Illegible Handwriting Research Articles

Prevalence and Types of Prescribing Errors at A Public Tertiary Care Centre in Malaysia

Background: The current study aimed to determine the prevalence and types of prescribing errors at a public tertiary care center in Malaysia. Methods: This was a cross-sectional study, undertaken at the Pharmacy Department of the Raja Permaisuri Bainun Hospital, Ipoh. All the new prescriptions received during a four-week study period in 2012 were examined for prescribing errors. Results: Of the 11,009 prescriptions screened, 450 (4.1%) were found to have prescribing errors. The Emergency and Trauma Department (16.2%) recorded the highest number of errors. Omission and commission errors, respectively, constituted 56.4% and 40.2% of the cases, while 3.3% of the prescriptions contained illegible handwriting. Unspecified frequency (51.2%) and incorrect dosage (49.7%) were, respectively, the most common omission and commission errors. Conclusion: The findings confirm that prescribing error was common in the hospital. Efforts to reduce such errors, including the introduction of a system conducive to appropriate prescribing, are therefore warranted. Key words: Medication errors, Pharmacies, Tertiary care center, Drug-related side effects, Adverse reactions.

Circulando hacia la seguridad del paciente: realidad y deseo

ObjectiveTo evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation. MethodThe study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety. Results365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use. ConclusionThe differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety.

Assessment of prescription pattern using WHO drug prescribing indicators in medicine wards of a tertiary care teaching hospital: a retrospective observational study

Background: Rational prescribing is an essential skill for every prescriber. However many times it seems a difficult task for various reasons. Such practices ultimately increase the mortality, morbidity and financial burden on the patient. Hence, we aimed our study to evaluate appropriateness of prescription pattern according to WHO drug prescribing indicators, few complementary indicators and classify prescription errors.Methods: A retrospective observational study, conducted in medical record section of tertiary care teaching hospital of Maharashtra during the period of 6 months. Total 400 randomly selected prescriptions from Medicine inpatient wards were scrutinized.Results: Average number of drugs per prescription was 5.20 trending towards polypharmacy. Drugs prescribed by generic name were 13.88%, injectable drugs were part of 93.50% prescriptions, 78.25% prescriptions contained an antimicrobial agent and Percentage of drugs prescribed from NELM 2011 was 72.36%. Illegible handwriting in 68% cases was the important cause of prescription errors. These errors found in 73% of prescriptions.Conclusions: The present study showed that the practices were trending towards irrational prescribing. Polypharmacy and illegible prescriptions were dominated. Regular prescription audit will help to rectify such practices. Also, there is an urgent need of sensitization of prescriber through new treatment guidelines, seminar, presentations and discussions on regular basis.

Impact of Electronic Prescribing System on Prescribing Error Rate at Patients’ Transition of Care: An Interventional Study

: Objective:To estimate the prevalence of prescribing errors before and after implementing electronic discharge prescription system in the wards of General Surgery in a tertiary care hospital in India. Methodology: Patients discharged from General Surgery wards with a prescription containing atleast one drug were selected. Discharge prescriptions were collected before and after implementing the electronic prescribing system. Patients’ demographic details like age, gender, diagnosis and number days of hospital stay were recorded in the specially designed case record form. Discharge orders were scanned to evaluate the prescribing errors in these orders. Results: A total of 1045 handwritten and 1152 electronic discharge summaries were collected, of which 76.7% and 76.2% were of <60 years aged patients, 64.3% and 63.5% of male gender respectively in both the groups. Average number of drugs prescribed per prescription was 3.5 and 4.1 before and after intervention; error rate was 33% and 8.4% of drugs prescribed respectively, 46.3% of prescriptions were of illegible handwriting. The intervention of an electronic prescribing system has reduced 75% of prescribing errors. Handwritten prescriptions had 5.5 higher odds of having prescribing errors (OR 5.5, 95% CI 4.6-6.1). Conclusion: The electronic prescribing system has a high impact in reducing prescribing errors in discharge prescriptions. Handwritten prescriptions had 5.5-times odds of higher risk for prescribing errors. Increase in age, number of drugs prescribed and length of hospital stay were major predictors of prescribing errors. Key words: Prescribing errors, Adverse drug events, Discharge orders, Medication safety, e-prescribing.

