Handwritten outpatient prescriptions: a risk to patient safety

Summary

James Andrews is a pharmacist currently working as a Superintendent for multiple outpatient pharmacies, including specialist cancer care. He is also a Topic leader for the hub. 

In this blog, James explains the safety risks that come with handwritten prescriptions and the wider impact this has on patients, staff and the system. He highlights the importance of high-quality patient counselling and digitisation in reducing the risk of medication errors.

Content

The scale of the issue

Prescribing a medicine is the most common patient intervention in healthcare and is the second biggest cost to the NHS after staffing [1].

It has been estimated that despite more than 104 million outpatient attendances a year[2] only 2% of hospitals have dedicated electronic outpatient prescribing systems[3] and the majority of outpatient prescriptions are still hand-written. In contrast, more than 95% of the 1.1 billion prescriptions issued by GPs each year are electronic[4].

While jokes about doctor’s handwriting are well known, we also know that poor-quality handwritten prescriptions can contribute to medication errors and risk patient safety[5,6]. 

Medication errors cost the NHS an estimated £98.5 million annually (excluding legal costs) and are linked to more than 1,700 deaths[7].

The patient safety risks of handwritten prescriptions

As described by Anne Kinderlerer and Benjamin Ellis in in their blog[8], prescribers may have to make prescribing decisions without access to a patient’s full clinical information.  

This could result in:

• a harmful drug being prescribed, particularly in the context of increasing patient and therapeutic complexity
• an inappropriate dose being selected or the duplication of an existing therapy
• in the extreme, one drug intended for a patient may be accidentally prescribed for another because of a mix-up of paper prescriptions. 

Pharmacists responsible for clinically screening each outpatient prescription are spending large amounts of time trying to ensure that prescriptions are legible and legal. They want to make sure that the medicines prescribed are safe and effective in relation to the risks and benefits for the individual patient.

Given all of this, and despite their best efforts, pharmacy teams may then also be forced to make clinical decisions without full information, compounding the initial prescribing risk to patients.

Wider impact on patients, staff and relationships

Patients may be left confused from mixed messages or unclear decisions, particularly at transitions of care. As this situation takes up significant clinical pharmacist resource it slows down the dispensing process, pushing up waiting times for patients. This creates workplace pressure which itself is an independent safety risk [9], and reduces the pharmacy team’s capacity for direct patient care. 

These secondary impacts are acutely felt by staff, reducing their satisfaction with work and leading to a staff retention risk.

The impact is also felt at the primary and secondary care interface, as clinicians try to unpick and navigate prescribing decisions, drug choices and doses during transitions of care. This is complicated further when care crosses multiple integrated care boards (ICBs), each with their own prescribing formulary, creating frustrations and tension between clinicians.

How to reduce the safety risk

High quality patient counselling

Outpatient pharmacy’s current highest-impact intervention is providing high quality patient counselling. It is important that patients know:

• what their medicines are
• why they have been prescribed them
• how to get the best outcomes with the least risks.

Crucially, patients should also be able and happy to take their medicines, and here pharmacy teams have a critical role in providing patient counselling and support, as well as being available to answer questions or discuss concerns. This is particularly important for marginalised groups or those with lower health literacy.

Outpatient pharmacies as integrated clinical-digital hubs

Looking ahead, the NHS 10-Year Plan [10] may provide the foundation for more transformational change. The Plan aims to shift care to the community, prioritise prevention, and digitise access, and as medicines are a ‘golden thread’ throughout most patient pathways, outpatient pharmacy can be a critical enabler of these goals in pursuit of enhanced patient safety. 

Underpinning this ambition must be the digitisation of outpatient prescribing, which should be linked to the patient’s own record within the NHS App.

Transforming outpatient pharmacies as integrated clinical-digital hubs would utilise existing infrastructure to deliver a high return from:

• maintaining careful management of high-risk and high-cost drugs
• reducing avoidable medication-related harm
• improving outcomes from medicines use
• reducing avoidable prescribing waste. 

Where needed, patients would be supported by pharmacy-enabled on-boarding to the NHS App, with the option for remote reviews and virtual consultations at the point of dispensing. 

Released clinical capacity could provide additional independent prescribing at ‘the front door’ (i.e. via A&E) and in high-impact specialties such as cancer, cardio-vascular disease and respiratory. Redeploying pharmacy expertise in this way would help to integrate prescribing decisions across the NHS, and improve patient safety.

Share your insights

Have you been affected by any of the points raised in this blog, as a patient, carer or member of staff? What changes would you like to see? Comment below to share your thoughts (sign up here first for free), or contact our editorial team at [email protected].

References

1. NHS Digital, Prescribing. Accessed online 15/09/25.
2. NHS Digital. Hospital Outpatient Activity 2023-24. September 2024. Accessed online 15/09/25. 
3. Ahmed Z, McLeod MC, Barber N, Jacklin A, Franklin BD. The use and functionality of electronic prescribing systems in English acute NHS trusts: a cross-sectional survey. PLoS One. 2013 Nov 20;8(11).
4. NHS Digital, Electronic Prescription Service. Accessed online 15/09/25. 
5. Dave, T.  How the standard of prescriptions received in a hospital outpatient pharmacy can be improved. The Pharmaceutical Journal, PJ (2010).
6. Abramson EL, Barrón Y, Quaresimo J, Kaushal R. Electronic prescribing within an electronic health record reduces ambulatory prescribing errors. Jt Comm J Qual Patient Saf. 2011 Oct;37(10).
7. Elliott, R; Camacho, E; Campbell, F. PREVALENCE AND ECONOMIC BURDEN OF MEDICATION ERRORS IN THE NHS IN ENGLAND: Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK. The University of Sheffield. Report. 2024.
8. Kinderlerer A and Ellis B. Patient safety in outpatients: What are the gaps in measuring and reporting harm? Patient Safety Learning's the hub. July 2025. Accessed online 15/09/25. 
9. Joint Royal Pharmaceutical Society of Great Britain and Pharmacy Practice Research Trust Symposium. Workload pressure and the pharmacy workforce: supporting professionals and protecting the public. Accessed online 15/09/25. 
10. NHS England. Fit for the Future: 10 Year Health Plan for England. Accessed online 15/09/25. 

About the Author

James Andrews is a pharmacist by profession and over the last 20 years has worked in lots of different private and NHS sectors of pharmacy practice. This includes front-line community pharmacy, working directly in general practice and as a national quality lead role for a large community services provider that covered everything from prison healthcare to paediatric and district nursing. During the Covid pandemic James worked as a senior pharmacist in a hospital and for the last 3 years he has been the Superintendent for multiple outpatient pharmacies, including specialist cancer care.