The dangers of illegible prescriptions

20170504060000, Mak Wen Yao 
Misreading a badly written prescription and subsequently dispensing the wrong item may even cost the pharmacist’s practising license.
The illegible scrawls written by a rushed doctor may come with adverse consequences when the writing cannot be deciphered.

Pharmacists, otherwise known as the unofficial cryptographers, are the most directly impacted. Misreading a badly written prescription and subsequently dispensing the wrong item may be deemed as negligence. It may even cost the pharmacist’s practising license.

The Malaysian scenario


Nearly all prescriptions in the country are written by hand, except for a selected few hospitals that utilise the electronic prescribing system. The readability of a prescription falls entirely on how well the doctor can write, and how aptly the pharmacist can interpret such writing.

National legislations only loosely regulate such issues, with the Poison Act 1952 (Revised – 1989) describing “No prescription… shall be written wholly or partly in code or in such manner that it is not readily decipherable and capable of being dispensed by any pharmacist.”

The legislation does not provide a strict definition to determine if the writing on the prescription is "legible" or not. This is in large part due to the subjectivity of the matter.

Readability of a doctor's writing depends highly on the skill of the reader, and how familiar he or she is with the particular doctor’s scribble. Nonetheless, problems arise when the pharmacist fails to clarify a badly written item on the prescription or mistook the item for other similarly named drugs, and proceeds to dispense the wrong medicine.

Adverse medico-legal implications


When the true message from the prescriber cannot be accurately conveyed to the dispensing pharmacists, the consequences could be dire as it puts patients at risk.

Pharmacists have the responsibility to clarify with the prescriber when illegible writing on prescriptions is found. Under no circumstances should a pharmacist dispense an item with doubt.

When things do go wrong, the pharmacist typically has to bear the largest responsibility as their core task is to ensure the safety of patients. However, common sense dictates that a significant part of such responsibility, if not equal to the pharmacist, must be shouldered by the prescribers as well.

Patients’ safety should not depend solely on the ability of pharmacists to read bad handwriting, but also on the ability of prescribers to write nicely. This is evident in the 1999 negligence case where an American cardiologist indirectly caused the death of his patient, due to the dispensing pharmacist wrongly interpreting his prescription of 20mg Isordil as 20mg Plendil.

The jury attributed the death of the unfortunate patient to the sloppy handwriting of the prescriber, and ordered him to pay a compensation of USD225,000 to the patient’s family member. An equal sum had to be borne by the dispensing pharmacist as well.

Electronic prescription systems


In this electronic age, it is surprising to find that many doctors are still prescribing on paper. Nonetheless, progression towards electronic prescribing is not an easy feat. Not only does it require substantial re-training of existing healthcare staffs, but also an overhaul of the IT system and integration between the public and private healthcare sectors.

Until the healthcare system is sufficiently mature to support the use of electronic prescribing, prescribers are urged to periodically stop and think "have I prescribed illegibly?”. Pharmacists are also urged to act vigilantly when handling doubtful prescriptions. After all, it is the lives of patients that are at risk. MIMS

Read more:
5 of the most disastrous medical stories involving human errors
The importance of a Clinical Information System (CIS) for your clinic
How pharmacists can spot fake prescriptions

Sources:
Poison Act 1952 (Ord. No. 29 of 1952). Malaysia; 1989.
Charatan F. Compensation awarded for death after illegible prescription. West J Med. 2000 Feb;172(2):80.
Noraziani K, Nurul’Ain A, Azhim MZ, Ekhab S, Drak B, Sharifa Ezat WP, Siti Nurul Akma A. An overview of electronic medical record implementation in healthcare system: Lesson to learn. World Appl Sci J. 2013;25(2):323–32.
Nisar S, Said AB. P Roposed F Ramework for E Lectronic. Int J Comput Sci Appl. 2011;1(1):17–25.