Illegible handwriting and other prescription errors on prescriptions at National District Hospital, Bloemfontein

Background: It is generally accepted that doctors have illegible handwriting. The writer usually knows what is written, but other parties often have problems with reading and interpreting.&#x0D; &#x0D; Aim: The aim of the study was to determine whether illegible doctors’ handwriting and other factors that can lead to dispensing errors occur on prescriptions at National District Hospital.&#x0D; &#x0D; Method: In part one the prescriptions of 20 doctors were read by five doctors, nurses and pharmacists to detect who could read it most accurately. In part two, these doctors were asked to write a prescription with an IntelliPen®.&#x0D; &#x0D; Results: From the 300 measurements, 88% of the doctors read the prescriptions correctly, compared with 82% of the nurses and 75% of the pharmacists. A potential fatal error was lorazepam injection 4 mg, which was read as 40 mg (lethal dose) by 20% of healthcare workers (HCWs). With the IntelliPen® only 39% of the prescriptions were readable. Only 65% of prescribers could be identified from their handwriting or the name stamp used.&#x0D; &#x0D; Conclusion: Pharmacists read the prescriptions worst and they are the people who must dispense the prescriptions. Some of the reading mistakes were critical and could be lethal. Many of the prescriptions did not meet the legal requirement for prescriptions.&#x0D; &#x0D; (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)&#x0D; &#x0D; S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1254932

Quality of and Attendance at Healthy Child Clinics inGermany

Background For several years the German healthy child clinics program has been a highly appreciated preventive measure and is subject to constant development. However, attendance depends on the families' sociodemographic situation. Findings are documented in a medical checkup booklet (the so-called Gelbes Heft). Currently, there is noprocedure to use the data collected for epidemiological purposes nor to evaluate the pediatric prevention measures in Germany. Methods Between 2011 and 2016, we recruited 3480 study participants for our population-based cohort study LIFE Child in Leipzig. 90.6 % submitted their check-up booklets which were subsequently scanned, the data was digitalized and transmitted to a computerized form. Furthermore, data on social status (so-called Winkler-Index) were collected for each family using a structured questionnaire. The study population consisted of the families' oldest child for whom both data sets were available. Results The transmission of data from the check-up booklets was time-consuming and cost-intensive due to large datasets, uncoded diagnoses as well as the necessity of trained employees for transferring often illegible handwriting. Early diagnostic tests for children enjoy a high level of acceptance among all social classes. With increasing age, attendance rate decreases gradually. Only 83 % of the population with a lower social status attend the U9 test. The documentation of diagnoses in the check-up booklets was implausible because the frequency fluctuated heavily between the different check-up time points. With only less than 2 %, the documentation of psychosocial difficulties in a child was particularly surprising Conclusion It is not possible to draw conclusions regarding the prevalence of target diseases from the frequency of documented findings in the check-up booklets. In order to make the data both comparable and evaluable, documentation must be digitalized in the future.

Keyword spotting in doctor's handwriting on medical prescriptions

In this paper, we propose a word spotting based information retrieval approach for medical prescriptions/reports written by doctors. Sometimes due to almost illegible handwriting, it is difficult to understand the medication reports of doctors. This often confuses the patients about the actual medicine/disease names written by doctors and as a consequence they suffer. A medical prescription is generally partitioned into two parts, a printed letterhead part containing the doctor's name, designation, organization name, etc. and a handwritten part where the doctor writes patient's name and report his/her findings and suggests medicine names. There are many significance impacts of the proposed work. For example, such work can be used (i) to develop expert diagnostic systems (ii) to extract information from patient history that can be obtained by this proposed method (iii) to detect wrong medication (iv) to make different statistical analysis of the medicines prescribed by the doctors etc. To extract the information from such document images, first we extract the domain specific knowledge of doctors by identifying department names from the printed text that appears in letterhead part. From the letterhead text, the specialty/expertise of doctors is understood and this helps us to search only relevant prescription documents for word spotting in handwritten portion. Word spotting in letterhead part as well as in handwritten part has been performed using Hidden Markov Model. An efficient MLP (Multilayer Perceptron) based Tandem feature is proposed to improve the performance. From the experiment with 500 prescriptions, we have obtained encouraging results. Information from printed letterhead part improved the word spotting performance in handwritten part, significantly.

