Study on Prescription Audit from a Rural Tertiary Care Hospital in North India (original) (raw)
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Asian Journal of Pharmaceutical and Clinical Research, 2022
Objectives: Standards of the medical treatment at different levels of the health-care delivery system influence the quality of life. A prescription audit is a kind of vigilant activity that can oversee the observance of these standards. We conducted a prescription audit to evaluate the prescribing pattern in the general outpatient department (OPD) in a rural hospital in West Bengal. Methods: The study was a cross-sectional study spanning for 1 month, from September 1, 2021, to September 30, 2021. It was conducted at the general OPD of a Rural Hospital in West Bengal. Four hundred and ninety first encountered prescriptions were collected from the OPD and analyzed. Results: All prescriptions contained the name, age, and gender of the patients, but body weights of the patients were documented only in 12.4% of cases. Proper diagnosis was mentioned in 43.7% prescriptions and route of administration was mentioned in 58.4% of cases. Medicines were prescribed in generic name in 78.2% cases and 2.9% contained an injection. Antibiotic was prescribed in 19.4% prescriptions and 32.3% of drugs were prescribed from the essential medicine list. Correct duration of treatment was provided in 32.7% cases. Standard treatment guidelines were followed in 26.4% prescriptions. Conclusion: Our study showed encouraging trends regarding prescribing in generic name and limitation of antibiotic usage. However, there were deficits in mentioning the diagnosis and vital drug related information such as route of administration and duration of therapy.
An audit of outpatient prescriptions and drug use pattern at a tertiary care centre of Central India
IP Innovative Publication Pvt. Ltd. , 2018
Objective: A cross sectional observational survey to assess the drug use pattern and habit of writing rational prescription followed by a feedback to the prescribers to ensure the best practice in writing prescriptions. Materials and Methods: Prescriptions were analyzed in the month of January 2016 at All India Institute of Medical Sciences, Bhopal, MP, India using the WHO core prescribing indicators. In addition, quality of prescription writing was also assessed in terms of legibility and completeness of information e.g. whether diagnosis, strength, frequency and duration of drug prescribed was written or not. The collected data was analyzed in Microsoft Excel 2007. Statistical analysis had been done to obtain frequency, average/mean, and percentage. Result: Total number of prescription analyzed were 503, contained a total of 1118 drugs i.e. on an average 2.2 drugs per prescription. Drugs prescribed by generic name and injectable route were 71(6.3%) and 9(1.0%) respectively. A total of 163 antimicrobials were prescribed in 117(23.2%) prescriptions out of which 108 were anti-bacterials. A large proportion (60.1%) drugs prescribed were not included in the NLEM. Incomplete and illegible prescription were 357(70.9%) and 219(43.5%) respectively. Conclusion: This prescription audit revealed that polypharmacy, overuse of injections and unnecessary use of antimicrobials were not a concern in the target prescribers. But there is a scope for improvement in generic prescribing, use of essential medicines, better quality of prescription writing in terms of completeness of information provided and legibility of prescriber details. Introduction Prescribing drugs is the most common therapeutic approach offered to patients by the doctors. It is therefore imperative that this tool be used to make the best possible use of a valuable resource that is a drug. One way of ensuring this is by regular and periodic audits of prescriptions. By throwing light on problems of irrational prescribing, a prescription audit helps in promoting most efficient use of therapeutic agents, reducing prescribing costs by reducing unnecessary use of antibiotics and injections in prescriptions, encouraging generic prescriptions and reducing polypharmacy. This in turn improves patient care and management and reduces noncompliance and wastage of valuable resources. Besides irrational prescribing, many ADEs are caused by medication errors, which in turn are often due to errors in prescription writing, like illegibility, ambiguous abbreviations, lack of date of prescription, dose, route, frequency of administration and duration of treatment. 1,2 At the prescriber level, a prescription audit enables continuing professional and personal development of the practitioner and helps to identify, analyze and plan future development needs. Since a prescriber is clinically and legally responsible for his/her own prescription, every practioner needs to demonstrate that they prescribe effectively and safely, by regularly analyzing and changing their practice where necessary.
