Impact of prescriber’s handwriting style and nurse’s duty duration on the prevalence of transcription errors in public hospitals

Abstract

AIMS AND OBJECTIVES: To investigate the prevalence of transcription errors in a main public hospital in Pakistan and to test the impact of medication name and dose writing styles and the nurse duty duration on the occurrence of transcription errors. BACKGROUND: Medication errors occur frequently in public hospitals. Errors occurring at the transcription stage have not been sufficiently investigated. DESIGN: Medications transcripts and dispensed item labels were prospectively reviewed. In the second stage, nurses (n=25) transcribed medication charts in a double-blind randomised cross-over design administered at one, six and 10 hours after the commencement of their duty. METHODS. Inpatient (n=1000), discharge patient (n=1000) medication transcripts and labels of dispensed items for (n=1000) transcripts were reviewed. On medication charts, orthographically similar medications (n=20) were written in lowercase and Tall Man, decimal doses were written covered and uncovered, and metric doses were written with and without trailing zeros. RESULTS: Of the 6583 and 5329 medications transcribed from inpatient and discharge patient charts, error rates were 16·9 and 13·8%, respectively. Labels for 6734 dispensed items were reviewed, and error rate was 6·1%. Tall Man, covered decimal points and avoiding trailing zeros with decimal units significantly reduced transcription errors. CONCLUSION: Errors increased with increasing nurse duty duration. Highlighting orthographically similar medications and the use of proper decimal and metric units reduce errors. RELEVANCE TO CLINICAL PRACTICE: Transcription errors are highly prevalent in Pakistan public hospitals; therefore, elimination of transcription stage is encouraged.