Meyer T A
Scott and White Memorial Hospital and Clinic, 2401 South 31st Street, Temple, TX 76508, USA.
Am J Health Syst Pharm. 2000 Dec 15;57 Suppl 4:S18-22. doi: 10.1093/ajhp/57.suppl_4.S18.
Because many preventable medication errors occur at the ordering stage, a program for improving the quality of writing inpatient orders and outpatient prescriptions at one institution was developed. To determine whether potential problems existed in the order-writing process for inpatients, all physician orders for a seven-day period in 1997 were reviewed (n = 3740). More than 10% of all orders had illegible handwriting or were written with a felt-tip pen, which makes NCR copies difficult to read. Other potential errors were also identified. Following educational programs for physicians and residents focusing on the importance of writing orders clearly, physician orders were reviewed for a 24-hour period (n = 654). The use of felt-tip pens decreased to 1.37% of all orders, and no orders had illegible handwriting. A similar quality improvement approach was used to evaluate the outpatient prescription-writing process. A review of all new prescriptions for a consecutive seven-day period at a local hospital-owned community pharmacy (n = 1425) revealed that about 15% of the prescriptions had illegible handwriting and roughly 10% were incomplete. Additional data were gathered through a survey sent to 71 outside provider pharmacies requesting information on problems related to prescriptions written by physicians from the institution; 66% responded. Failure to print prescriber name (96%), illegible signature (94%), failure to include DEA number (89%), and illegible handwriting other than signature (69%) were reported as the main problems. Each physician was given a self-inking name stamp to use when writing prescriptions. In addition, educational programs covering examples of poorly written prescriptions and the legal requirements of a prescription were held for physicians and residents. A follow-up survey showed that 72% of pharmacies saw stamps being used; when stamps were not used, however, illegible signatures continued to be a problem. Follow-up reviews of outpatient prescriptions indicate improvements in handwriting and completeness, but continuing educational efforts are needed. The quality of order writing for inpatients and outpatients continues to be monitored on a regular basis. Ongoing educational programs, follow-up reminders, and feedback to physicians have greatly improved the prescription-writing habits of physicians.
由于许多可预防的用药错误发生在医嘱开具阶段，因此在某一机构制定了一项提高住院医嘱和门诊处方书写质量的计划。为了确定住院患者医嘱书写过程中是否存在潜在问题，对1997年为期七天的所有医生医嘱进行了审查（n = 3740）。超过10%的医嘱字迹难以辨认或用毡尖笔书写，这使得无碳复写件难以阅读。还发现了其他潜在错误。在针对医生和住院医师开展了关于清晰书写医嘱重要性的教育项目之后，对24小时内的医生医嘱进行了审查（n = 654）。毡尖笔的使用降至所有医嘱的1.37%，且没有字迹难以辨认的医嘱。采用了类似的质量改进方法来评估门诊处方书写过程。对当地一家医院所属社区药房连续七天的所有新处方进行审查（n = 1425），结果显示约15%的处方字迹难以辨认，约10%不完整。通过向71家外部提供处方的药房发送调查问卷收集了更多数据，问卷要求提供与该机构医生开具的处方相关问题的信息；66%的药房做出了回应。未打印开方医生姓名（96%）、签名难以辨认（94%）、未包含药品管理局编号（89%）以及签名以外的字迹难以辨认（69%）被报告为主要问题。为每位医生提供了一个自动上墨的姓名印章，供其开处方时使用。此外，还为医生和住院医师举办了涵盖书写不佳的处方示例及处方法律要求的教育项目。一项后续调查显示，72%的药房看到了印章的使用；然而，当未使用印章时，签名难以辨认仍是一个问题。对门诊处方的后续审查表明，字迹和完整性方面有所改善，但仍需要持续的教育努力。住院患者和门诊患者的医嘱书写质量仍在定期监测。持续的教育项目、后续提醒以及向医生提供反馈极大地改善了医生的处方书写习惯。
