Priya, et al.: Electronic Prescription Audit Process to Reduce Medication ErrorsThis study was undertaken to evaluate the impact of electronic prescription audit for outpatients in a quaternary care hospital. This reviews the clinical benefits of pharmacist driven electronic prescription audit process in monitoring and detecting prescription errors before it reaches the patient. This prospective study was conducted for one year (August 2015-July 2016) by the Department of Clinical Pharmacy, Aster Medcity. During the audit process, each prescription generated through computerized physician order entry will appear immediately in an electronic prescription audit tool which is integrated with a clinical decision support system. Pharmacist audits each outpatient prescription for drug interactions, drug allergies, dosing errors, frequency errors and therapeutic duplications. Clinical decision support system integrated with the audit tool provides brand and monograph details of prescribed drugs and automatic alerts for drug interactions and drug allergies. Pharmacist reported 266 interventions during the study period. Out of that 0.08 % (n=140) errors were prevented before it reached the patient and 0.05 % (n=86) interventions were rejected by physicians with proper justifications. Drug interactions were found to be 0.03 %, wrong drug frequency errors were found to be 0.04 % and drug allergies (prescriptions with pre-identified allergic drugs) were found to be 0.00 5 %. Reported medication errors were categorized according to National Coordinating Council for Medication Error Reporting and Prevention index. Real time audit of outpatient prescriptions using automated prescription audit tool can reduce the risk of harm that arises from prescribing errors, improve the quality of prescriptions, and enhance the safety and quality of the prescribing process.

Objective: Medication costs comprise the majority of health system budgets and continue to increase faster than other health-care expenditures. The objective of this study is to evaluate the causes and monetary value of cost-saving prescription interventions made by clinical pharmacists in outpatient pharmacy. Materials and Methods: Outpatient prescriptions were randomly audited for a period of 11 months (August 2017–June 2018) using a customized outpatient prescription audit tool integrated with computerized physician order entry. Drug-related problems were communicated to respective prescribers, and their response to each intervention was documented in accordance with PCNE classification. Both unit dose cost and anticipated dose cost savings were calculated to evaluate the monetary benefit for patients. Results: Unit dose cost of INR 4875.73 and anticipated dose cost of INR 26890.8 were saved from outpatients. Majority of the prescribing errors were associated with therapeutic duplication (43.4%) and drug interaction (25.7%) that account for anticipated dose cost savings of INR 17812.65 for patients. Major contributory drug classes that reduced the cost of therapy were antibiotics (24.23%), proton-pump inhibitors (13.27%), and analgesics (12.34%). Prescribers' response to pharmacist intervention varied, 53% responded to stop the drug, 21% responded to change the brand, and 20% changed the frequency of administration. Necessary instructions were verbally given to patients without making any modification in the prescription for 3.2% ( n = 10) of cost-saving interventions. Discussion and Conclusion: As clinical pharmacist has the expertise to detect, resolve, and prevent medication errors, the development of clinical pharmacy practice in a hospital outpatient pharmacy will have a significant impact on reducing prescription errors and health-care cost also.

The present study aims at analyzing the prescribing patterns of antimicrobial agents in different liver diseases and to identify the drug-drug interactions among the prescribed drugs. A cross sectional observational study was conducted from February to July 2018. A total of 120 cases of patients receiving antimicrobials having different types of liver diseases were included. Statistical analysis shows that 80% of the popuation were male and 64% of the population was above the age of 50 years.. Liver disease like Liver Cirrhosis, Non alcoholic steato hepatitis, Viral hepatits, Jaundice, Hepatocellular carcinoma was found to be present among the study population, 50% of the population was overweight and 32% were alcoholic. Majority of them had ascites, abdominal distention and pedal edema as chief complaints and complications were hepatic encephalopathy and esophageal varices. The prescribed antimicrobial agents were antibiotics (95%) viz., Piptaz, rifaximin and taxim. antivirals (4%) such as entecavir and antifungals (1%) likeflucanazole. The drugs were prescribed according to the guidelines of the hospital. Mostly broad spectrum antibiotics were used in the management of liver disorders like Linezolid, Meropenem, Ertapenem, and Tobramycin. In severe cases combination of antimicrobials were given for effective therapy. Patient's transplantation was based on the MELD score, as the MELD score increases, the mortality rate also increases. MELD score =40 indicates mortality rate is >70%.