Update: Thanks to Kevin, MD, The Consumerist, and The Wall Street Journal Health blog, this entry is getting a lot of traffic. If you enjoy it, please take the time to Digg it. :)
The first round was popular, so I thought I would share another round of Bad Prescriptions. Answers will be posted tomorrow (Thursday) night around midnight.
Remember there’s more to a prescription than the drug. You need to get:
- Drug name
- strength
- directions
- quantity
- number of refills
The last prescription is totally legible. I have included it so you can cringe along with me. It was for a 6 year old child. And the folks in the Ivory Tower think MinuteClinics are bad…
Exhibit A:
Exhibit B:
Exhibit C:
(Standard disclaimer about electronic prescribing not being the perfect answer applies.)
[tags]Medicine, pharmacy, prescriptions, bad handwriting, doctor’s handwriting[/tags]
1. Benadryl 12.5mg/5 ml
2.5 ml every 6 hours if needed
no idea
refill 4 times
2. Tylenol 80 mg/0.8 ml
80mg/0.8 ml every 4 hours if needed
4oz- no refill
3. Amoxicillin 250/5ml
dispense 1 bottle
2-3 tablespoonsful a day
Doses for 6 year old are all wrong- From what I read on the Tylenol directions the dose is 80 mg- 6 yr old should get more around 325 mg. Diphenhydramine is dosed on weight (5 mg/kg/day)but I would assume a 6 year old weighs more than 5kg. directions for Amox- Wrong on dose and no idea of length of therapy cause we are supposed to choose the bottle size.
I think I would be making a phone call. But you know if a pharmacist can check these doses why can’t the physician look it up before they write for it? I worked in pediatrics at a large hospital for 4 years. We always checked doses on every order. I know other hospitals where the MDs must write their dosing calculations on every order. What if a pharmacist didn’t check these doses? The benadryl and tylenol are OTC and could have been bought at any store. Since it is not an overdose it wouldn’t have killed the child but it certainly wouldn’t have helped and then another visit or even hospitalization for eleveated temps. Shameful.
Benadryl Liq 5mg/5ml; sig: 0.5ml po q 6 hours prn & (??? – looks like before rash, but that doesn’t make sense); disp: 4oz, 4 refills
Tylenol 80mg/0.8ml; sig: 80mg/0.8ml po q 4 hours prn pain; disp: 4oz, 4 refills
terri,
You are incorrect on Script #1. Directions, refills, etc.
Tylenol directions are incomplete. Need more than that; they’re actually very specific. Refill is also incorrect.
Not a freaking clue.
I think the second line of the second one is written in Hebrew.
That amoxicillin Rx is just lame.
OMG, Dr Dino is stumped! :p (After all, you won the last one. :))
ok- try again
Benadryl- 4 refills- and I have no idea what the sig is, it almost looks like 1 before meals?? And if the other part of the sig is 0.5 ml- then even worse UNDER dose than I thought.
tylenol – prn pain? and 4 refills
Some hints:
Benadryl: the actual number of refills looks nothing like what’s written. The second line of the sig is a red herring. It’s not dosed before anything, even though it says it is. (To give you an idea how fucked up these prescriptions are.) Dose is not 0.5mL, either. Qty is correct.
This tylenol script has nothing to do with pain. It was filled with four refills, but I suspect it was supposed to be something else. Looks close enough to a 4, though. (And yes, I realize that it looks almost the same as the other script.)
These prescriptions are more ridiculous than Round 1’s set.
It’s a couple of hours early, I know, but I’ve got an early shift tomorrow.
I am NOT making these up. I called the office and verified the first one by speaking with the doctor herself. The second one was verified by someone else. I don’t know who she spoke to.
These prescriptions are written by the SAME DOCTOR on the SAME DAY for DIFFERENT PEOPLE. Her handwriting is universally shitty. These are not one-off occurences. The writing is so bad, and what the prescription turns out to be is often so different from what it looks like on paper that I feel uncomfortable filling any prescriptions from her because the probability of success is about 50-50.
Script #1:
Benadryl 12.5mg/5mL
4ml po q6 hours prn
#4oz
2 refills
Script #2:
Tylenol 80mg/0.8mL
0.8mL q4 hours prn temperature > 101 degrees
#6oz
4 refills
Witness how what looks like a 4 in the refills section is actually a 2 in one case, and filled as a 4 in the other. What’s actually right? Even now, I don’t know.
Looking at these prescriptions days later, my mind is still boggled. I actually have to look at my notes as I write this to be sure what is what. Horrific.
Horrible- but these doses are still underdosed- I don’t know in the retail sector ’cause I practice in hospital but do you dispense as written or get the doc to change. I would not have given as written- in fact in my practice setting if doc wouldn’t agree to appropriate dosing – I would have gone over her to another partner in her practice or the pediatrics supervisor. just my 2 cents.
terri, I’m not sure what you mean. Which scripts were underdosed? They all seem pretty reasonable to me. If it seems wildly off (the third one), I call and have it changed, which is what I did. I ended up telling the prescriber what I thought was a good middle ground, and he seemed relieved to have someone else take the problem off his hands. He was a dentist, and he was WAY over his head, it seemed.