Illegible handwriting and other prescription errors on prescriptions at National District Hospital, Bloemfontein

Background: It is generally accepted that doctors have illegible handwriting. The writer usually knows what is written, but other parties often have problems reading and interpreting.Aim: The aim of the study was to determine whether illegible doctors’ handwriting and other factors that can lead to dispensing errors occur on prescriptions at National District Hospital.Method: In part one the prescriptions of 20 doctors were read by five doctors, nurses and pharmacists to detect who could read it most accurately. In part two, these doctors were asked to write a prescription with an IntelliPen®.Results: From the 300 measurements, 88% of the doctors read the prescriptions correctly, compared with 82% of the nurses and 75% of the pharmacists. A potential fatal error was lorazepam injection 4 mg, which was read as 40 mg (lethal dose) by 20% of healthcare workers (HCWs). With the IntelliPen® only 39% of the prescriptions were readable. Only 65% of prescribers could be identified from their handwriting or the name stamp used.Conclusion: Pharmacists read the prescriptions worst and they are the people who must dispense the prescriptions. Some of the reading mistakes were critical and could be lethal. Many of the prescriptions did not meet the legal requirement for prescriptions.

Prevalence of dyslexia among school children in Mysore

Background: Dyslexia is defined as difficulty in learning to read and spell despite adequate education, intelligence, socio cultural opportunities and without any obvious sensory deficits. Objective: 1) To estimate the prevalence of dyslexia among school children. 2) To study the factors associated with dyslexia. Materials and Methods: A cross-sectional study conducted in 4 randomly selected government schools of Mysore for a period of two months from August 2013 to September 2013. Data was collected by using a pretested dyslexia screening questionnaire. Result: Out of 400 students overall prevalence of dyslexia was found to be 13.67%. When compared with gender, prevalence of dyslexia was 19.00 % among males and 8.50% among females. About 66.70% dyslexics gave a family history of dyslexia. History of difficulty with spellings was seen among 54.80% of dyslexics. About 61.70% experienced difficulty in copying from the blackboard, 56.30% were confused following instructions while playing games. It was noticed that about 64.30% dyslexics were left handed. It was found that 64.30% dyslexics were unable to count backwards from 100 down to 0 and about 77.80% dyslexics were observed reversing numbers or digits. Eighty percent of dyslexics had difficulty in following directions like left and right. On observing their handwriting 59.60% dyslexics had illegible handwriting. Conclusion: This study suggests that the prevalence of dyslexia is on a higher side which suggests that more prevalence studies is required to develop remedial education and policy interventions in the educational system to improve the school performance of such children.

Prescribers adherence to the basic principles of prescription order writing in shashemene referral hospital and malka oda district hospital

Aim: Prescription writing is a science and an art, as it conveys the message from the prescriber to the patient. Prescribing an inappropriate drug is a global problem. Objective: The objective of this study was to assess the adherence of prescribers towards the basic principles of prescription order writing. Materials and Methods: A retrospective study was conducted from February 18 - 22, 2013 to assess the prescriber adherence to basic principle of prescription in Shashemene Referral Hospital (SRH) & Malka Oda District Hospital (MODH) pharmacies on oneyear prescriptions. Results: A Total of 384 prescriptions were analyzed of which 234 &150 prescriptions were collected from MODH & SRH pharmacies respectively. The main findings were, name of the patients and sex was mentioned in 100% & nearly 98% of the prescriptions in both hospital pharmacies. Some prescriptions were found with missing date and legible handwriting which accounted 58.12%, 10% (MODH) & 59.17%, 10% (SRH). However, similar results were obtained for illegible handwriting (10%) in both hospital pharmacies. The most frequently missed drug information by prescribers was the dosage form which accounted 63.25% & 56.67% for MODH & SRH respectively. Conclusion: The results showed that there was relatively poor adherence of prescribers following the basic principles of prescription order writing in both hospital pharmacies. However, the results of SRH were better than MODH. There might be a need for continuing education of prescribers and adoption of best methods to improve the quality of prescription order writing and promote the rational use of drugs.

