• E-mail
• Print
• RSS

Hospital uses handwriting course to improve legibility, overturn JCAHO RFI

Nurse Leader Weekly, January 6, 2006

Want to receive articles like this one in your inbox? Subscribe to Nurse Leader Weekly!

Jackie Kovacs, RN, had a feeling that illegible medical records might be a problem during Saints Memorial Medical Center's JCAHO survey. So a year before its scheduled survey, the manager of medical staff quality at the Lowell, MA-based hospital set out to educate physicians about the importance of legible medical records.

Unfortunately, the hospital's survey occurred six weeks earlier than Kovacs expected and while she was on vacation. On the first day of the hospital's January 2005 on-site visit, surveyors visited a unit that was home to the physician with the worst handwriting at the hospital. Surveyors quickly spotted the problem, and the hospital received its one and only requirement for improvement (RFI).

When Kovacs returned, she quickly sprang into action, and the hospital took a four-step approach to correct the problem, which resulted in the JCAHO overturning the RFI. Kovacs shared her solution during the Massachusetts Health Information Management Association's (MHIMA) September meeting, "Effective Tools for Defending & Defining Our Health Information."

Addressing the problem

First, Kovacs served on a team of four people who reviewed 300 charts during a period of seven days. The team separated medical records into piles that were readable, somewhat readable, or totally unreadable and then compiled a list of names of physicians with the worst penmanship.

Next, the medical director discussed the legibility problem with the medical executive committee (MEC). This was somewhat awkward because three of the offenders were on the MEC. During the meeting, the medical director chose the chart with the worst handwriting to illustrate the problem, but the physician's handwriting was so bad that the medical director couldn't read the doctor's name.

The medical director then visited the medical staff and presented five gold pens to the five best handwriters on the medical staff. The remaining physicians received a letter inviting them to a mandatory dinner and handwriting remedial class.

Working with the docs

Twenty-four physicians out of the 36 invited attended the two-hour class. Kovacs said the instructor asked each participant to practice writing a sentence by joining the words so the pen never leaves the paper.

"Her theory is that physicians write fast to get to the next job, and when you write fast, you write messy," Kovacs said. "Each one had to go up to the board and write a sample. At the end of the meeting, they were all thanking her."

To make sure physicians didn't forget everything they learned in the class, Kovacs and her team monitored those identified as bad handwriters. Two made such a significant improvement that the team thought they had hired scribes.

To keep up the success, the medical director gives gold pens to the physicians with the most improved handwriting. Next quarter, she said, they may give out pens to the five physicians who have sustained their improvements.

Source: This article is adapted from Medical Records Briefing (December 2005), published by HCPro, Inc.

Want to receive articles like this one in your inbox? Subscribe to Nurse Leader Weekly!

• E-mail to a Colleague
• Print
• RSS
• Archive