Inadequate medical order writing. A source of confusion and increased costs.
Audits of medication and intravenous fluid orders and of return to the pharmacy of unused intravenous solutions were conducted in 1980 at a university teaching hospital in response to a prevailing impression among pharmacists that physicians' orders were often written in an incomplete, nonstandardized fashion and that intravenous fluid wastage was common. A disturbing number of order were incomplete and judged to be ambiguous. Less than 25% of orders for intravenously given solutions contained adequate instructions for subsequent administration of fluids. Intravenous fluid return amounted to an estimated loss of $137,695 per year in wasted material and labor. The results of the audits were disseminated among the staff. In addition, the pharmacy changed its operations to detect more quickly and correct the problems caused by ambiguous orders. Later studies showed a reduction in the return of unused intravenous fluids and some improvement in order writing. Inadequate and ambiguous orders were still judged to be a problem, however, especially intravenous fluid orders that omitted instructions for subsequent fluid requirements and "open-ended" intravenous fluid orders. Such orders were eight times more likely to be associated with return of unused intravenous fluids than orders with adequate instructions for giving fluids subsequently.