Washington physicians told: Write prescriptions legibly

Legislation recently passed in the state requires physicians to use legible handwriting when writing prescriptions, but some contend that alone won't reduce prescribing errors.

By Linda O. Prager, AMNews staff. Sept. 18, 2000.

Washington state physicians should be practicing perfect penmanship under a new law aimed at reducing medical errors that took effect this summer.

As tough a challenge as this new legibility law may be for many physicians, it's likely just the first draft of a major overhaul of an antiquated prescribing system. Ongoing debate in Washington and elsewhere suggests that putting an end to doctors' scribbling is only part of a series of systems changes needed to make medication delivery safer.

Stricter measures originally sought

The original measure would have required physicians to print, type or computer-generate all prescriptions. Physician groups opposed this as an overly prescriptive change to prescription writing.

"Can you imagine our members sitting at their desks during a busy office day typing out prescriptions?" asked Len Eddinger, director of public policy and planning for the Washington State Medical Assn. "Medication errors aren't just about the sender. You can type them, you can computer-generate them, but that doesn't necessarily mean the end result for the patient will be absent an error at some other level of the process."

The law eventually passed requires only that all prescriptions be legible -- defined as readable by the pharmacist or nurse who must act on it.

Experts suggest this watered-down version will do little to improve medication safety -- or even legibility, for that matter. "It's a very weak error-prevention strategy, at the bottom of the totem pole," said Michael R. Cohen, president of the Institute for Safe Medication Practices.

His organization issued a call to action earlier this year for the complete elimination of handwritten prescriptions by 2003. It's a challenge that's also recently been picked up by former Speaker of the U.S. House of Representatives Newt Gingrich. He's calling on Congress to require computerization of every doctor's prescription within three years.

"I'm afraid until we get to the point where we're computerizing, we won't have a major impact on errors," Cohen said. A focus on handwriting does nothing to ensure necessary information is available to avoid drug interactions, overdoses and allergic reactions, he added.

Others noted that laws aimed at legibility will be hard to enforce. There are no penmanship police. To see if anything's actually changed because of Washington's measure, the pharmacy board is studying prescriptions written since the law took effect in June to see how many are deemed legible by a three-person panel.

Past history suggests it'll take more to clean up doctors' prescription-writing habits. WSMA passed policy in 1994 calling on doctors to add a purpose line to every prescription. That measure had absolutely no impact, however. Data set for release later this year show that only 28% of more than 6,000 prescriptions studied the year the policy was adopted specified the purpose of the drug. Half of the prescriptions for controlled substances outlined a purpose, while only 5% of those for antibiotics did. Now four years after the policy, that percentage remains exactly the same, said William O. Robertson, MD, a pediatrician and medical director of the Washington Poison Center.

He's optimistic, however, that debate arising out of the state's legibility law finally will change that and prescription-writing habits overall. "The profession realizes it had a narrow escape this year [on stricter mandates], so I think we'll see a major voluntary push for people to finally change their behavior," Dr. Robertson said.

Part of the impetus may come from another part of the law, which called on the state health department to develop broad recommendations on reducing medication errors. That report, due in December, is supposed to address legibility as well as prescription drug labeling, error reporting, automated ordering systems and patient awareness.

The department currently is conducting site visits and meeting with physician and other health care groups to assess current systems, said Patty L. Hayes, director of policy, legislative and constituent relations.

"We have to step back and look at the entire system," she said. "We can't keep pointing the finger at providers but need to see what can support the work of these professionals."

Some legislators have indicated they'll still seek mandates to change how doctors communicate their drug orders. And although Hayes didn't rule out a call for such mandates in the department's upcoming report, she suggested there's much that can be accomplished voluntarily in cooperation with professional and industry groups.

Government funding and other incentives to help spur hospital and physician investment in computerized systems could go a long way toward improving medication safety, ISMP's Cohen said.

"Just telling doctors to be more careful isn't going to work," he said. "That's not the answer."

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