Medical errors that involve handwritten prescriptions

by Daphne Swancutt

Two people in the United States just died in the last hour. Seventeen more will die in the next 7 to 8 hours. Over a year, that number will accumulate to about 7,000.

The reason? Medical errors that include misread or otherwise misinterpreted handwritten prescriptions. Believe it. This means that doctors are being sloppy, pharmacies are making mistakes and people are getting dead.

Even more disturbing about this statistic is that 85 percent-plus of pharmacies are equipped to receive electronic prescriptions, yet only one-third of the nation’s prescribers use this system.

It seems appropriate, then, to draw some attention to this stupid and nonsensical tragedy during Health Literacy Month and to ask: What’s the deal?

Of course, this is the darkest side of the problems surrounding health literacy. And, as tragic as those 7,000 annual deaths are because of measly handwriting skills and a refusal to at least tiptoe into technology, it’s merely one symptom in a cluster-you-know-what of absurdities.

Consider the following:

  • 9 out of 10 adults have trouble understanding and using everyday health information.
  • Low literacy costs the U.S. health system an estimated $106 billion to $238 billion annually.
  • Health literacy is a stronger predictor of your health than your age, income, employment status, education level and race.

Those factoids come from the Institute of Medicine, which defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” For patients, that’s more than being able to read a prescription label. It means amassing, analyzing and interpreting health information that may be basic to some, but quite complex to others.

For providers, pharmaceutical companies, insurers and others who disseminate health information, it means communicating important—even life-saving—material that is neither engorged with CYA legalese nor “dumbed down,” but is plain, succinct, relevant and understandable. And, it also means individualizing information to specific audiences depending on their vulnerabilities (age, language, ethnicity, education, etc.).

The concept of health literacy isn’t new, but it was only this year that the Department of Health and Human Services announced its National Action Plan to Improve Health Literacy—no doubt answering the call of our new health reform law to make health literacy a priority.

For those of us communicators who support all of the various healthcare professionals, this is our mandate, too. It means taking a closer look at how and where patients are getting information—your website, other health information sites and social networks, smart-phones, the kiosk in your hospital, or the caregiver who attends to them—and making sure you’re doing your part to make it clear and helpful.

Let’s all work toward clarity and use the technologies available to us—we sure don’t need people dying because of bad handwriting.

Daphne Swancutt is Director, Healthcare Strategy at IMRE, and blogs at IMRE Health HQ.

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  • justin

    e-prescribing costs money and insurance won’t pay for it. Maybe patients will pay for it. What do you think about that?

    And saying “that doctors are being sloppy” isn’t fair to all of us doctors with excellent handwriting. You should say “some” doctors are being sloppy.

    I agree with the whole health literacy thing.

  • Paul Watson

    ‘Over a year, that number will accumulate to about 7,000.
    The reason? Medical errors that include misread or otherwise misinterpreted handwritten prescriptions. Believe it.’

    We might believe it if you provided a source for this stat.

  • http://www.millerandzois.com Ron Miller

    This is a good post but I agree with Paul that this is the Internet. No one trusts anything without a reliable source it can click on behind it. And we shouldn’t.

  • http://www.millerandzois.com Ron Miller

    One more problem… the one stat that is provided is not on the link (the 85% stat). I just assumed that one was supported. The rule should be that you have to provide a source, preferably one we can click on or at least cite the sources so it can be checked.

    Again, this is a great blog but we have no idea what kind of quality control is going on or whether these guest post statistics are checked. This hurts the credibility of the entire otherwise good post.

  • Matt

    Actually, people don’t trust anonymous stats that disagree with their opinions. If they confirm their preconceived notions, they think they’re right on!

  • http://www.mrs4life.com/ Mrs. Life

    It always seems like such a joke that doctors, who spent almost a decade in their schooling can have such terrible handwriting. You’d think they’d have a more sophisticated handwriting skills after all those years? But if it means endangering, and opening up to misinterpretation, there better be a new way to give out prescriptions.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    The alternative to handwritten prescriptions is not solely electronic transmission. Faxed prescription and printed out prescriptions are as clear as anything else going electronically.

    Also how many of those 7000 are going to die because of handwritten prescriptions of controlled substances which are currently prohibited from electronic transmission?

    As to health literacy education, I’m all for it….

  • Greg

    Interesting post: I currently have a fully automated electronic Rx system at my disposal, which I had fought for with the administration of our clinic, based on the idea that it would reduce errors and make things easier for everyone. Though it was expensive, the administration eventually agreed. I helped teach the other docs and nurses in the practice how to use it. The irony now is that I have gone back to handwritten prescriptions. Here’s my reason – it might not apply to most doctors, but here goes anyway.