He didn’t even want to get on the phone with me, I could hear him in the background. I felt bad for the guy, actually.
You cant read them because most doctors are in too much of a hurry to get to their next Px.
Inconsiderate pricks.
They can graduate from medical school, but not have the common courtesy to write legibly?
I thought you had mentioned they were for a 6 year old child. But as I go back and read you say just the last one is for a 6 year old. Sorry. But yes I still insist on weights on all my kids and base doses on weights. It has been my experience that most docs underdose because they are afraid to give too much. But underdosing can lead to a number of issues also. It frustrates me that I would never guess at a dose especially for a child yet we see it all the time. If they want to pick the drug and let us dose- great. I consider it a value added service. Thanks for the exercise! I’d say it was fun, but a little depressing.
I confess, I wrote these. Here’s what I really wrote … they were intended to by Haikus, not scripts, for a poetry class:
#1:
Scrooge 1 IQ say Lassie.
Yo, smile, Poog Pro.
And FIFO mail.
#2:
7 Ylert song lo smile.
My song lo smile
is on purple.
#3:
This is a real script. I had a headache coming up with good haikus.
i am developing a legibility clinic and would love to know the correct decipher of the above scripts. I have Benadril 12.5 mg/15 mL, sig: 0.5 mL: PO Q6hours prn ______________ disp 4 oz. refills 4; 2nd- Tylenol 80 mg/0.8 mL
sig 8 oz/0.8 mL PO Q4 hours prn pain disp 6 oz; 4 refills; 3rd–Amox 250 mg (liquid form) disp 1 bottle, sig take 2-3 tablespoons per day
debbie, the answers are posted above. (Here.)
Seriously, isn’t there something to be done here? That first script CLEARLY has a 0.5, i think she messed up and she saw it when you questioned her or she let the kid she was prescribing for write the thing.
I used to work in an area with a physician who’s handwriting was so bad, that I had to fax his office with the Rx to have it deciphered EVERY time I got one. His own office staff was also unable to read his handwriting. While I was waiting for clarification, I would educate his patients on how his writing was risking their health and safety, as well as wasting their time and mine. I would tell them that they needed to insist that he have a nurse or secretary either call in Rx’s or write the Rx’s so he could just sign them. The best part was when one of his Rx’s wound up in the “Can You Read This?” segment in Pharmacy Times!
This is terrible, I could not make out what it says and I am a Coder, I have to interpret progress notes everyday
Oh my gosh…this is horrible! I’m glad someone else share the same frustration. I pull my hair out everyday looking at their progress notes…You should see their handwriting diagnoses”
BTW i’m a coder
the last ones really simple champ. im in nursing school and i can read it Amox for amoxocillin 230 mg (liquid form)
DISPENSE : 1 bottle
siq: TAKE 2-3 TABLOE SPOONS PER DAY ( i mean its not exactly gonna win penmanship of the year award but its deffinantly alot more legible than many ive seen
1) It’s 250mg, not 230.
2) “1 bottle” isn’t a quantity. Amox 250 comes in 4 different sizes
3) 2-3 tablespoons a day isn’t a dosage. It’s a suggestion. (“Hey you (the patient) figure it out”)
In short, it was written by a total jackass.
What the hell is a TABLOE SPOON?Â
I couldn’t find your answers so here is my opinion.
1. Benadryl 5mg/5ml sig take 5ml po q 6 h prn for some kind of rash (can’t really tell due to the handwriting) dispense 4 oz
2. Tylenol 80mg/0.8ml sig take 80mg po q 4 h prn for pain dispense 6 oz
3. Amoxil 250/5 the wording is clear but makes no sense like you stated, do these doctors think everything comes in a pint bottle or something? They might have as well put prn if they are not going to come up with a set dosage.
Why does everyone in nursing school have to state that they’re in nursing school? As a very general rule of thumb, I find that they usually mean “I’m going to say something that’s not entirely correct but if you don’t know anything about healthcare, you’re going to get misinformation and not know it.”
Benadryl 12.5mg/5ml sig: take 2.5 ml by mouth every six hours as needed for rash dispense 4oz refill 4
Tylenol 80mg/0.8ml dig: take 80mg(0.8ml) by mouth every 6 hours as needed for pain dispense 4oz
Amoxil 250/5ml dispense 1 bottle take 2-3 tablespoons per day
Quit nursing school and go back to grammar school.
“tablespoons”, “it’s” x2, “definitely”, “a lot”.
Don’t try to school anyone until you learn to use proper grammar. Also, Amoxicillin doesn’t come in 230mg.