Prescription audit and drug utilization pattern in a tertiary care teaching hospital in BHOPAL

Background: Indiscriminate use of antimicrobials is rampant throughout India, and this is a matter of serious concern. There are several reports linking antibiotic usage to bacterial resistance. Towards addressing this problem, community wise surveillance needs to be undertaken to monitor antibiotic exposure including their misuse. This study was meant to assess the extent and pattern of antibiotic use in a tertiary care facility. Methods: Subjects for study were patients attending a suburban hospital in central Kerala. Case records of patients who were prescribed systemic antibiotics were perused for relevant data. Seriously ill patients were excluded from the study. Results: 610 encounters with antibiotics could be identified from a total of around 2000 patient records, indicating an encounter rate of 29%; which is quite acceptable as per the WHO standard of prescribing indicators. However, more than 70% of prescriptions carried only brand names of medications. Use of antibiotics was mostly on the basis of clinical symptoms (presumptive), and culture reports were not given due credence. Prescriptions were invariably therapeutic in nature, and the concepts of surgical prophylaxis conveniently given a go by. The most common infections were those of the Upper Respiratory Tract (URTI), followed by skin and soft tissue infections. Ampicillin, azithromycin and cefuroxime were the most frequently prescribed agents. More than one third of infections were treated with a combination of antimicrobials. A general temptation for using cephalosporin -betalactamase inhibitor combinations could be related to the aggressive promotional policies of the pharmaceutical industry. Conclusions: The overall antibiotic encounter rate is acceptable as per WHO standards. But the tendency for using injections as well as antibiotic combinations is very high. Prophylactic use of antibiotics in surgical procedures is not being followed at all. A serious attempt needs to be made to implement National Guidelines for use of antimicrobials.

Section: Discussionmentioning

confidence: 99%

A prospective study on the pattern of antibiotic use in a tertiary care hospital

Mani

Hariharan

2017

“…Our study had much better result when compared to study done by Mishra et al with 27.5% prescriptions documenting duration of treatment. 8 Our subsequent PTAM showed improvement in prescriptions in this aspect, hence proved beneficial.…”

Section: Discussionmentioning

confidence: 68%

“…This was quite higher than previous studies done by Saha et al, Mishra et al and Sandip et al with 40%, 70%, and 47% rates respectively. 7,8,9 This marked difference could be probably due to better diagnostic facilities at tertiary care center with good laboratory support, which could have helped in establishing diagnosis prior to initiating treatment.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapeutic audit meetings as a tool of improving prescribing practices

Kumar¹,

Kant²,

Handu³

et al. 2020

Background: Pharmacotherapeutic audit meeting (PTAM) is a good tool to review prescriptions for rationality and suggest measures for improving quality of prescriptions. To promote this, World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD) provided drug prescribing and drug use indicators. To assess the impact of PTAMs as an intervention for improving quality and rationality of prescriptions.Methods: This was a single centre, prospective study conducted from December 2018-February 2020. Prescriptions from outpatient surgical departments were collected, screened using WHO/INRUD core indicators and discussed in PTAMs. The same process was repeated over next 2 months to assess change in prescribing patterns after PTAM. Chi-square and Student’s t-test was used for statistical analysis.Results: The difference in proportions for antibiotic prescribing was 8.7% [95% CI (1.0%-16.7%), p=0.02]; injectable preparation use was 0.7% [95% CI (-0.4%-2.3%) p=0.23]; prescriptions with generic name drugs was 10.9% [95% CI (5.6-16.2%) p<0.0001] and prescriptions from Essential drug list (EDL) was 8.1% [95% CI (2.5%-13.5%) p=0.0046].Conclusions: Our research showed PTAM could be an effective tool to implement WHO/INRUD drug prescribing indicators robustly. Hence, it could be included in WHO/INRUD policies as an intricate part of institutional healthcare delivery system.

“…As per prescription standards essential drugs must be prescribed and in the study, we found that 44.1% prescriptions followed and our results are similar to the study of Mishra et al but lower than the studies reporting 75% and 60%. 8 Prescribing drugs from EML insure about appropriate use of drugs with minimal side effects and drug interactions.…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotics prescribed were 27.1% which highest among other groups and it is acceptable as compared to 50% as mentioned in Gupta et al study but disappointing as compared to 17.48% as per Mishra"s study results. 8,9 It is necessary to use antibiotics appropriately to prevent risk of emergence of resistance and better to use after antibiotic sensitivity testing.…”

Section: Discussionmentioning

confidence: 99%

Prescription auditing: an important tool for sensitization of resident doctors for rationale prescription and utilization of drug

Dhavalshankh¹,

Rajadnya²,

Patil³

2019

Background: The main objective of the Maharashtra Health Systems Development Project (MHSDP) is to enhance the quality of care by improving health care; in the hospitals, in the state. Improvement in the prescribing practice of resident doctors working in the hospitals is one of the initiatives taken up, to improve the rationalizing service delivery. A prescription audit may become an important tool for sensitizing resident doctors for rational prescription and utilization of drug.Methods: An observational study was carried out during the period of March 2017 to May 2017 in tertiary care teaching hospital, Kolhapur. Total 247 first prescriptions written by resident for in-door-patient department were collected, scrutinized and analysed. Prescriptions were evaluated for completeness of prescription format while legibility was graded. Prescriptions were also analysed as per World Health Organization prescribing indicators.Results: In study 247 prescriptions with 1091 drugs with average 4.42% drugs per prescription, 49.8 % prescriptions wrote the drugs by generic name. We found that 44.1 % prescriptions written with drugs included in essential medicines list while antibiotics prescribed were 27.1%. In prescription format 34% had incorrect dosage, 67% of prescriptions omitted the duration of treatment. Direction for drug use was not mentioned in 25% of prescriptions. Weight was not mentioned on any prescriptions even for paediatric group.Conclusions: Through prescription auditing, sensitizing resident doctors for rational prescription and utilization of drug can be done to achieve the goal of the MHSDP of enhancing the quality of care by improving health care; in the hospitals, in the state.