English

The word &quot;prescription&quot;, from &quot;pre-&quot; (&quot;before&quot;) and &quot;script&quot; (&quot;writing, written&quot;), refers to the fact that the prescription is an order that must be written down before a drug can be dispensed. Prescription is a written order by the prescriber to the dispenser on how the drug should be dispensed. It serves as a means of communication among the prescriber, dispenser and drug consumer pertaining to treatment. That is why doctors are legally obliged to write prescription clearly. However, most of the time prescriptions are found to be unclear. Accordingly, the main objective of this survey study was to investigate the factors that affect proper prescription writing in Jimma University specialized hospital. In order to achieve the main objective, four specific objectives related to knowledge and perception on importance of good prescription and consequences of sloppy prescription writing, the practice of good prescription writing and other factors that affect the proper prescription writing were formulated. One hundred (25%) of the physicians and 50(100%) of the pharmacists were included in the survey. In order to select sample physicians, convenience sampling technique was employed. In order to collect data from the sample, two instruments namely questionnaire and document analysis were used. The collected data were analyzed using percentage and mean value. The result of the survey showed that most of the physicians have knowledge on the importance of clear prescription writing and they positively perceived that sloppy prescription writing has negative impact on both pharmacists and patients. Nevertheless, the magnitude of writing clear prescription was low because 54.8% of the sample prescriptions were proved to be illegible. Moreover, 70% of the pharmacists also reported that physicians write clear prescription only some times. The major factors that affect the proper prescription writing, according to the physicians, are shortage of time (69%), difficulty of some medicine names to spell (80%) and lack of feedback from pharmacists (52%) on their (physicians&rsquo;) unclear prescription writing. Therefore, the university in collaboration with the hospital administrative bodies, ministry of health and other concerned bodies should work to make the physicians responsible and work cooperatively with pharmacists to alleviate the problem because illegible prescription may pose a medical threat to the treatment of a patient. &nbsp; Key words: Prescription, writing, medical threat, illegible handwriting.

Errors, omissions and medication patterns of handwritten outpatient prescriptions in Bangladesh: a cross-sectional health survey

Handwritten prescription errors are worldwide common problem. We investigated the types and extent of prescription errors in three cities of Bangladesh. Total 900 outpatient prescriptions were surveyed following the guidelines of WHO and BNF. Prescription errors in superscription, inscription and subscription were analyzed by Microsoft Excel 2010. About 73% patients visited MBBS and 8% BDS doctors. The male outpatients (55%) were slightly higher than female (45%). Commonly found errors of prescription were in superscription part, i.e. gender (64.33%), age (17.67%) and name (5%) of the patients. In inscription part, most common error was the direction for drug use (42%) followed by the dosage regimens (28%), doses (26%), and dosage forms (12.67%) of the drug. In subscription part, illegible handwriting was most common (46%) followed by the prescribers’ sign (10.67%) and date (4%). In a single prescription, averagely 3 and maximally 8 drugs were found to be prescribed. Most frequently prescribed drugs were antibiotics (18.25%) followed by antacids (17.45%) and NSAIDS (13.60%). Errors in handwritten prescriptions are the primary causes of treatment failure in Bangladesh. More professional care by the prescribers’ and the inclusion of pharmacists in hospital can only reduce the errors and assure safer health.

Prescription audit for evaluation of present prescribing trends in a rural tertiary care hospital in South India: an observational study

Background: Prescription is a written order from the physician to pharmacist which contains name of the drug, its dose and its method of dispensing and advice over consuming it. The quality of life can be improved by enhancing the standards of the medical treatment at all levels of the health care delivery system. Prescription audit aims to provide precise information to a particular setting which enables rational policy decisions to be made. The present study was undertaken to find errors in current prescription practices in a tertiary care hospital situated in B G Nagara, Nagamangala, India. Methods: An observational study in Adichunchanagiri Institute of Medical Sciences, B G Nagara, Nagamangala, India was conducted during October 2015. 113 prescriptions were analyzed. Information regarding the patient, doctor, drug and legibility of the prescription were obtained. Results: Regarding patient details, name was present in all prescriptions with absence of height and weight in all prescriptions. Regarding prescriber details name, qualifications, address, phone number were not found in any prescriptions, but with 100% presence of signature. Regarding drug details generic name was found in 9.7%, and dose and frequency were found in 96.45% and 95.5% respectively. 96.4% of the prescriptions were found to be legible. Conclusions: Irrational prescribing is a global problem. The rationality of prescribing pattern is of utmost importance because bad prescribing habits including misuse, overuse and underuse of medicines can lead to unsafe treatment, exacerbation of the disease, health hazards, economic burden on the patients and wastage. Computerised prescription ordering eliminates some of the subjective features of prescribing. Thus, if the proper information is entered correctly in the electronic system, medication errors due to illegible handwriting, incorrect dose, incorrect medication for medical condition, and drug interactions can be reduced, because each prescription can be linked to high-quality drug databases that check that the information on the prescription is appropriate for the patient (e.g., age, weight, gender, condition, lab values, disease being treated, concurrent medications) and that known warnings and potential problems are brought to the attention of the physician, pharmacist and patient.

