Assessment of prescription patterns in a tertiary care teaching hospital of Eastern Uttar Pradesh: a retrospective observational study

Charushila Rukadikar; Shashikant Bhargava; Ramashankar Rath; Shashank Shekhar; Manoj Kumar Saurabh; Ratnesh Gajbhiye; Balveer Singh; Radha; Kimmi Mehra; Sakshi Sharma; Atul Rukadikar

doi:10.18203/2394-6040.ijcmph20252103

Authors

Charushila Rukadikar Department of Physiology, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Shashikant Bhargava Department of Pharmacology, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Ramashankar Rath Department of Community & Family Medicine (CMFM), AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Shashank Shekhar Department of Radiotherapy, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Manoj Kumar Saurabh Department of Pharmacology, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Ratnesh Gajbhiye Department of Physiology, Government Medical College, Gadchiroli, Gadchiroli, Maharashtra, India
Balveer Singh Department of Nursing, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Radha Department of Nursing, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Kimmi Mehra Department of Nursing, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Sakshi Sharma Department of Nursing, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India
Atul Rukadikar Department of Microbiology, AIIMS Gorakhpur, Gorakhpur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20252103

Keywords:

Prescription analysis, