Student and doctors’ handwriting and transcription skills : how great is the potential for medical error?

Abstract

Medical errors are commonly the result of poor doctors’ handwriting. The latter was assessed by asking 150 medical students, in the third to the fifth year of studies, and 50 doctors of varying grades from Foundation to consultant level, to complete a pre-prepared prescription including 5 medications onto a standard hospital prescription chart. Every participant’s handwriting was graded using a standard score, cross-checked by two researchers and a further 3 independent assessors.

166 prescriptions were completed by 137 students and 29 doctors, of which 15 had some prior training in handwriting skills. Handwriting quality was of ‘print quality’ in 25% of both student and doctor participants, legible in 50%, but poorly legible in 25%. Prescription errors were committed by 92% of all participants, with a mean/median of 2 errors per participant. 111 errors were found in the transcription of the patient’s name, identification, age, height, weight and allergies. 422 errors were identified in the prescriptions of the 5 given medications, including the omission of drug details in 53%, incorrect dosage in 49% and incorrect instructions for administration in 47% of prescriptions. Although some of these errors were relatively minor, all could have resulted in serious consequences if extrapolated to real patients.

Although 78% of participants admitted to being concerned with poor handwriting and would take appropriate action, 22% reported that they would choose to ignore illegible writing, an attitude that could potentially increase the risk of medication errors. A concerted effort to address this problem at undergraduate level, and ongoing emphasis during and after medical training, is essential if medical errors and subsequent patient morbidity and medico-legal costs are to be averted.