Asian Journal of Pharmaceutical and Clinical Research, 2021
Objectives: The objectives of the study were to study the pattern of major drug groups prescribed, assess the Rational Prescription pattern by measuring the WHO Core Prescribing Indicators and to assess the quality of the prescriptions by assessing the legibility of prescription in the outpatient department of a tertiary care hospital. Methods: It was an analytical cross-sectional study done in Outpatient Department for a period of 6 months. Approval from Institutional Research Committee and Institutional Ethics Committee was taken before starting the study. Sample size was taken as 1020. Results: One hundred and twenty prescriptions were analyzed. About 49% prescriptions were of males and 54% of females. Mean age of the patients were 46 years. A total of 3557 medicines were prescribed in 1020 prescriptions. Due to lack of legibility, we were unable to decode 122 medicines out of 3557 medicines prescribed. The dosage forms prescribed were; oral 87.4%, injections 1.4%, inhalational agents 0.4%, and topical agents 10.8%. Average number of medicines per prescription was 3.5. Percentage of medicines prescribed by generic name was 45%. Percentage of antibiotics per prescription was 24.8%. Percentage of injections per prescription was 4.8%. Percentage of medicines prescribed as per NATIONAL essential drugs list (EDL) was 3.2% and as per the WHO EDL was 2.6%. Percentage of fixed dose combinations (FDCs) was 6.5%. Conclusion: It was evident that polypharmacy was present as indicated by the average number of medicines prescribed. Medicines prescribed by generic name and from Essential Medicine List were less in number. Antibiotics and injections prescribed was in conformity with the WHO recommended values, which means that there was no irrational use of antibiotics and unwanted use of injectables. Percentage of FDCs was 6.5%. Most commonly prescribed drug was Ranitidine as per our study. Hence, as per this study, prescribers did not follow prescribing core indicators of the WHO closely, except for two indicators. The quality of prescriptions with respect to legibility and clarity was found to be optimal.
Background: The quality of a prescription is an important part of rational prescribing. Rational use of drugs is an essential factor for achieving high quality patient care. The aim of this study is to audit the prescriptions in outpatients departments as per WHO core prescribing indicators for rational use of drugs. Materials & Methods: 1050 prescriptions were audited over a period of two months in a tertiary care hospital in Jharkhand. Prescriptions were assessed for WHO core prescribing indicators and legibility. Results: Antibiotic use was more than recommended WHO criteria. 96.14 percent of medicines were prescribed from essential drug list. Percentage of injections was within WHO recommended limit. Two percent prescriptions were not legible. 29.25 % of drugs prescribed were in generic name. Conclusion: Sensitization, awareness , and motivation of prescribers is needed for rational prescription and avoidance of medication errors.
International Journal of Basic & Clinical Pharmacology
Background: Prescriptions are an important link between physicians and patients. Any medication therapy can become ineffective if not communicated properly to the pharmacist and patient. Therefore, it’s important to maintain the quality of prescription-writing. Thus, we conducted a prescription audit in a tertiary-care hospital.Methods: 413 prescriptions having 1683 drugs were selected by convenience sampling. Adherence to 4 quality parameters, namely mention of date, allergy status, date of next visit, and whether or not the prescription was signed legibly, were observed for each prescription. 5 parameters viz. whether or not the drug was written in capital letters, whether the generic name of the drug was mentioned, and prescription of drug schedule, dose, and duration were evaluated for each drug separately. Frequency tables and appropriate bar plots were created.Results: Dates were mentioned in all prescriptions. There were 4.07±0.44 (mean±SD) drugs per prescription. Using capit...
Outpatient prescription audit in a tertiary care hospital at Puducherry
International Journal of Basic & Clinical Pharmacology, 2019
Background: Rational use of medicines promotes good health practices and prevents inappropriate use of medicines, polypharmacy, unnecessary use of antimicrobials, injections, and also encourages use of medicines from essential medicine list and dispensing by generic names. The aim of the study was to analyze the outpatient prescriptions of a tertiary care centre by utilizing World Health Organization (WHO) core drug use prescribing indicators.Methods: A retrospective observational study was conducted in a tertiary care health setup at Puducherry, South India. Outpatient prescriptions from all the major clinical departments were analyzed using WHO prescribing indicators and they were compared with some similar studies.Results: The average number of drugs per prescription was 2.74. The percentage of prescriptions with antibiotics was 20.33% and the percentage of prescriptions with injections was 0.16%. The percentage of drugs prescribed by generic names and from essential medicine lis...
2012
Prescription auditing is a type of vigilance activity, which is beneficial in clinical practice in terms of reducing the burden of disease because of medication errors. Rational use of drugs is multifaceted. Its medical, social and economic aspects are well reflected in the WHO definition: "Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an ABSTRACT Background: In India, a proper reporting of medication errors in the hospital is not available. Drugs worth crores of rupee are consumed every year but a substantial part of these drugs are irrationally prescribed. In order to promote rational drug usage standard policies on use of drugs must be set, and this can be done only after the current prescription practices have been audited. The prescriptions were analyzed based on the objectives of the study in order to promote rational use of drugs in a population. Methods: The study was carried out prospectively over a period of two months and 15 days in general medicine OPD of our tertiary care hospital. A specially designed performa was used with pre-inserted carbons. Results: Two hundred and thirty seven prescriptions were analyzed. Total no. of drugs in 237 prescriptions were 1001. Therefore average number of drugs/prescription is 4.22. Drugs were prescribed by generic names in 3.79% of cases, drugs on EDL are only 53.25% and fixed dose combinations are 26.87% of total drugs. Dosage forms used were mostly oral-93.51%. Injectables were only 6.19% and topical forms were least 0.299%. Doctors profile indicates that maximum number i.e. 93.67% were general practitioners. Basic information of patient was written in 72.57% prescriptions. Complete diagnoses were written in 70.04% prescriptions. Only 88.61% prescriptions were legible and only 76.79% prescriptions were complete in terms of dose, route, strength, frequency and dosage forms. Disease pattern seen was variable. Diseases of respiratory system were maximum 44.72 % followed by infectious and parasitic diseases-16.03 % and diseases of digestive system-13.92 %. The most common drug groups prescribed were NSAIDs± serratiopeptidases, antibiotics, antihistaminics, multivitamins, minerals, enzymes and expectorants & bronchodilators. The incidence of polypharmacy was also common with maximum number of drugs which were prescribed per prescription were four in 39.24% of prescriptions. The prescriptions also had other minor anomalies. Conclusions: This study showed that there is scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions. Polypharmacy was also evident from our study. Establishment and implementation of appropriate clinical guidelines, use of essential medicines list, public education about medicines and regular update to the clinicians will help in implementing the principles of rational pharmacotherapeutics.