Data Quality Associated with Handwritten Laboratory Test Requests: Classification and Frequency of Data-Entry Errors for Outpatient Serology Tests

Objective: Manual data-entry of handwritten laboratory test requests into electronic information systems has implications for data accuracy. This study sought to identify the types and number of errors occurring for handwritten serology test requests received from outpatient clinics. Methods: A 15-day audit at a serology laboratory in Sydney, Australia, compared the content of all transcribed serology outpatient test requests in the laboratory information system with the handwritten request form. Results: One or more errors were detected in 67/627 (10.7%) audited requests ( N=68 errors). Fifty-one of the errors (75.0%) were transcription errors: the wrong test was transcribed in 40/68 cases (58.8%) – ten of these occurred when the abbreviations ‘HBsAb’ and ‘HBsAg’ were confounded for one another – and transcribed requests were missing a test in 11/68 cases (16.2%). The remaining 17 non-transcription errors (25.0%) described request forms not signed by the ordering clinician, mislabelled specimens, and wrong tests due to computer algorithm errors. Conclusions: Manual data-entry of handwritten serology requests is an error-prone process. Electronic ordering has the potential to eliminate illegible handwriting and transcription errors, thus improving data accuracy in hospital information systems.

G515 Pest – prescribing error surveillance team

Context This quality improvement project was carried out at a large general paediatric hospital. The project was performed on our medical and surgical inpatient wards, involving all prescribing healthcare professionals. Problem There had been numerous minor and moderate prescribing errors identified via DATIX and CPSQ meetings, the majority not affecting patient care and were identified prior to administration of medication, thus avoiding serious incidents. However, they caused delays in treatment and sub-optimal, timely patient care. This inefficient practice wastes time and resources of nurses, doctors and pharmacists in identification of errors and re-prescribing of medication. Assessment of problem and analysis of its causes This problem had already been identified at CPSQ meetings and the medication errors were ongoing despite improvement in prescribing training at staffing induction. A multidisciplinary meeting involving doctors, senior nursing clinicians and the pharmacy lead was held to identify common errors. The prescribing errors were primarily illegible handwriting, inaccurate history taking, confusion with drug names, inappropriate use of decimal points, incorrect completion of drug charts and use of verbal orders and abbreviations. Clinicians were often unaware of errors, with colleagues amending drug charts, with no direct feedback to the person making the error. Intervention Our quality improvement intervention was to implement a “zero tolerance policy” of prescribing errors, such that no medication would be given until correctly prescribed. No verbal orders were accepted. All errors once identified were photographed by paediatric pharmacists. All photographic evidence was then communicated to the consultant who directly discussed it with the individual responsible, either face-to-face, or via email. Individuals’ results were published monthly. The intervention was timed so that it would there would be no staff change over. The information was relayed back to the multi-disciplinary team in a teaching session, highlighting the numbers and types of errors using graphical evidence. Strategy for change The implementation was simple once agreement had been reached with the pharmacy team who wished to prioritise a reduction in prescribing errors. The main stakeholders involved were the pharmacy team, senior nurses and consultants. Results were disseminated as previously described. It was expected that change would occur slowly initially, with the project needing to be ongoing as medical staff rotate every four months. Measurement of improvement A total of 204 errors were identified in the four months prior to the zero tolerance policy being implemented, and assigned according to staffing posts. These included 26 errors at consultant level, 53 at registrar, 74 SHO errors, and 51 for other prescribing posts. In the first month of our project being initiated, there were a recorded 74 errors, with the biggest reduction being between this and the second month (34), with a further 34 errors in the third month, reducing to only 10 by the fourth month. This demonstrated a clear trend in reduction of prescribing errors. Effects of changes There was a dramatic decrease by 81% in total errors. Additionally there has been a generalised perceived but unmeasurable improvement in efficiency of distribution of medication. Lessons learnt This was a surprisingly simple intervention with excellent results. However it has been hard to maintain momentum at continuing this analysis. Message for others This was a simple project to implement and to demonstrate improvement. It improves individual accountability and self-awareness. There is potential to develop a phone application capturing errors and sending feedback to prescribers, producing a league table. Since incorrect medical prescribing has been identified as being the single most preventable cause of patient harm (previous studies identifying errors in one in eight charts), this could form part of a formal assessment in the e-portfolio, with doctors providing annual error reports.

