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TOPIC: Make more room on order sheets to eliminate illegibility

HIM Connection, September 16, 2003

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Read between the lines. It sounds simple enough. But when the lines are too close together, reading can be difficult. Add a physician's poor handwriting into the equation, and it can be nearly impossible.

But make a little more room between the lines, and illegibility diminishes.

That's what Barb Swehla, RN, MN, quality services supervisor and risk manager at St. Peter's Hospital in Helena, MT, found when she was working on a performance improvement project that focused on prescribing and ordering errors.

"When we took a look at those physician order sheets, the lines were fairly narrow, and it kind of forced the physician, who may not have had the best handwriting in the first place, to write smaller," says Swehla. "You also had the opportunity for a tail from a letter above a line-like a y or a j-to come down and turn a 1 into a 9."

In December, the hospital changed the order sheets to provide more writing space between the lines. Immediately, physicians began writing larger, and the problems diminished. Pharmacists and health unit coordinators were thrilled with the change, says Swehla.

"The pharmacists said they feel so much more comfortable posting their orders now because they can read them much more easily," she says. "We nearly eliminated the impact of illegibility on medication errors.

"It decreased errors in all orders, not just medication orders, but lab order entry, diet order entry, because they're just that much easier to read," she adds.

"We know that when we go to computerized order entry, which is probably going to happen for the majority of physicians in the next year, handwriting won't even be an issue," concludes Swehla. "But we also know in the meantime, we had the opportunity to make a pretty simple change and see whether it made a difference, and it did."

This week's HIM Connection was adapted from an excerpt of the special report, "Reading Between the Lines: Improve Legibility to Reduce Medical Errors." Go to HCMarketplace for more information or to order for the special price of $25. Check out the Editor's Choice section below for a kit for training coders on the 2004 ICD-9-CM codes.

Sincerely,

Lauren McLeod
Executive Editor
lmcleod@hcpro.com

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