Ugh... Chicken Scratch

[Crimsonking]

Hi All,

I have to ask, how do you put up with the Chicken Scratch Dr.'s call their handwriting? I just started a part time job as a Unit Secretary and while being trained, I'm trying to put in orders. I swear I thought one order said "CT Hot Dog Bun" and asked the Sec training me what she thought it was. She said, "OH.. That says CT Chest with and with out Contrast" And then I'm supposed to know who the ordering Doc is by his signature that looks like the letter "O" . When it's so bad, I have to verify it with the Doc. and get attitude for doing so.

I believe that this presents major problems in healthcare. As far as someone, who gets paid next to nothing, being responsible to enter important orders in and can't understand what the order says and get flack for not being able to read chicken scratch, I don't see how more "accidents" happen. My hospital is notorious for sending people down to radiology for tests that they don't need. I can see why. I personally think that Doc's should be held accountable for their handwriting. Your thoughts?

[MS._Jen_RN, ASN, RN]

Student question here:

If you can't read the orders then aren't you putting yourself at risk by trying to interpret what you see?

Never having worked in a unit, I have no idea, but it seems like illegible writing should always mandate a page or call followed by a return visit by the doc to write orders that can be interpreted.

What happens if something goes bad? Who assumes the liability?

This seems like something that the hospital QA team (do they have those?) would address. Seems like the "low-hanging fruit" on the "reducing medical errors" tree.

Yes, you are putting yourself at risk, and that's why if you aren't sure about what it is you are reading you call or page as the others have said. It's the attitude that follows that page which I really get steamed at. I LOVE the electronic ordering system at my hospital for this and many other reasons.

~JenRN

[herecomestrouble]

QA=quality assurance

I have worked at a place that used computers and got very spoiled by not having to struggle with chicken scratch orders.I am very uncomfortable where I am now with "guessing" what is written and will call a Dr to ask what he wrote,sure they get mad at me but they'll also get mad when I do the wrong thing/order the wrong med/run the wrong test,so it's a no win situation.

[Intenstudy]

I work as a Unit Sec. and usually if I can't decipher chicken scratch, i'll try to catch the doctor if they're still on the unit and ask them to read it for me. Some have been nice enough to rewrite the order! I've noticed that if I do it enough, they'll be sure to let me know after they write an order or be neater!

[nurturing_angel]

We once had a doctor with handwriting no one could interpret. I caught him before he left the floor one day and asked him to tell me what his new orders were and he couldn't even read it!!!! He had to go back and look at the chart and then write new orders. How hospitals let these lawsuits waiting to happen continue is beyond me!

I am happy to say that we have a new computer charting system and doctors will be putting in their own orders soon. They already have one or two doing it with the rest to follow in the next few months.

:balloons:

[Elvish, BSN, DNP, RN, NP]

One of the few nurse-friendly results of our JCAHO visit was that MDs are mandated to have legible orders AND signatures. If we can't read their orders, we are expected to call/page them for a clarification. And tptb back us up on it. For the most part, though, our docs have been more than happy to write neatly. Or is it just they've learned their lesson? Either way, we are all better for it.

[ASSEDO]

you are so right!! i audited medical records for cms and would love to get a progress note or physician order i could not read. i would deny payment to the hospital using the code of federal register 482. however, the hospital would eat the cost, and i am sure the reason for denial was never passed on the the physician (or else, the physican didn't care). poor physician handwritting has probably killed more patients than we care to believe. i was recently asked by a physician to read another physicians progress notes. the new physician couldn't read the medical record, neither could i.

code of federal register 482

(c) standard: content of record. the medical record must contain information

to justify admission and continued hospitalization, support the diagnosis,

and describe the patient’s progress and response to medications and services.

(1) all entries must be legible and complete, and must be authenticated

and dated promptly by the person (identified by name and discipline) who is responsible for ordering, providing, or evaluating the service furnished.

(i) the author of each entry must be identifed and must authenticate his or

her entry.

(ii) authentication may include signatures, written initials or computer

entry

[pagandeva2000, LPN]

What is interesting is we have docs that can't read other docs poor handwriting and then they get mad...um yah!!!!

