ISMP calls for elimination of written prescriptions

Saying handwritten prescriptions are a significant source of medical errors, the Institute for Safe Medication Practices (ISMP) in Huntingdon Valley, PA, is calling for their elimination in three years.

ISMP president Michael Cohen, MS, acknowledges that a total changeover in three years is a bold goal, but he says the time has come to take a major step toward addressing medication errors.

"Technology can’t solve all the medication error problems in the world, and in fact we often see that technology can actually introduce a whole new set of problems if we don’t use it appropriately," Cohen says. "Still, with proper systems design, implementation, and maintenance, the benefits of handheld prescribing far outweigh the drawbacks. There’s simply no good reason why we can’t begin to use this technology now to make prescribing a lot safer." (See related story, p. 70.)

Cohen points out that, despite recent publicity over the November 1999 release of a report from the Institute of Medicine (IOM), drug errors are nothing new. A recent white paper released by the ISMP notes that injuries resulting from medication errors "are not the fault of any individual health care professional, but rather represent the failure of a complex health care system."

In the medication management system, errors can be introduced at multiple points. Numerous problems are related to the naming, labeling, and/or packaging of drugs or to inefficient distribution practices. Patients often contribute to errors by failing to comply with instructions. Many errors occur as prescriptions are written; those tend to be failures of communication, and, in far too many cases, the underlying problem is the clinicians’ handwriting.

"The health care industry has been slow to adopt new technologies, although these tools hold promise for enhancing the delivery of health care," the ISMP white paper says. "Prescription writing is perhaps the most important paper transaction remaining in our increasingly digital society; it seems simplistic to note that electronic prescribing tools could minimize medication errors related to handwriting. Yet even though such devices are available for use in hospitals, ISMP estimates that less than 5% of U.S. physicians currently write’ prescriptions electronically."

Wireless will overcome

ISMP attributes the slow adoption of prescription-writing technology to several problems. Until recently, clinicians were hesitant about computer use in general, and there was a lack of hardware and software that would make it convenient for prescribers to select medications electronically. Providers also fear the costs associated with such technology. ISMP suggests that the advent of wireless handheld devices could overcome all of those problems.

"Easy-to-use point-of-care systems, some that offer comprehensive applications in real time, are becoming available from a number of manufacturers and at perhaps a surprisingly low cost of entry," the report says. Such integrated programs may provide benefits for cost and risk management as well as for clinical care, and they may enhance the prescribing process beyond addressing penmanship alone.

For example, handheld devices can alert practitioners to potential drug or allergy interactions through up-to-date databases of medications connected with patient records. That kind of functionality should help expand adoption of electronic prescribing rapidly among practitioners, ISMP says.

There is no reason to wait for legislative activity or task forces to insist upon a switch from traditional handwritten prescriptions to this new technology, the report says.

"Put simply, handwritten prescriptions ought to be a thing of the past," the report says. "Health care practitioners and providers across the nation should rapidly and aggressively take advantage of the electronic prescribing technology that can help prevent medication errors today. The need is urgent. As such, a serious public health problem calls for a bold goal: Let’s eliminate handwritten prescriptions by 2003!"