Prescription auditing based on World Health Organization (WHO) prescribing indicators in a teaching hospital in North India

Abstract

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.

Prescribing patterns in primary and secondary level government health facilities in a district of Assam: a cross sectional study

“…In this study average number of drugs per prescription was found to be 3.8±1.3 which is similar to what was found by Ahsan et al 8 Other studies have reported a varied range of average number of drugs per prescription from 1.9 to 8.8. 9-13 However it is much higher than the standard value of average number of drugs per prescription (1.6-1.8) set as ideal.…”

A Prescription Audit and Assessment of Drug Utilization Pattern in a Tertiary Care Teaching and Referral Hospital in Uttar Pradesh, India

“…These errors make the prescription invalid, as certain drugs can only be dispensed with a valid prescription of the doctor. The prescription errors analyzed by our study were in correlation with errors found in another study done by Ahsan et al where 17% of prescriptions lack the initials of the prescriber [9], leading to serious dosing and dispensing errors. In a study done by Seden et al, it has been suggested that electronic prescribing can eliminate these errors through cautions and alerts at the time of prescribing drugs [14].…”

“…The antibiotics prescribed were around 32.22%, which is higher than the designated range by the WHO (≤30%). The percentage of encounters was around 39%, which was comparable to a study done by Ahsan et al [9]. More than one antibiotic is prescribed in 5.12%% of cases.…”

“…However, systematic reviews suggest that prescribing errors are common and can affect from 4.2 to 82% of prescriptions [9]. These prescribing errors can also cause adverse effects.…”

Audit of prescriptions from the department of general medicine based on the WHO core prescribing indicators at Sapthagiri hospital, Bangalore

“…However, lack of knowledge of drug-drug and drug-food interactions can pose a risk of increased adverse effects or even therapeutic failure. 8 Polypharmacy is a major issue seen especially with private practitioners as compared to government doctors, as observed in a study conducted by Ahsan et al 9 This study shows an average of 2.23±1.03 Creating an awareness about the importance of antibiotic stewardship and implementing a rigid hospital antibiotic policy might help in combating the problem of injudicious use of antibiotics leading to antimicrobial resistance. In this study, 25% of prescriptions contained an antibiotic, which is comparable to another study conducted by Chandelkar et al, where 31.8% of prescriptions contained an antibiotic.…”