I hear talk at our facility that someday soon the docs will have to computer enter orders...won't that be great...and oh...interesting I am sure.

Please allow me to SCREAM (they need an icon with a bullhorn here...) that it will not always make things better. We use computerized charting in our clinic, and there, you will see the mis-spellings, fragmented sentences, and horrible grammar. I swear, they write sloppy so that you can't determine that they failed English 12 times:angryfire:angryfire:angryfire

[ericalynn, BSN, RN]

Don't take the attitude! Let the MD know that you have difficulty reading their hand writing and that you would prefer to get the orders CORRECT as opposed to have some type of error occur regarding patient care. If they don't understand this and continue to have attitude let the floor supervisor know. You are a person just like the MD is and you deserve respect like anyone else, just because someone has the letters MD that follow their name doesn't make them any more special than you are. Many hospitals have systems in place that will reprimand (sp?) MD's who throw attitude for no reason.:monkeydance:

[pagandeva2000, LPN]

Don't take the attitude! Let the MD know that you have difficulty reading their hand writing and that you would prefer to get the orders CORRECT as opposed to have some type of error occur regarding patient care. If they don't understand this and continue to have attitude let the floor supervisor know. You are a person just like the MD is and you deserve respect like anyone else, just because someone has the letters MD that follow their name doesn't make them any more special than you are. Many hospitals have systems in place that will reprimand (sp?) MD's who throw attitude for no reason.:monkeydance:

I totally agree with your statement, but unfortunately, many facilities support the physicians and leave the nurses with mud on their faces; mine being one of them. I do make sure that they clear up their orders, though.

[jrring1019]

I know what you are saying and I have been there.

However ,I must thank you for that laugh!! 'CT hot dog bun' made me laugh out loud and I needed that!

[Crimsonking]

Don't take the attitude! Let the MD know that you have difficulty reading their hand writing and that you would prefer to get the orders CORRECT as opposed to have some type of error occur regarding patient care. If they don't understand this and continue to have attitude let the floor supervisor know. You are a person just like the MD is and you deserve respect like anyone else, just because someone has the letters MD that follow their name doesn't make them any more special than you are. Many hospitals have systems in place that will reprimand (sp?) MD's who throw attitude for no reason.:monkeydance:

I understand what you are saying, however, all of the supervisors know how bad it is. I always get, "you'll get used to it, so don't worry about it now." It's harder to fix when the current staff have put up with it for so long. Now you're talking culture change. I don't know a Unit Secretary, 10 days on the job, can have that much of an effect.

I used to think that this was an urban legend. Just a rep given to a profession because of a few bad apples. I'm shocked to see how bad it really is. It's not just the residents at this hospital. All the consulting practices and interns have the same problem. I'm starting to think this is a conspiracy drafted in Medical Schools across the country. :chair: I've even been told that they do it on purpose, in order to keep those orders "open to interpretation" in case of litigation.

[ericalynn, BSN, RN]

I understand what you are saying, however, all of the supervisors know how bad it is. I always get, "you'll get used to it, so don't worry about it now." It's harder to fix when the current staff have put up with it for so long. Now you're talking culture change. I don't know a Unit Secretary, 10 days on the job, can have that much of an effect.

I used to think that this was an urban legend. Just a rep given to a profession because of a few bad apples. I'm shocked to see how bad it really is. It's not just the residents at this hospital. All the consulting practices and interns have the same problem. I'm starting to think this is a conspiracy drafted in Medical Schools across the country. :chair: I've even been told that they do it on purpose, in order to keep those orders "open to interpretation" in case of litigation.

I think you can have an effect. If when you call an MD to ask for clarification and he/she has an attitude simply ask them how you could have handled it better, ask them if you should have just assumed what you as a unit tech thought the MD might have ordered? I know it's easier to say then do, believe me I am intimidated by MD's as well, but my licencse depends on me doing the correct things for my patients and if I can't read an order I don't give a hoot who has an attitude probelm, I am a patient advocate and I want to do what's right for my patient. If that means clarifying unreadable orders written by snotty, pretentious MD's then so be it. Be confident and I can promise you that most MD's will be happy to clarify for you, and the one's who aren't, TOO BAD FOR THEM!