They might save time by using cursive writing, but the time saved needs to be weighed against the risk of creating errors and the tremendous waste of staff time when poorly handwritten orders must be interpreted. Prescribers are encouraged to use block printing for handwritten orders. Mixed-case (e.g., Tall Man) letters are also more easily distinguished compared with all upper-case or all lower-case letters.īlock printing on lightly lined forms. Although some handwritten lower-case letters are difficult to distinguish (see Table 1), they are more easily differentiated than upper-case letters. Using lower-case letters or mixed-case letters. S afe P ractice R ecommendations: Various methods are available to enhance recognition of look-alike alphanumeric symbols. 1 The letters l (el) and 1, O and 0, Z and 2, and 1 and 7 accounted for more than 50% of the errors. In research conducted at Bell Labs, some symbols were more vulnerable than others to being misidentified. It may also be difficult for word-recognition software to distinguish L from I, Z from 2, and other look-alike symbols from each other. For example, the letters Z, I, and O, amid an array of numerals, can easily be mistaken for the numbers 2, 1, and 0. Although the context can sometimes clarify which letter or numeral is meant, it can also detract from recognition. Information that contains both numerals and letters-including e-mail addresses or medication orders-is particularly easy to misread. Most of us know how easy it is to misidentify a computer-generated lower-case letter l in an e-mail address as the numeral 1 or the letter O as a numeral 0. For example, a clearly typed prescription for 25 mcg of LEVOXYL (levothyroxine) could be misread as 125 mcg if the name appears without proper spacing as “Levoxyl25 mcg,” especially since both dosage strengths are available for this drug. Although the use of these technologies is growing, even typewritten or computer-generated physician orders might not prevent confusion with certain alphanumeric symbols. Electronic medical records, medication administration records (MARs), and computerized prescriber order entry (CPOE) systems can help minimize many problems with handwritten information.
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