Background and aims: Transcription errors pose significant risks to patient well-being, potentially leading to morbidity, mortality, and financial burdens on healthcare systems and society. This study assessed the prevalence of transcription errors and their impacts on medical treatment approaches, hospitalization duration, and associated costs. Methods: Direct observation was used to evaluate and compare all patients’ medical records, identifying errors, costs, and hospitalization duration. Physician orders and patient applications were checked, with intervention and control groups categorized based on the presence or absence of errors, respectively. Data were analyzed using descriptive and quantitative methods such as the chi-square, student’s t-test, Mann-Whitney test, and ANCOVA, to assess statistical significance. Results: No significant differences were observed in gender (P=0.73) and age (P=0.89) between patients. Omission errors and incorrect dosage forms were the most common. Errors were more frequent in patients with underlying diseases (P<0.001), with nurses frequently involved (P<0.001). Errors were more prevalent in intensive care units (ICUs) (P=0.002) and during morning and night shifts (P<0.001). A significant association was found between trauma severity and medication error occurrence (P<0.001). Moreover, patients with transcription errors had higher medical expenses and extended hospital stays (P<0.001). Conclusion: Effective preventive measures are crucial to avoid transcription errors and their adverse consequences. Recommendations include minimizing abbreviations, ensuring complete and explicit orders, rigorous training, double-checking, using technology such as Electronic Prescription and Physician Orders, maintaining a distraction-free, ergonomic work environment, and fostering open communication among healthcare providers and patients to enhance medication safety.