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Errors on a handwritten cardex: is it time for a change?

A Rijal1, K Gautam, A S Rijal

  • 1Department of Surgery, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, Nepal. anjan.rijal@gmail.com

Nepal Medical College Journal : NMCJ
|September 29, 2012
PubMed
Summary

Medical orders in Nepal, written on cardexes, show high error rates in documentation and handwriting legibility. Modifications to the cardex system and doctor education are recommended to improve patient safety.

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Area of Science:

  • Medical Informatics
  • Patient Safety
  • Health Records Management

Background:

  • Medical orders are critical legal and medical documents.
  • In Nepal, patient orders are managed using a cardex system by nurses.
  • Electronic systems are emerging as potential improvements over traditional methods.

Purpose of the Study:

  • To evaluate the adequacy of the existing cardex system for medical orders.
  • To identify specific areas of error within the cardex system.
  • To determine if modifications or a shift to electronic systems is necessary.

Main Methods:

  • A prospective observational study was conducted.
  • 240 cardexes were randomly sampled from eight departments at a Medical College Hospital.
  • Thirteen parameters were assessed, including handwriting legibility and data completeness.

Main Results:

  • High error rates were observed in column utilization (77.9%), allergy history documentation (77.5%), prescriber name (89.6%), and discontinuation dates (62.5%).
  • Handwriting was unreadable or difficult to read in 49.2% of cardexes.
  • No assessed parameter was entirely error-free.

Conclusions:

  • The current cardex system requires modification to reduce errors.
  • Enhanced doctor education is crucial for minimizing documentation mistakes.
  • A transition to a computerized system may be necessary for future error reduction, particularly for handwriting issues.