    I’ve somehow found that the writing of the prescription, with a pen, using your own hand, and then looking the patient in the eye when you give them this little note, has a ritual significance to both the patient and doctor which helps to cement the relationship between the two. You came to me for help, and I’m writing down how I can maybe help you, and I hand this note to you – it’s actually a very intimate shared experience, infused with meaning. I’ll let the psychologists dissect what meanings in particular, but I’ve found that with the electronic Rx, where I just click a button and the prescription is sent directly to the pharmacy, some of this close human interaction is lost. “Ok, I’ve sent your scripts to the pharmacy for pickup” just feels like it’s missing something – it’s cold, corporate, dehumanized, cattle-call like, DMV-ish. Modern medicine has too much of this already and I say unless we draw a line in the sand somewhere, we’ll continue to sacrifice the little human connection we have left with our patients and be left with a dry, rote, skeletal, Walmart-ized version of our profession. So, that’s why I went back, despite our clinic dropping some serious money on an e-Rx system. I had to draw a line somewhere, so why not here?

  • http://paynehertz.blogspot.com Payne Hertz

    Google is your friend:
    http://www.time.com/time/health/article/0,8599,1578074,00.html

    Electronic prescribing for free:
    http://www.nationalerx.com/

    No more excuses.

    • Paul Watson

      There’s no excuse for not providing references and in this case the 7,000 figure is highly suspect given it’s plucked from a third party (Time magazine) which in turn is from an IOM report of several years ago, which in turn is from limited studies, many of which are old. That said, medication errors are very common of course but the contribution of handwritten prescriptions is not known with anything like the degree of certainty that the blog writer says.

  • stargirl65

    I have been using printed prescription in the office for 10 years. As technology improved I added faxing printed prescriptions as well. As it improved further I added electronic prescriptions as well.

    I still have to print some prescriptions for patients for mail away and for controlled substances. But these are clear as they are done on a printer and signed, not hand written.

    Interesting side light. They have found in the last year that electronic prescribing has a lower rate of picking up prescriptions than giving a person a paper prescription. This study was recently reported. (I can try to find if someone insists but read it last week.) So somehow handing someone a prescription increases the chances that they will fill it and use it.

  • Max

    That CNN article also notes that 80% of rx are written by only 30% of prescribers. Stastically speaking, most of us aren’t causing the error as 80%x7000=5600 deaths. 30% of physicians x 954,000 total u.s. physicians (doesn’t include all prescribers i.e. np, pa, etc)=286,200. So 667,800 physicians (again not total prescribers) are responsible for 1400 rx miswritten deaths. Take into account NP and PA etc and it may only be 800 deaths from 667,800 physicians. That’s pretty small odds. Probably more killed crossing the street to/from the physicians office or slipping on the sidewalk outside their office.

    • http://paynehertz.blogspot.com Payne Hertz

      Problems with your analysis being we don’t know which doctors in particular are responsible for prescription drug errors. The error rate is also influenced by the pharmacist’s ability to read hieroglyphics.

      You wouldn’t think one death per year for every 600 doctors is low odds if it was your child being killed. The DEA successfully prosecutes less than 5 doctors every year for drug abuses and that’s enough to scare the majority of doctors into not prescribing controlled substances. But 7000 patients a year dying from preventable handwriting errors? Meh.

      The same IOM report puts the number of people injured by prescription errors at over 1 million a year. That’s more than one patient per doctor per year, though it doesn’t cite handwriting as the cause. Add in people who are made ill but don’t report problems, or those who are simply inconvenienced, and you have a truly massive problem.

      There is no excuse for inaction in fixing this problem when the fix is so easy and the cost of ignoring the problem so high.

  • http://www.millerandzois.com Ron Miller

    Right, Max, but, ah, that is 800 folks we would still like to have with us.

  • http://myheartsisters.org Carolyn Thomas

    The same incompetence that caused my former doctor to write down double the normal dosage of my meds on a prescription pad, or write 40 pills (instead of 90, the standard 3-month supply) for the blood pressures meds I’ve been on for years may likely kick in if she had to use the electronic Rx format, too.

    I started getting used to my concerned neighborhood pharmacist phoning me back to double-check a clearly wonky prescription. Without that confirmation, I have no doubt that I’d be one of the 7,000 dead (or 800 – who cares? I’d be just as dead whether I had a little company or lots!)

    Bad handwriting or bad medicine? Whichever it is, I now believe it is entirely up to the patient to be able to decipher the prescription, ask questions while still in the doctor’s office, and before dropping the piece of paper off at the pharmacy, ask the pharmacist to review the recommendations, too.

    Trouble is, as a heart attack survivor with ongoing cardiac issues who now takes a fistful of meds every day, some days I’m not the sharpest knife in the drawer during these doctor visits.

    Unfortunately, neither was my doctor.

    • http://paynehertz.blogspot.com Payne Hertz

      I would agree the first line of defense against medical error are patients themselves. It is dangerous to rely on doctors and pharmacists to get it right and you need to stay informed and double check every prescription to make sure it’s correct.

      This doesn’t mean the patient is responsible for any errors, of course. Just that the patients need to recognize that errors do occur and protect themselves against them.

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