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Good handwriting is essential to patient safety

Ambulatory Safety Monitor, July 7, 2005

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Do pharmacists call you to clarify prescriptions you've written? Do nurses constantly need clarification of orders you've written?

You may have what handwriting experts Barbara Getty and Inga Dubay refer to as "cacography," more commonly known as bad handwriting. Cacography not only impedes efficiency by creating extra work for you and your colleagues, it also poses a significant risk to the safety of your patients.

To battle cacography and indirectly boost patient safety, Getty and Dubay have created a handwriting seminar for physicians and medical professionals around the world. Physicians who have attended the two- to three-hour seminar for continuing medical education credit-and staff who have to read their orders-report remarkable changes in their handwriting.

For example, Cedars Sinai Medical Center in Los Angeles hosted the first seminar in May 2000. The 63 physicians who attended reported that call backs from pharmacies to clarify their orders decreased 50% after they attended the class.

The seminar features a presentation on prescription-writing, including how illegible writing causes abbreviations and numerals to be misread. Getty and Dubay highlight certain abbreviations-including those on the JCAHO's do-not-use list-that are particularly dangerous if misread, citing examples from news articles about hospitals where illegible handwriting led to fatal medication errors.

"Physicians' handwriting isn't worse than anyone else's," says Getty. "It just has the most impact."

Getty and Dubay teach italic handwriting, which is a simple, clear style of writing, says Getty. Students spend a portion of the seminar practicing writing the alphabet in italics style.

In addition to attending their seminar, Dubay and Getty offer the following tips for improving handwriting:

1. Make sure decimal points are visible. There's a difference between prescribing 35 micrograms of potassium chloride and prescribing 3.5 micrograms, for example.
2. Do not use abbreviations because they are easily misread, says Getty. In addition, print the complete names of look-alike/sound-alike medications to avoid confusion.
3. Drop the loops, says Dubay. In cursive writing, different letters with loops, such as i, e, and l begin to look identical, especially if the writer is rushed. "When you add speed to loop cursive, you have a train wreck," she says. Instead, print clearly in italics.
4. Keep a consistent letter slope, says Getty. This makes for more legible writing.

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