April ’12 Article

Hand written scripts.

As I reviewed my scripts at the end of last month it occurred to me that for me at least the number of hand written scripts seemed to be on the increase. This seemed a bit strange as although there is a slight increase in numbers overall it is still from the same pool of docs. Then it occurred to me. One of my local docs who previously had most of his scripts prepared by the receptionist on a PC has reverted to hand writing some of them. And as I thought about this I wondered to myself should hand written scripts be allowed any-more?
The first thing that struck me was that the potential for error is much greater with hand written. Both on the pharmacist’s side misreading it and on the prescriber’s side where a slight ink mark can change the context. For many years now it has been considered unprofessional for a pharmacist not to have his practice computerized and to have all labels except in some extreme instances typed and yet many docs are allowed to keep hand written records and issue hand written scripts. One of my biggest concerns if I was in this type of situation would be a fire or burst pipe wiping out all my patient records. At least with an electronic backup off site you would have a hope of getting up and running again in some sort of reasonable time frame.
I feel that by this stage most GPs should be moving towards computerised record keeping and typed or computer generated scripts. I think that there will always be a place for hand written scripts such as home visits and emergency situations but other that this I feel that typed scripts should be the default. There is also the issue of scripts for controlled drugs. We are all well aware of the details on these scripts which has to be in the prescriber’s hand writing. They are a legal requirement and there are many good reasons for them. If there is to be a move away from hand written scripts then there will need to be a change in the Controlled Drugs Act to accommodate this. However I suspect that like most pharmacists my biggest problem with controlled drug scripts is not with the hand written ones. It is with the typed or computer generated ones where the prescriber has neglected/couldn’t be bothered to fill in the required details in his/her own hand. This puts the pharmacist in a conundrum. Do we break the law and dispense the prescription or do we send the patient back to the doc and delay them getting a much needed medication? I know that in my case if it is a local doc and I am otherwise satisfied with the script I will dispense it and then send the prescription over to the doc with a note covering what needs to be done and have it collected ASAP. However if it not a local or a doctor with whom I do not have a relationship with then I am left with little choice but to send the patient back to the doc. And while a pharmacist who dispenses this script may be sanctioned there is no come back against the doc who places both pharmacist and patient in this predicament. Unless of course the patient who has to return to get the script completed lets fly at them for putting them to this inconvenience. I feel that this does not happen nearly enough for it to have any meaningful effect.
The Medical Council takes a stand-offish view of this. When quizzed on this subject their reply was to point me towards Guide to Professional Conduct and Ethics for Registered Medical Practitioners. All that this has to say is that
“The prescriptions you issue must be legible, dated and signed and must state your Medical Council registration number. When prescribing medications, you must comply with the misuse of drugs legislation and other relevant regulations and/or guidelines. ”
There is nothing about what might happen to you if you don’t meet these requirements. When pursued further it seems that the only way that a doc could be taken to task over an in-correctly written CD script is if somebody (the pharmacist?) was to make a formal complaint to the Medical Council. Not something that I would think is very likely. On the issue of record keeping again it kicks to touch.
“You have a duty to maintain accurate and up-to-date patient records either in manual or electronic form. You are expected to be aware of your obligations under the Data Protection Acts in relation to secure storage ..”
No mention of keeping proper back-ups which I would of thought goes without saying.
So what is needed if typed/computer generated scripts are to become the norm. Well a change in the Controlled Drugs act for starters but more importantly a change of attitude from the Medical Council. Just as pharmacy underwent a major upheaval about 20 years ago I think that the docs need one now. Feather quills and pots of ink are so 20th century, time to move into the 21st century. Of course there will always need to be provision for hand written scripts for home visits and emergency situations but typed or computer generated has to be the way to go. In suspect that if this is to happen then an exception will have to be made for hospitals under government control. The cost of installing PC’s and printers for every emergency department and training all personnel in their usage would send current HSE budgets into free-fall. So nothing new there.

So for now we just have to accept that some docs are still in the last century using parchment and ink and some are into the 21st century but not meeting all the CD requirements. And until there is some sanction against them for this behaviour or encouragement for better habits then I’m afraid that it will continue. As for the hospitals I think that we will have to wait for the economic recovery before we see any major changes there. The other great hope is that as the younger generation of docs move into general practice they will want to retain all the benefits of the computers that they were raised on and trained with. As things stand that should be completed in time for my retirement. That’s if I can afford to retire given the current economic situation. But that is a subject for a whole different article.

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