A move is on to inculcate the concept of writing prescription by the medical practitioners in capital letters only in a bid to prevent fatal dispensing errors by pharmacists due to illegible handwriting. Dr MB Shantagiri, physician assistant at Medical Intensive Care Unit (MICU) from MS Ramaiah Memorial Hospital is spearheading this initiative in Bangalore.
With several drugs having similar sounding names and spellings, there have been numerous instances of pharmacists dispensing the wrong medications because of illegible handwriting of the doctors.
While corporate hospitals are all computerized and doctors generate printed prescriptions, smaller hospitals, private clinics and primary health centres, which cannot afford the technology, still depend on handwritten prescriptions.
"Where there is no technology available, writing prescriptions in block letters prevents confusion. Though there is no rule stipulating use of capital letters in prescriptions, I hope to set an example by taking this initiative,'' says Dr Shanthigiri, who also writes his patient history and death certificates in capital letters.
According to a section of doctors in government hospitals which has a large daily inflow of out-patients, number of drugs prescribed per prescription ranged from one to ten. There are repetitions of the drug, and many a time in a different trade name. More than 90 per cent of prescriptions were written in illegible handwriting. Another big issue resulting out of cell phones was the gross errors in tele-prescription which more often leads to confusion in getting the right name of the drug.
The US FDA has made electronic medical records mandatory for all hospitals in the US and for Indian medical centres which are recognized in the global medical tourism map need to have EMR to offer high-end tertiary care.
However, there are no guidelines by the Indian Medical Association. The need to write prescriptions legibly is a self motivated exercise and for the benefit of patients, stated Dr. KM Prasanna Kumar, head department of endocrinology and diabetology, MS Ramaiah Memorial Hospital, which is fully computerized. Use of technology eliminates legal complications too since details of the prescriptions and patient, including time and date, are clearly spelt out.
"It is vital for doctors to know the spelling of drugs and write in capital letter to ensure errors do not take place, stated Dr Ramananda S Nadig, president, Triesta Sciences, a clinical research arm of Health Care Global Enterprises, the cancer care centre.
Anarchy in prescription practices prevail primarily because of lack of time and long patient-consultation, leading to fatigue and repetitiveness in prescribing drugs. Similar sounding names have different therapeutic implications, therefore, use of capital letters will prevent fatal errors, stated VR Kannan, a pharma consultant. Names of drugs which can confuse pharmacists if the prescriptions are illegible include:o Amoxapine for depression with amoxicillin which is an antibiotic.o Artemeter vials for intramuscular use for severe malaria against Artesunate which is for only cerebral malaria o Azathioprine for renal transplant or severe rheumatoid arthritis is confused with Azithromycin an antibiotic o Dionil an anti-diabetic drug against Divol an antacid.o Suganil an ayurveda drug and Sugarnil a pain killer oBetahistine for Vertigo and another drug with the same name Betahistine for psoriasis and eczema.
Supporting the initiative of encouraging the concept of all capitals of drug names in prescriptions, B Harkrishnan, president, Bangalore Druggists & Chemists Association stated that it was also important to ensure that prescriptions carried the registration number of the doctor, along with the details of duration and quantity of drug to be taken, all endorsed by the consulted doctor. In many nursing homes, nurses and paramedical staff were engaged in writing prescriptions, added to more confusion, he added.