A Practical Approach to Measure the Quality of Handwritten Medication Orders: A Tool for Improvement

Objective: System level solutions to reduce prescribing errors are not yet widely implemented and prescribing errors commonly occur in hand written orders. We sought to develop and use a practical method to measure prescribing errors that could be used in interventions to improve the quality of hand written medication orders. Methods: We measured prescribing errors in orders written by house staff at a Midwestern, urban teaching hospital. Eligible orders were randomly selected and assessed for prescribing errors by a trained reviewer using a structured tool. Prescribing errors included an incomplete order, dangerous abbreviations, an illegible order, ambiguous instructions, and an obvious error that could lead to harm (overt error). Results: We reviewed 1422 orders, of which 366 (26%) were error-free. Overall, we identified 1979 errors (1.3 errors per order). 299 (21%) orders were missing core components including, drug name (19, 1%), dose (138, 10%), dosage form (35, 3%), route (130, 9%), and dosing frequency (44, 3%). 410 (29%) orders contained a dangerous abbreviation and 262 (18%) were illegible. 251 (18%) orders were ambiguous and 13 (1%) had an overt error. Conclusion: Prescribing errors occurred often in a teaching institution with a handwritten ordering system. Whereas institutions struggle with the costs of implementing system level solutions, alternative practical solutions to improve the quality of handwritten orders must be identified and implemented to improve patient safety. This measurement strategy was easy to implement and could become part of or be used to assess the effectiveness of interventions to reduce prescribing errors.