Illegible handwriting and other prescription errors on prescriptions at National District Hospital, Bloemfontein

Risks in the analogue and digitally-supported medication process and potential solutions to increase patient safety in the hospital: A mixed methods study

BACKGROUND

In hospital medication errors are common. Our aim was to investigate risks of the analogue and digitally-supported medication process and any potential solutions.

METHODS

A mixed methods study including a structured literature search and online questionnaires based on the Delphi method was conducted. First, all risks were structured into main and sub-risks and second, risks were grouped into risk clusters. Third, healthcare experts assessed risk clusters regarding their likelihood of occurrence their possible impact on patient safety. Experts were also asked to estimate the potential for digital solutions and solutions that strengthen the competence of healthcare professionals.

RESULTS

Overall, 160 main risks and 542 sub-risks were identified. Main risks were grouped into 43 risk clusters. 33 healthcare experts (56% female, 50% with >20 years professional-experience) ranked the likelihood of occurrence and the impact on patient safety in the top 15 risk clusters regarding the process steps: admission (n = 4), prescribing (n = 3), verifying (n = 1), preparing/dispensing (n = 3), administering (n = 1), discharge (n = 1), healthcare professional competence (n = 1), and patient adherence (n = 1). 28 healthcare experts (64% female, 43% with >20 years professional-experience) mostly suggested awareness building and training, strengthened networking, and involvement of pharmacists at point-of-care as likely solutions to strengthen healthcare professional competence. For digital solutions they primarily suggested a digital medication list, digital warning systems, barcode-technology, and digital support in integrated care.

CONCLUSIONS

The medication process holds a multitude of potential risks, in both the analogue and the digital medication process. Different solutions to strengthen healthcare professional competence and in the area of digitalization were identified that could help increase patient safety and minimize possible errors.

Handwritten prescription practices in a public hospital in Uasin Gishu County, Kenya: a best practice implementation project

BACKGROUND

Prescription writing error is a common phenomenon in the health sector. Appropriate handwritten prescription practices minimize medical errors during medical drug dispensing.

OBJECTIVES

This project aimed to identify the extent to which clinicians adhere to handwritten drug prescription best practices and implement evidence-based strategies to improve compliance with handwritten prescription best practices in an outpatient department.

METHODS

The project was conceptually informed by the JBI Model of Evidence-Based Health care and the JBI Evidence Implementation Framework. Baseline and follow-up audit data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. The JBI Getting Research into Practice (GRiP) program was used to identify potential barriers and design intervention strategies. The project was conducted in a public hospital outpatient department in Uasin Gishu County, Kenya.

RESULTS

There was a 100% improvement in compliance with the number of prescribers who had received education on essential features of a handwritten drug prescription. High compliance was observed in prescriptions that indicated the patient name (99%) and date of prescription (98%) in the follow-up audit. Approximately half of the prescriptions included a diagnosis of the disease in both the baseline and the follow-up audit. However, in the follow-up audit, only 21% of the prescriptions had legible handwriting and 27% prescribed drugs using the generic drug name.

CONCLUSION

Regular audits and dissemination of audit findings through continuous medical education, hospital communication forums, and notices improved compliance with the number of prescriptions that contained the patient identifier and the date of prescription.

A scoping review of legibility of hand-written prescriptions and drug-orders: the writing on the wall

INTRODUCTION

Prescription and drug order writing are key components of patient care allowing physicians communicate their therapeutic plans. Although electronic prescriptions are becoming more common, handwritten prescriptions are still quite prevalent and a persistent issue with handwritten prescriptions is the illegibility of physician handwritings. Prescriptions have to be legible to avoid delays in healthcare provision and consequences as serious as patient death.

AREAS COVERED

We did a scoping review of multiple articles that assessed the legibility of prescriptions in different settings (inpatient, outpatient, and pharmacies) and countries, ranging from 1997 to 2020. Studies also elaborated on possible reasons for these suboptimal prescriptions and ways to address them.

EXPERT OPINION

While the degree of legibility of prescriptions varies widely, it remains a concern because a single incorrectly read prescription can have severe consequences. Various measures exist to possibly minimize illegible prescriptions and while none alone is probably sufficient, combining is likely to yield great results. One is the sensitization and education of physicians and physicians-in-training. Another option is audits and a third and very potent option is the use of computerized provider order entry (CPOE) system which will help improve patient safety by reducing errors due to inappropriately read prescriptions.

