title: Physicians Failed to Write Flawless Prescriptions When Computerized Physician Order Entry System Crashed.
abstract: OBJECTIVE
  Clinical care has become increasingly dependent on computerized physician order entry (CPOE) systems. No study has reported the adverse effect of CPOE on physicians' ability to handwrite prescriptions. This study took advantage of an extensive crash of the CPOE system at a large hospital to assess the completeness, legibility, and accuracy of physicians' handwritten prescriptions.
  
  
  METHODS
  The CPOE system had operated at the outpatient department of an academic medical center in Taiwan since 1993. During an unintentional shutdown that lasted 3.5 hours in 2010, physicians were forced to write prescriptions manually. These handwritten prescriptions, together with clinical medical records, were later audited by clinical pharmacists with respect to 16 fields of the patient's, prescriber's, and drug data.
  
  
  RESULTS
  A total of 1418 prescriptions with 3805 drug items were handwritten by 114 to 1369 patients. Not a single prescription had all necessary fields filled in. Although the field of age was most frequently omitted (1282 [90.4%] of 1418 prescriptions) among the patient's data, the field of dosage form was most frequently omitted (3480 [91.5%] of 3805 items) among the drug data. In contrast, the scale of illegibility was rather small. The highest percentage reached only 1.5% (n = 57) in the field of drug frequency. Inaccuracies of strength, dose, and drug name were observed in 745 (19.6%), 517 (13.6%), and 435 (11.4%) prescribed drug items, respectively.
  
  
  CONCLUSIONS
  The unintentional shutdown of a long-running CPOE system revealed that physicians fail to handwrite flawless prescriptions in the digital era. The contingency plans for computer disasters at health care facilities might include preparation of stand-alone e-prescribing software so that the service delay could be kept to the minimum. However, guidance on prescribing should remain an essential part of medical education.
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Chen
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Chou
authors.affiliation: Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chin-Chin
authors.initials: CC
authors.lastname: Ho
authors.affiliation: Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chung-Yuan
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan. Electronic address: ycchou@vghtpe.gov.tw.
authors.forename: Yueh-Ching
authors.initials: YC
authors.lastname: Chou
mesh_terms: D002983:Clinical Competence; D011307:Drug Prescriptions / Q000592:standards*; D055695:Electronic Prescribing; D004868:Equipment Failure; D006236:Handwriting; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000706:statistics & numerical data*; D010820:Physicians / Q000592:standards*; D055553:Prescription Drugs; D013624:Taiwan
chemical_list: D055553:Prescription Drugs
keywords: CPOE system downtime; ambulatory care; handwritten prescriptions; medical education; stand-alone e-prescribing software