Data quality associated with handwritten laboratory test requests: classification and frequency of data-entry errors for outpatient serology tests.

Manual data-entry of handwritten laboratory test requests into electronic information systems has implications for data accuracy. This study sought to identify the types and number of errors occurring for handwritten serology test requests received from outpatient clinics. A 15-day audit at a serology laboratory in Sydney, Australia, compared the content of all transcribed serology outpatient test requests in the laboratory information system with the handwritten request form. One or more errors were detected in 67/627 (10.7%) audited requests (N=68 errors). Fifty-one of the errors (75.0%) were transcription errors: the wrong test was transcribed in 40/68 cases (58.8%)--ten of these occurred when the abbreviations 'HBsAb' and 'HBsAg' were confounded for one another--and transcribed requests were missing a test in 11/68 cases (16.2%). The remaining 17 non-transcription errors (25.0%) described request forms not signed by the ordering clinician, mislabelled specimens, and wrong tests due to computer algorithm errors. Manual data-entry of handwritten serology requests is an error-prone process. Electronic ordering has the potential to eliminate illegible handwriting and transcription errors, thus improving data accuracy in hospital information systems.

Practice of the principle of right conduct in obtaining informed consents and legibility of the consent forms - a clinical audit

Background Informed consent forms must be clear and include all the necessary information of the possible risks, benefits and complications of the procedure needing consent to. Thus, the form should not include illegible handwriting, medical jargons and abbreviations. Ethically, it should be obtained by a higher ranked physician [1]. In a thirteenweek audit conducted in a Dublin hospital, we observed the effects of revised informed consent forms by quantifying the number of errors, if any, created through this process and propose an immediate solution to it.

Prohibited abbreviations in electronic medical records.

To the Editor: The Joint Commission provides guidance to practitioners on safe medication practices through its “Do Not Use” list of abbreviations. In this list, clinicians are encouraged to avoid the use of prohibited abbreviations in patient history and physicals, progress notes, discharge summaries, and medication orders. Avoidance of prohibited abbreviations helps to reduce medication errors that can lead to patient harm. The use of electronic medical records (EMRs) has decreased medication errors caused by illegible handwriting by health care providers, but medication errors can be increased if prohibited abbreviations are used in these communications. Electronic communication must follow previous standards for safe medication practices. Pharmacists play an integral role on an institutional performance improvement committee through their knowledge of safe mediation practices. Our institution performed a rapid-cycle improvement initiative targeting health care provider’s use of institutionally recognized prohibited abbreviations in EMRs. In parallel, the impact of pharmacy on a quality improvement initiative was assessed. Pharmacy led education regarding the avoidance of prohibited abbreviations in free-text EMR documentation and evaluated compliance with our institution’s safe medication practice policy, which includes an expanded prohibited abbreviation list. Eighty patient charts were randomly selected for inclusion in this 10-week evaluation. The pre-education audit found 295 prohibited abbreviations in 40 EMRs, with medication abbreviations being the most common prohibited abbreviation (78%) (Table 1). Education interventions to reach practitioners were performed by pharmacy personnel, including publishing prohibited abbreviations in physician workrooms, nursing work areas, and morning resident and faculty meetings; distributing data collection results and educational material to physician department chairs; recruiting unit-based clinical pharmacists to educate medical teams; and participating in the nursing skills fair. The post education audit found that pharmacist-led education resulted in a 68% reduction of prohibited abbreviations in 40 EMRs. Table 1. Frequency of prohibited abbreviation use in electronic medical records (EMRs) before and after educational intervention (N = 40) As advances in technology are integrated into health care, communication is increased between health care providers. Providers must continue to avoid using prohibited abbreviations to ensure patient safety. Our performance improvement initiative highlights the impact pharmacists may have on an institution’s achievement of National Patient Safety Goals and encourages pharmacists to be at the forefront of safe medication practices at their institution.

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Rapid, illegible handwriting as a symptom of obsessive-compulsive disorder.

This is a case report of a 13 year male child who had co-morbid OCD and trichotillomania. On evaluation, he had rapid, illegible handwriting as a symptom of OCD, which has hitherto not been reported.