Impact of Illegible Prescriptions on Dispensing Practice: A Pilot Study of South African Pharmacy Personnel

Illegible prescriptions are an illegal, frequent, and longstanding problem for pharmacy personnel engaged in dispensing. These contribute to patient safety issues and negatively impact safe dispensing in pharmaceutical delivery. To date, little is documented on measures taken to assess the negative impact posed by illegible prescriptions on South African pharmacy dispensing personnel. Therefore, this pilot study was performed to evaluate the ability of pharmacy personnel to read and interpret illegible prescriptions correctly; and to report on their perceived challenges, views and concerns when presented with an illegible prescription to dispense. A cross-sectional, three-tiered self-administered survey was conducted among pharmacy personnel. A total of 885 measurements were recorded. The ability to read an illegible prescription is not an indicator of competency, as all (100%) participants (novice and experienced) made errors and experienced difficulty evaluating and deciphering the illegible prescription. The medication names and dosages were correctly identified by only 20% and 18% of all participants. The use of digital prescriptions was indicated by 70% of the participants as a probable solution to the problem. Overall, improving the quality of written prescriptions and instructions can potentially assist dispensing pharmacy personnel in reducing illegible prescription-related patient safety issues and dispensing errors.

A nationwide assessment of community pharmacists’ attitudes towards dispensing errors: A cross-sectional study

Objectives

Dispensing errors (DEs) are common causes of preventable harm to patients. Interestingly, very little is known about their prevalence and types in the community pharmacy setting in Lebanon due to the lack of an effective reporting system. Therefore, this study aims to explore the perceptions of community pharmacists about the types of these errors in Lebanon, the factors behind their occurrence, the reasons for underreporting, and the current practices for reducing them.

Methods

A cross-sectional survey was conducted through a self-administered questionnaire, using a scale of 0–4, distributed among a sample of community pharmacists in Lebanon.

Results

A total of 171 pharmacists responded to the survey, of whom 68% reported that DEs were common, and 52% believed that they were increasing. The main reported contributing factors to DEs were unreadable and incomplete prescriptions (≈3.0 ± 1.0 out of 5), workload, multitasking, interruptions, similarity in names of medications, and fatigue (≈2.5 ± 1.0). Moreover, the perceived strategies to limit the risks of DEs were collaboration with physicians, improving handwriting, double-checking, proper patient counselling, encouraging reporting, and issuance of guidelines (≈3.2 ± 1.0). Finally, the main reasons for underreporting DEs were the lack of obligation to report and the lack of reporting systems (59% and 56%, respectively).

Conclusions

DEs may be very prevalent in Lebanon because they are unmonitored by the authorities. Electronic prescription and fair reporting systems are highly recommended, along with follow-up studies.

Community Pharmacists' Opinions towards Poor Prescription Writing in Jazan, Saudi Arabia

Avoidance of medication errors is imperative for the safe use of medications, and community pharmacists are uniquely placed to identify and resolve the errors that may arise due to poorly handwritten prescriptions. Purpose: To explore the opinion and attitudes of community pharmacists towards poor prescription writing and their suggestions to overcome this concern. Methods: A cross-sectional, self-administered survey was conducted among the community pharmacists in the Jazan region, Saudi Arabia. Descriptive analysis and chi-square test were used at 5% p-value (p > 0.05) as the significance level. Results: The response rate for the survey was 78.66%, and 140 community pharmacists agreed to participate. Among the study subjects, the majority (73.57%) had a bachelor’s degree. Nearly three-fourths (3/4) of the pharmacists (72.29%) chose to send the patient back to the prescriber when they found difficulty in interpreting the information from an illegible prescription. As many as 80.71% of the pharmacists believed that poorly handwritten prescriptions were the cause of actual errors when dispensing medications. The most commonly encountered problem due to poorly handwritten prescriptions was the commercial name of medicine, which was reported by around two-thirds (67.86%) of the pharmacists. The use of e-prescription was suggested by 72.86% of the pharmacists as a probable solution to encounter this problem. Conclusion: Our findings highlight the belief and attitudes of community pharmacists in the region and their opinions to solve this impending problem of poor prescription writing. Continuous professional development courses can be adopted to tackle the problem. Additionally, health authorities can work on incorporating and facilitating the use of e-prescription in the community sector, which can be a boon to physicians, pharmacists, and patients. Proper and extensive training is however needed before the implementation of e-prescribing.

Safety Assessment of the Pharmacotherapy Process at the Nurse and Midwife Level - An Observational Study

Purpose

Pharmacological errors are among the most common in the healthcare system. This study aimed to determine the level of safety of the pharmacotherapy process at the stage performed by nurses and midwives by indicating the key risk factors affecting patients’ safety.

Methods

A group of 1276 nurses and 136 midwives in Poland participated in the study. The survey was conducted in the period from May 2019 to August 2019. The original Nursing Risk in Pharmacotherapy (NURIPH) tool was used.

Results

The Cronbach alpha coefficient was 0.832. The low legibility of the medical orders (item 1) was indicated as the highest risk. A mean of 4.50 means that this factor’s significance is assessed between “very significant” and “significant.” The communication between physician, nurse and midwife, time pressure, and work organization were also rated high (Items 2, 3, and 4). The averages for these factors are higher than 4, so their evaluation is more than “significant.”.

Conclusion

Nurses and midwives involved in the pharmacotherapy process are exposed to many ergonomic factors triggering risk. A huge problem is the lack of readability of medical orders, which may be a factor triggering a medical error.