this issue."
http://www.hcpro.com/CCP-31725-862/What-can-we-do-about-illegible-physician-handwriting-Do-we-have-to-give-our-privacy-notice-to-all-of-our-existing-patients-Payperview-article-The-inside-scoop-How-the-OIGs-pharma-guidance-affects-providers.html

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Why is handwriting important? Prescription for Safety, American College of Physicians:"Physicians' handwriting is a source of endless jokes, but illegible orders are no laughing matter. Illegible handwriting on prescriptions takes extra time to interpret, and pharmacist callbacks result in lost time to the practitioner. Tragically, illegible handwriting is a common cause of medical error and has led to patient injury and death. According to a 1997 American Medical Association report, errors related to misread prescriptions were the second most common and expensive malpractice claim over a seven-year period.2"
http://www.acponline.org/running_practice/patient_care/safety/faq.htm

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Prescription Mistakes:"Poor legibility of doctors' handwriting may lead to prescription errors and problems with referral letters. Using computer technology to assess handwriting in an objective manner, a British survey compared doctors' handwriting with that of administrative staff and other healthcare professionals. Participants were asked to complete a form that contained boxes for the respondent's name, the 26 letters of the alphabet, and the digits 0-9. They were told that examples of handwriting were needed to test computer software for optical character recognition and were asked to write as neatly as possible"
http://132.183.145.103/forum_2/PorphyriaF/12.16.998.36PMPRESCRIPTIO.html

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Doctors Penmanship Sickening - Study:"London - A new study has confirmed what most people already know: Doctors have terrible handwriting. "The age old prejudice people have about doctors' handwriting is actually true," Ronan Lyons, a doctor with the Department of Public Health in Swansea, said in a telephone interview Friday."
http://www.edmontonjournal.com/weird/093098weird.html

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Deciphering illegible handwriting (1): causes and solutions to deciphering illegible handwriting, International Journal of Forensic Document Examiners:"An important aspect of the forensic examination of documents is deciphering or transcribing illegible handwriting in order to comprehend the contents of the document. This is more often required in the case of wills in which the handwriting may be extremely deformed/degraded due to the psychosomatic condition of elderly or sick people. The main methods of deciphering are: the photographic magnifying of the text, microscopic examination, the use of video spectral comparator and scanning by means of a computer. This paper demonstrates some representative cases."
http://static.highbeam.com/i/internationaljournalofforensicdocumentexaminers/january011999/decipheringillegiblehandwriting1causesandsolutions/

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Illegible Handwriting Strikes Again ... by John Dodge, Health-IT World:"There's no shortage of snafu stories in healthcare when it comes to illegible handwriting. The experience I am about to relate was but an annoyance, but I can certainly see where it could repeat itself thousands of times every day across the vast landscape of American healthcare. Undoubtedly, illegible handwriting is one of the major causes of inefficiency when tests or prescriptions are ordered."
http://www.health-itworld.com/enewsarchive/e_article000216777.cfm

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Computerized Order Entry Results in More Timely and Efficient Care, Cincinnati Children's Hospital Medical Center:""The COE system makes illegible physician handwriting a thing of the past," says Dr. Jacobs. "It also is seamlessly integrated with a clinical documentation system. This system documents things nurses used to document on multiple paper forms, such as vital signs, allergies, heights and weights. And, it includes an electronic medication administration record, formerly transcribed onto a piece of paper by a health unit coordinator and/or a nurse but now seamlessly integrated into the informatics system." Clinical documentation is essentially electronic charting and supports the COE system by providing patient data such as vital signs, weights and patient assessment information for use in the ordering process. It eliminates safety issues, such as misinterpretation of orders and transcription errors, and it gets rid of redundant charting, which is an inefficient use of a nurse's time."
Jim Feuer, 513-636-4656, jim.feuer@cchmc.org
Cincinnati Children's Hospital Medical Center
3333 Burnet Avenue, Cincinnati, Ohio 45229-3039
513-636-4200 | 1-800-344-2462 | TTY: 513-636-4900
http://www.cincinnatichildrens.org/about/news/release/2003/1-coe.htm

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/nursing/directpatientcare/illegible.handwriting.physicians.penmanship.htm

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Created on January 30, 2000

Last updated by Andrew Lopez, RN on Friday, January 24, 2014


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