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Dangers of doctors' shorthand and bad writing

Inappropriate use of abbreviations and illegible writing on hospital prescription charts are leading to prescription errors, according to findings presented this week at Diabetes UK’s Annual Professional Conference in Liverpool.

Researchers from the Royal Liverpool University Hospital looked at 75 prescription charts of people with diabetes and found that in 5 per cent of cases, the use of doctors’ own abbreviations and hastily written notes could easily be misread by the nursing staff.

The audit also reveals that one in six charts had prescription errors. The majority of these were illegible, a few were not dated and some were not signed by the prescribing doctors. Medication must only be given if the prescription is signed by a doctor, which means there was delay in the administration of insulin. In addition, one in three charts did not have the correct timings for insulin injections.

Extreme concern

“Diabetes UK is extremely concerned at this audit’s startling revelations," said Simon O'Neill, Director of Care, Information and Advocacy at Diabetes UK. "Correct insulin doses and the timely co-ordination of medication and meals are basic, but essential factors for good diabetes management and improved health.

"At least ten per cent of people in hospital have diabetes. Although not all people with diabetes treat their condition with insulin, the potential health risks to tens of thousands of people can be avoided with simple measures.

“Hospitals should ensure that specialist diabetes teams are available to assure competences of non-diabetes staff and provide appropriate support to ensure that people with diabetes in hospital are able to access the high quality care they should expect.”

Serious consequences

Dr Nagaraj Malipatil, lead researcher at the Royal Liverpool University Hospital, said: “Insulin prescribing, has for a long time been subject to less scrutiny and is prescribed less diligently because it is such a common medication in hospitals. Our audit has demonstrated an unacceptably high percentage of errors.

“A misunderstanding from an abbreviation for insulin units could have serious if not fatal consequences. For example, a doctor should prescribe insulin as “10 units” at a specified time, if written as “10 I U” or “10 I units”, this could be easily misread as 101 units.

Following guidelines

“There are guidelines and medicines policies on writing correct prescriptions. It is this strict adherence to the medicines policy that forms the basis to reduce the incidence of potential errors in patients’ treatment. Doctors must avoid the use of abbreviations for insulin units and all hospitals need to ensure that correct insulin prescribing is covered in junior doctor training as part of their risk management strategy.

“We undertook a re-audit after intensive training of junior doctors and members of the team have shown significant reduction in prescription errors.”

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