This week, I’ll be spending a few hours with second year medical students. As part of the Advanced Family Practice curriculum, family doctors take time from their own practices to meet with small groups of medical students to discuss topics including the management of diabetes, headaches and congestive heart failure.
This week’s topic is prescription writing.
No, this isn’t the class where budding young doctors learn to write illegibly. There’s actually no such course. Messy writing is a side effect of a doctor rushing to get things done.
I’ve spent many hours trying to help nurses decrypt the handwritten notes of colleagues. This is less of a problem in family practices where a growing number of doctors type or dictate all their notes into their computers in what we now call EMRs (electronic medical records) and send prescriptions wirelessly to a printer.
Occasionally, I might take out the old-fashioned prescription pad for old time’s sake (The feel of the paper has a pleasant nostalgic feel) . . . or when I encounter a computer problem.
Yet illegible writing remains a problem – and a risk to patients – in most hospitals.
In spite of technological advancements in other areas of inpatient care, doctors continue to put pen to paper in the writing of their chart notes and their orders. Fortunately, most consultations are dictated and eventually hospitals may eliminate handwritten orders.
In the meantime, our hospitals have banned some of our traditional medical abbreviations.
As medical students, we loved to learn the abbreviations of Greek and Latin words along with the vocabulary of the language of medicine. Sometimes, a handwritten prescription may not make sense to a layperson because of our abbreviations rather than handwriting.
If a medication is to be taken before meals, we would write ac for ante cibium, meaning “before meals”. Similarly, pc means post cibium or “after meals”. A bedtime medication would be followed by hs (hora somni). Orders for a drug taken by mouth, would include the abbreviation po (per os). One for drops for the right eye would include od for oculus dexter.
The abbreviation, od may also mean “once daily”.
Hospitals are now banning more easily misinterpreted abbreviations. The alternative abbreviation, qd intended to mean “each day” may be confused with qid which means “four times a day”. QOD may be intended to mean “every other day” but may be misinterpreted as “every day”. In both cases, the patients would take the drug too frequently.
Similarly, we now avoid “U” because when handwritten it may be misinterpreted as O or zero. Instead, the full word “unit” should be used.
In the case of dosing, a zero after a decimal point must be avoided. If the tiny decimal point isn’t noted, a patient may receive 30 mg instead of 3.0 mg.
Similarly, to avoid missing a leading decimal point, a zero should be written in front so that a dose of 0.5 mg will not be dispensed as 5 mg.
If you’re in the hospital, all this takes place behind the scenes without your awareness. As your healthcare providers, we have to be conscientious and write clear, unambiguous notes and orders. If we’re not absolutely sure what a doctor has written, we have to confirm the orders.
Outside of the hospital, it’s good to review your prescription before you leave the clinic to confirm the dosage of your medication and how you should be taking it.