Why Doctors Should Stop Writing Opioid Prescriptions by Hand

Researchers from Johns Hopkins University have identified an easy, effective step that doctors can take to work towards curbing the nationwide opioid epidemic — simply stop writing opioid prescriptions by hand.

In a 15-day survey of more than 500 handwritten and electronic prescriptions, 92% of prescriptions written by hand contained errors, failed to comply with federal opioid prescription rules, or failed to meet ideal practice standards including legibility, date, pill quantity, and the presence of at least two patient identifiers, a university statement said.

“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,” said Mark Bicket, MD, assistant professor of anesthesiology and critical care medicine, and the paper’s lead author.

“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 abbreviation,” Bicket added.

In the study, 47% of the total prescriptions surveyed were written by hand and 53% were produced electronically. Researchers found that 42% of all prescriptions contained some error.

While both groups failed to meet the US Drug Enforcement Agency’s (DEA’s) standards at the same rate, all of the prescriptions that violated best practices or did not include at least two patient identifiers were written by hand.

Furthermore, while 89% of all handwritten prescriptions deviated from Johns Hopkins “best practices” guidelines or were missing at least two forms of patient information, not a single electronic prescription showed these same errors.

Handwritten prescriptions continue to demonstrate higher associations of errors, discrepancies, and variation from ideal practice and government regulations, researchers wrote, while all computer-generated prescriptions adhered to best practice guidelines and contained tow patient identifiers. Moreover, all HER prescriptions were fully compliant with DEA rules.

The author emphasized that errors in prescriptions do not usually result in patients receiving the wrong drug or incorrect dosage because there are other safety measures in place, like pharmacists who double check prescription information.

However, errors do increase the risk for mistakes.

“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,” Bicket said.