Background: Appropriate medications are the backbone for effective control of infections and diseases. Objective of the study was to analyse the prescriptions relating to national list of essential medicines (NLEM) of a tertiary care hospital. Methods: Data was collected from 525 case sheets of the surgical in-patients for a period of 1 year which included total number of drugs prescribed, single (NLEM/non-NLEM) drugs, fixed dose combinations (NLEM/non-NLEM) drugs, most common drugs (NLEM/non-NLEM), route of administration, ADR/ADE and herbal drugs. Descriptive statistics was used for analysis of the data. Results: The total number of drugs observed in the case sheets was 2575. Out of the total drugs, 1942 drugs (75.4%) were from the list of NLEM (2022) while 633(24.6%) drugs were of non-NLEM. 266 drugs (10.33%) were generic drugs and 2309 drugs (89.67%) were proprietary drugs. The total number of single drug was 1839 (NLEM, 1805 + non-NLEM, 34) and that of the total FDC was 736 (NLEM, 137 + non-NLEM, 599). The most common drugs which were prescribed were analgesics: paracetamol 517 (NLEM); diclofenac supp.14 (non-NLEM), antibiotics: ceftriaxone 258 (NLEM, 14.5%), cefpodoxime proxetil 3 (non-NLEM, 8.9%), antihypertensive: telmisartan 13 (NLEM, 0.7%), non-NLEM nil, anti-diabetics: metformin 15 (NLEM, 0.8%), dapagliflozin 6 (non-NLEM, 16.7%), and gastroprotective drugs: pantoprazole 493 (NLEM, 27%), non-NLEM nil. Conclusions: Non-NLEM drugs should be prescribed only when there is definite advantages of the same over the NLEM drugs. Prescription of proprietary FDC drugs, factors for non-availability and under-prescription of NLEM drugs should be highlighted through CME coupled with awareness about the aim and objectives of the NLEM during clinical practice to the prescribers.