Physicians Failed to Write Flawless Prescriptions When Computerized Physician Order Entry System Crashed.

Area of Science:

• Medical Informatics
• Health Systems Research
• Clinical Pharmacy

Background:

• Clinical care increasingly relies on Computerized Physician Order Entry (CPOE) systems.
• The impact of CPOE on physicians' manual prescription writing skills is understudied.
• A major CPOE system failure provided a unique opportunity to assess handwritten prescription quality.

Purpose of the Study:

• To evaluate the completeness, legibility, and accuracy of physician-written prescriptions during a CPOE system outage.
• To identify specific deficiencies in handwritten prescriptions when digital systems are unavailable.

Main Methods:

• Analysis of 1418 handwritten prescriptions from an academic medical center in Taiwan following a 3.5-hour CPOE shutdown.
• Prescriptions were audited by clinical pharmacists for completeness and accuracy across 16 data fields.
• Data included patient demographics, prescriber information, and drug details.

Main Results:

• No handwritten prescriptions were fully complete; patient age and drug dosage form were frequently omitted.
• Illegibility was minimal, with the highest rate at 1.5% for drug frequency.
• Significant inaccuracies were found in drug strength (19.6%), dose (13.6%), and drug name (11.4%).

Conclusions:

• Physicians struggle to produce flawless handwritten prescriptions in the digital era.
• Healthcare facilities need robust contingency plans, potentially including standalone e-prescribing software.
• Prescribing guidance must remain a core component of medical education to address skill degradation.