RX - Pharmacist’s Dilemma
Pharmacy professionals across the country often get presented with ineligible prescriptions, as a direct result of this, patient care and service delivery are negatively impacted. But the results could be dire. Nhlanhla Mafarafara takes stock of the risks of attempting to decipher an ineligible handwriting through social media.

Illegible Prescriptions – the Pharmacist’s Dilemma


Nhlanhla G. Mafarafara; BPharm, MPharm.

Pharmacists face a challenge of having to read and correctly interpret illegible prescriptions in their daily practice. Sizwe Welcome Lubisi, in a Facebook post wrote that, “some pharmacists feel like kings after cracking an illegible prescription.” Some of the incorrect interpretations of badly written prescriptions could be fatal. Often such prescriptions do not meet the legal standard to be dispensed by a pharmacist in the first place.

It is generally accepted that doctors have illegible handwriting, handwriting that other parties often have problems reading and interpreting1. Doctors’ bad handwriting contributes to 7 000 deaths annually2 with incidences that include unreadable clinical notes3, medicines used by anesthesiologists4 and spelling mistakes5. They are also the leading cause of medication dispensing errors5. The most common recorded errors are caused by unclear abbreviations, unclear doses, lookalike names and generally unreadable handwritings2. Other studies show that pharmacists are often presented with incomplete or illegible prescriptions6.

Prescribing errors could result in adverse events and harm patients7. Pharmacists play a critical role in identifying and preventing medication errors by communicating with the prescriber to solve such problems. However, sometimes, not even the name of the prescriber can be identified1.

On the other hand, pharmacists have to deal with meeting the patient’s medicine needs against meeting their own profit goals. This has made the use of social media a convenient platform to share these illegible prescriptions in order to solicit help from other pharmacists. While the law clearly prescribes the legal requirements of a prescription8, as well as the ethical obligation of a pharmacist, there may be a contradiction between what should be practised and what is practised. A prescription is required by law to be handwritten legibly by the prescriber or electronically generated and signed in person by a medical practitioner, dentist or authorised prescriber8. In instances where a pharmacist cannot read such prescription, or has any doubt whatsoever, the pharmacist should endeavor to call the prescriber for clarity and certainty9. The immediate consequences of illegible handwritten prescriptions include delayed dispensing, partial dispensing or dispensing of a wrong drug, dose or quantity5. In practice, the actions surrounding illegible or confusing prescriptions contribute to patient satisfaction or lack thereof.

Given the rise in the number of complaints against pharmacists with the South African Pharmacy Council (SAPC) related to dispensing errors10, pharmacists should exercise caution when handling prescriptions. Pharmacists are the gatekeepers of patient care, including the prevention of medication errors. There is a possibility of increasing the chances of dispensing errors when two or more pharmacists try to read a prescription and come up with more than one possible result, and the lookalike-soundalike medicines can be easily switched for one another.

Due to the increase in patient load, commercialised or profit-driven patient care, patient demands and dealing with the impatience of the patients at the dispensaries, some pharmacists opt to call or text the next available pharmacist for advice. It is convenient to do so, but may pose a threat to the patient and the image of the pharmacist, the pharmacy and the profession. Pharmacy professionals should know and keep within their ethical and professional boundaries when handling prescriptions and using social media platforms.

Professional conduct should not be replaced with convenient methods at the expense of patient safety and professional integrity. In all instances, pharmacists should always be careful and cautious in upholding their professional and ethical responsibilities when handling prescriptions. They must ensure that they safeguard the health and confidentiality of patients and protect the image of other health professionals, as well as that of the Pharmacy profession.

  1. Brits H, Botha L, Nicksh L, Terblanché R, Venter K & Joubert G.
    Illegible handwriting and other errors on prescriptions at National District Hospital, Bloemfontein. South African Family Practice. 2017; 59(1)52-55, DOI:10.108/20786190.2016.1254932
  2. Caplin J. Cause of death: sloppy doctors. Time Magazine. 2007.
    Available from: http://content.time.com/time/health/article/0,8599,1578074,00.html
  3. Rodriguez-Vera JJ, Marin Y, Sanchez A.
    Illegible handwriting in medical records. J R Soc Med. 2002; 95(11): 545-6. PMID: 12411618, PMCID: PMC1279250
  4. Raff M & James MFM.
    An audit of anesthetic record keeping. South Afr J Anaesth Analg. 2003; 9(3):7-9. DOI: 10.1080/22201173.2003.10873005.
  5. Chaturvedi SK. What’s wrong with doctor’s handwriting? Netl Med J India. 2018; 31: 47-48
  6. Michel B, Hemery M, Rybarczyk-Vigouret, Wehrlé & Beck M.
    Drug-dispensing problems community pharmacists face when patients are discharged from hospitals: a study about 537 prescriptions in Alsace. International Journal for Quality in Health Care. 2016; 28(6): 779-784. DOI: 10.1093/intqhc/mzw111.
  7. Al-Dhawailie AA.
    Inpatient prescribing errors and pharmacist’s intervention at a teaching hospital in Saudi Arabia. Saudi Pharm J.2011; 19(3):193-196
  8. Medicines and Related substance Act 101, regulation 28
  9. Good Pharmacy Practice. Minimum Standards for Dispensing of medicines or scheduled substances on the prescription of authorized
    prescriber. South African Pharmacy Council. Juta and Company. 2018. (Section 76-79.
  10. Defty D. Pharmacist’s errors in the spotlight. Pharmaciae. 2016: 3(2)

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