International Journal of Medical Research and Review
Background: Prescription writing is an important means of therapeutic intervention by the doctor and reflects his approach towards safe prescribing. Complacency in prescribing results in errors which can even cause adverse effects. These errors can be detected through a prescription audit. We undertook this study to audit the outpatient department (OPD) prescriptions for completeness of prescription format, legibility and against the World Health Organization (WHO) prescribing indicators recommended to investigate rational use of drugs. Methods: OPD prescriptions were photographed from the pharmacy of a teaching hospital over a period of three months and 1274 prescriptions were audited. Prescriptions were evaluated for completeness of prescription format while legibility was graded as grade 1, 2 and 3. Prescriptions were also analyzed on the five WHO prescribing indicators. Results: An average of 4.02 ± 2.23 drugs were prescribed per prescription of which 39.01% were antibiotics. Though 79.2% drugs were prescribed from the Essential Drug List, none was prescribed by the generic name. Rate of injection use was 7.54% in our study. Registration number of the doctor was absent in 100% of the prescriptions. Errors such as omitting the mention of allergy status, follow-up advice and directions of use were common. Almost 8% prescriptions were illegible (grade 3) and 66.8% were legible with difficulty (grade 2). Conclusion: Majority of the prescriptions were incomplete and poly-pharmacy was evident in our study. Regular auditing and feedback is necessary for imbibing safe prescribing practices. Doctors need to be made aware about the errors and the recommended guidelines.
A comparative study of drug prescribing indicators in various hospitals of West Bengal, India
International Journal of Research in Medical Sciences, 2018
Background: Rational use of drugs is essential to ensure safety and welfare of patients. Thus, prescription audits are conducted to monitor the practice of writing prescriptions. Various standard parameters have been rationalized by World Health Organization (WHO) in order to regulate drug utilization, globally. Present study aimed to compare the pattern of prescriptions generated in different healthcare centres of West Bengal.Methods: A cross-sectional study was conducted in the inpatient and outpatient departments of RG Kar Medical College, Kolkata, in order to evaluate the prescriptions. Literature was also surveyed with the keywords “prescription audit”, “West Bengal”, to extract data on prescription audits conducted in various other hospitals of West Bengal. The WHO prescribing indicators of all these health facilities were then compared to estimate the rationality of drug prescribed by different physicians.Results: Seven published reports of prescription audits were published ...
prescription audit rural rajasthan
A descriptive study of prescriptions of outdoor patients was conducted to find out the prescribing pattern and rational use of drugs among doctors of primary health care delivery centers of Jhalawar district of Rajasthan. Prescription audit was conducted for a period of two months. After taking consent of doctors and patients their respective prescriptions were copied and evaluations were done on following heading (1) Legibility of prescription (2)Adherence to well defined format (3)Prescribing indicator by WHO (4)Rational use of drugs in prescriptions. Six hundred prescriptions were analyzed. Legible prescription was 93.5 %. The quality of format of the prescription was unsatisfactory because age or sex of patients was not mentioned in 7% and their addresses were missing in all prescription. Incorrectly written dose or duration of therapy in 21 % of total drugs prescribed. A clear instruction to the pharmacist was not available in 22 % of prescriptions and only verbal instruction to the patient was given. Ninety four percent prescriptions were signed by prescriber, but all prescriptions lack their identity. Polypharmacy was common, with 89 % of prescriptions and average numbers of drugs were 2.83 per encounter. Antimicrobials were prescribed in around two third of the prescriptions and injections were prescribed in 7.33 % of the prescriptions Out of total drugs (1696), Generic medicines were 25.70% were as essential drugs was 80.42%. Among the total drugs used in different categories 86% (1459 out of 1696) were prescribed from major five groups (antimicrobials 28%, NSAIDs 24.88 %, acid secretion reducing agent 11.46 %, and vitamins/hematinics 13.91 %). More than three quarter of prescriptions were not up to the marks of standards guidelines or were irrational. This study concludes that quality of prescription, both in term of format and content of medicines prescribed were inadequate. It arouses the urgent need of intervention by implementing clear and effective legislation and various educational methods.