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.