Illegible Handwriting Research Articles

Avaliação do nível de compreensão da prescrição pediátrica

This study intends to establish the relation between the understanding level of pediatric prescription by the mother, or other adult, accompanying the child to a doctors visit and the probable causes of noncompliance with the treatment, in order to improve the quality of pediatric health care. We randomly interviewed one hundred adults who accompanied children to the pediatric outpatient clinic of Hospital Universitário. They received medical orientation and/or prescriptions. The interviews were made from April to October 2000 and we used a questionnaire to evaluate social, economic and cultural status. We also evaluated aspects related to the appointment and treatment, and the understanding of doctors handwriting and prescription. Eighty-three percent of them received a prescription and 17% received only orientation; 88% were the mothers and 63% had not finished elementary school. Concerning the appointment, 80% felt satisfied. Seventy-one percent among those who received prescriptions could understand the doctor's handwriting and 29% had some or none understanding of it. Forty-seven percent of the prescriptions had symbols and/or abbreviations that could not be understood by 59% of the adults. Seventy-one percent could remember all the prescribed drugs without looking at the prescription; 15.7% needed to read it in order to remember the drugs; 7.2% could not remember the drugs and said that a pharmacist had to help them and 6% could not remember or read the prescription. Aspects related to the poor understanding of pediatric prescriptions are caused by the low social, economic and cultural status of the adult accompanying the child; as well as aspects regarding physicians such as the use of symbols and abbreviations, illegible handwriting and verbal orientation only.

The relationship between the Evaluation Tool of Children's Handwriting and teachers' perceptions of handwriting legibility.

The purpose of this study was to investigate the relationship between the Evaluation Tool of Children's Handwriting (ETCH) and teachers perception of handwriting legibility The ETCH was administered to 45 first-grade students with illegible handwriting as reported by their teachers. The teachers completed a teachers questionnaire at the same time to indicate the children's level of handwriting difficulties both in general and in specific tasks that resemble the test tasks of the ETCH. There was no significant relationship between the ETCH scores and the teacher questionnaire scores in either general legibility or task-specific legibility. The ecological validity of the ETCH, in reference to the teachers' perception of handwriting legibility, was not established. Further changes for scoring criteria may be warranted before the ETCH can be used with confidence that the scores obtained are meaningfully related to actual performance in the classroom as determined by teachers.

Illegible Prescription Handwriting; Blanket Medication Orders; “Range” Medication Orders; Automatic Stop Orders

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.

The Joint Commission Doesn't Think that Illegible Handwriting is a Joke

The Joint Commission Doesn't Think that Illegible Handwriting is a Joke

On Yael Feldman's No Room of Their Own

DURING ONE OF MY MANY extended stays in Jerusalem, I lived on Klausner Street in Talpiot, the same street on which you can find the relatively large and certainly comfortable house in which Agnon lived from the 1920s onward. Clearly marked as a mini-museum, and open to the public, the house looked inviting. I went inside to glean something about Agnon, Israel's 1966 Nobel Laureate in Literature. Photographs of Agnon hung on the walls of the front room, as might be expected. There were also photographs of people with Agnon, including young attractive women. There were no photographs of his wife. Upstairs, his desk is on display. On it is a kind of "out" basket with a sheaf of papers covered with his nearly illegible handwriting. If ever handwriting deserved to be called "chicken scratches," this was it.

On Yael Feldman'sNo Room of Their Own

DURING ONE OF MY MANY extended stays in Jerusalem, I lived on Klausner Street in Talpiot, the same street on which you can find the relatively large and certainly comfortable house in which Agnon lived from the 1920s onward. Clearly marked as a mini-museum, and open to the public, the house looked inviting. I went inside to glean something about Agnon, Israel's 1966 Nobel Laureate in Literature. Photographs of Agnon hung on the walls of the front room, as might be expected. There were also photographs of people with Agnon, including young attractive women. There were no photographs of his wife. Upstairs, his desk is on display. On it is a kind of out basket with a sheaf of papers covered with his nearly illegible handwriting. If ever handwriting deserved to be called chicken scratches, this was it.

Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions.

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.

Handwriting Error Patterns of Children with Mild Motor Difficulties

A large proportion of children referred to school-based occupational therapists experience difficulty with handwriting. Illegible handwriting is found to have secondary effects on school achievement and self-esteem. The purpose of this study was to identify handwriting error patterns of children with mild motor difficulties and to examine the relationship between handwriting error patterns and perceptual-motor abilities. Sixty-six children aged 7 to 12 years old with mild motor difficulties were involved in the study. The results indicated three possible handwriting error patterns: (1) Execution Factor; (2) Aiming Factor; (3) Visual-Spatial Factor. The Execution Factor was associated with visual-motor skill and sensory discrimination; the Aiming Factor was correlated with visual-motor and fine-motor performance. There were no significant associations with perceptual-motor abilities for the Visual-Spatial Factor.

The development and implementation of a computerized on-line obstetric record.

We developed and implemented a completely paperless and on-line obstetric record in the high-risk obstetric clinics at Columbia Presbyterian Medical Center. Patient care and interactions are input directly into the computer by the health care providers. Laboratory information is transferred automatically from the Laboratory Information Service into the computerized prenatal record. The system has been in continuous operation for 2 years and is highly regarded. Problems such as illegible handwriting, missing records, and missing laboratory data have disappeared. Research and data query capabilities have been facilitated. The feasibility and applicability of a computerized record replacing the paper record has been demonstrated.

Why Doctor Can't Write (Yet Again)

<h3>To the Editor.—</h3> May I bring to the attention of those who read this journal an irksome, significant, and correctable problem: illegible handwriting. I am a physical therapist practicing at the Veterans Administration Medical Center in Milwaukee, a large teaching institution. Other staff members and I waste considerable time trying to decipher illegible orders and notes written by doctors. As a result, care of the patient is usually delayed and encumbered. Why should this be the case? (1) Doctors have not attended grammar school and, as a result, have no training in handwriting skills. (2) Doctors are supposed to write illegibly. (3) It is not important for doctors to communicate with staff. The chart serves only as a device for papercompliance with regulations. (4) Doctors are not really confident about what they are doing or writing. People are less likely to criticize and judge them, or less likely to lose

Some notes on prescriptions.

Two separate surveys of prescriptions and prescription habits have been performed. In a survey in one pharmacy in Tamworth, 16 out of 750 prescriptions had to be returned to the doctor for correction. The most common problem was illegible handwriting. Another survey to determine the competence of script writing amongst 12 interns at Tamworth Base Hospital revealed a certain lack in their basic training.

Iz korespondence Ivana Zajca

Iz korespondence Ivana Zajca

Electrolyte Disturbance in Acute Alcoholism: With Particular Reference to Magnesium

Serum electrolyte determinations were made in 30 patients with acute, severe alcoholism before any therapy was given. Sixty per cent of the serum magnesium levels, 30 per cent of the serum potassium levels, and 20 per cent of the serum calcium levels were below the normal range. Approximately one-third of the patients showed hypernatremia and hyperchloremia. There was little correlation in most patients between serum magnesium levels and such clinical findings as hallucinations, tremor, and tremulous handwriting. All but one of the patients with completely illegible handwriting had low serum magnesium levels. Possible mechanisms suggested for the alterations in the serum electrolytes included poor food and electrolyte intake, poor gastrointestinal absorption, and accelerated urinary loss of electrolytes due to effects of starvation and dehydration. Water diuresis, a demonstrated effect of alcohol, might explain the occurrence of hypernatremia and hyperchloremia in some patients. The need for adequate fluid and electrolyte therapy in the treatment of the acute alcoholic was stressed in view of the deleterious effects of altered body electrolytes.