Doctors' handwriting frequently not legible

Alphabets, numbers and punctuation marks may not appear dangerous, but when quickly applied to paper to order medication, a misplaced decimal or letter could mean the difference between life and death. Because pharmacists throughout the country struggle to read illegible prescription orders, some states are making illegibility illegal. Most recently, Florida health-care practitioners were required by state law to print legibly or type prescriptions. South Carolina doctors are expected, but not mandated, to print legibly or type medication orders. While there is no prescription legibility law in South Carolina, the issue remains a concern. "Some physicians' handwriting is atrocious," said J.L. Brueggeman, a pharmacist since 1965. Brueggeman, who has operated the Medical Plaza Pharmacy for 20 years, estimates that 5 percent to 10 percent of the prescriptions he receives are illegible. In those instances, he or another pharmacist must call the doctor to clarify what has been ordered, a process that steals the time of the pharmacist and doctor. When pharmacists don't make those calls, patients suffer the consequences. "If the pharmacists can't read it, they have to pick up the phone," said Dick Harpootlian, a Columbia attorney who represented Annie Davis, a patient who received an incorrectly filled prescription in 1999. Davis, a teacher in Denmark, S.C., was prescribed Halotestin, a hormone drug. The local pharmacist gave her Haldol, a powerful, anti-psychotic drug. After taking the medication, Davis began having seizure-like symptoms. Davis recovered. She later sued the pharmacy, and the case was settled out of court. In 1995, Gabrielle Hundley, 7, was left mildly retarded after a pharmacist in Rock Hill issued a prescription of Glynase, an adult diabetes medication. Her doctor had prescribed Ritalin for hyperactivity. The parents sued the pharmacist and the company and were awarded $16 million by a York jury. Harpootlian is working on 10 cases involving medication errors at drug stores. APPROVED ABBREVIATIONS The Institute of Medicine of the National Academies found that 7,000 of the 98,000 estimated annual deaths from medical errors resulted from improper medication. "Abbreviations are an issue," Brueggeman said. To enhance medication safety, MUSC requires health care practitioners to write medication orders based on approved abbreviations. Abbreviations that may be misinterpreted have been labeled "dangerous," and are found in MUSC's "Guidelines for Writing Medication Orders." Pharmacist Michael Cohen, president of the Institute for Safe Medication Practices, said that while Florida's law may initially be helpful, it could actually do more harm than good. The ISMP is a nonprofit organization that provides an independent review of medical errors that are voluntarily submitted by practitioners to a national medication error reporting program. "We're really concerned about Florida. This law will hurt patients. It's really unlikely that doctors will change their habits," said Cohen. "Doctors are not going to do it. They're going to tell their staff to do it, and they're not going to get it right." The better solution is to use e-prescriptions, he said. At the very least, doctors should write the purpose of the medication on the prescription. The law does not stipulate penalties for doctors who fail to comply. The boards of medicine, pharmacy and nursing are now developing "educational measures" to deal with practitioners who are reported, said Maureen Doherty, spokesperson for the Florida Department of Health, ELECTRONIC PRESCRIPTIONS In 1992, the American Medical Association adopted a resolution that urged "its constituent organizations to encourage doctors to improve the legibility of handwritten orders for medications." The S.C. Medical Association has no official policy, but reinforces the message through publications and workshops, said Dana Yow, SCMA's spokesperson. MUSC medical students learn the basic rules of writing a prescription in a class during the sophomore year. Using the hospital's standard prescription form, the students are expected to choose the proper medication, dosage, quantity and provide directions to the patient and pharmacist. To ensure accuracy and decrease liability, some doctors now use electronic devices and computer software to create electronic prescriptions. ISMP estimates that less than 5 percent of U.S. physicians prescribe medication electronically. While few doctors in South Carolina e-prescribe, Dr. H.E. "Chip" Walpole Jr. of Powdersville Internal Medicine is one who has invested in the new technology. Walpole uses a handheld device with software marketed by Allscripts Healthcare Solutions of Chicago to write orders in his office. The software checks for patient allergies, possible negative interactions of other medications and even lets Walpole know what medicine the patient's health insurance policy will approve for payment. "It saves the patient money," he said. Walpole, a 1991 graduate of MUSC, said the software is integrated into his scheduling and accounting software and there is very little information that has to be re-entered. The system must be updated quarterly. At a cost of $14,000, the system was a significant investment for the private practice. Doctors like John F. Abess of Charleston e-prescribe using the Internet. "The reason I sometimes provide the electronic prescriptions is for the convenience of my patients," said Abess, a Charleston psychiatrist. Patients communicate with Abess via the RelayHealth Web site. In June, the AMA advised doctors not to prescribe medications online without first obtaining a medical history from the patient and performing a physical examination. Although prescribing electronically is on the rise, it is not being labeled the cure for medication errors. "Things can be mis-keyed as well as they can by miswritten," said Brueggeman.