Thursday, December 07, 2017 by Russel Davis
A study has revealed that a physician’s illegible handwriting may well affect the accuracy of opioid prescriptions and compromise patient safety. As part of the study, a team of researchers at the Johns Hopkins University School of Medicine has reviewed numerous opioid prescriptions for patients 18 years and older. The prescriptions have been processed at an outpatient pharmacy for 15 consecutive days in June 2016.
The experts have evaluated a total of 510 prescriptions based on three criteria. One criterion has assessed the physicians’ adherence to best practice guidelines for prescription writing, which focuses on legibility and date and pill quantity. Another criterion looked at the presence of at least two patient identifiers such as electronic health record (EHR) number, Social Security number, and date of birth. The last criterion focused on compliance with the United States Drug Enforcement Administration’s (DEA) rules on controlled substance prescription. (Related: America’s opioid epidemic is killing so many people that medical examiners can’t keep up with the body count.)
“Inconsistencies in opioid prescribing remain common. Handwritten prescriptions continue to demonstrate higher associations of errors, discrepancies, and variation from ideal practice and government regulations. All computer-generated prescriptions adhered to best practice guidelines and contained two patient identifiers, and all EHR prescriptions were fully compliant with DEA rules,” the researchers report in the Journal of Opioid Management website.
The findings show that up to 92 percent of handwritten prescriptions have fallen short on accuracy and compliance with ideal opioid prescription practices and policies. According to the results, 42 percent of handwritten prescriptions contained some forms of error. The results also reveal that 89 percent of prescriptions written by hand did not follow ideal practice guidelines and are missing at least two types of patient identifiers. In contrast, none of the prescriptions generated by EHRs contained these errors. The study has also found that up to 47 percent of handwritten prescriptions failed to meet the DEA’s standard.
“Mistakes can be made at any point in the prescribing, transcribing, processing, distribution, use and monitoring of opioids, but research has rarely focused as we have on prescribing at the time of hospital discharge or on written prescriptions prescribed for adults. There are the normal legibility issues you would suspect with a handwritten prescription, but we also commonly found things like missing patient identification information and errors in abbreviations…What we hope our results do is get more practitioners to adopt electronic prescribing systems because we have a duty to practice in a way that has the lowest chance of harm to our patients,” lead author Dr. Mark Bicket states in a press release.
Erroneous opioid prescriptions may be contributing to the worsening opioid overdose crisis in the U.S. In fact, an entry featured on the National Institute on Drug Abuse website reveals that more than 90 Americans die every day due to opioid misuse and overdose. The Centers for Disease Control and Prevention (CDC) also projects that prescription opioid misuse costs the U.S. a total economic burden of up to $78.5 billion annually. The CDC adds that these economic burdens cover health care costs, productivity loss, addiction treatment, and criminal justice involvement.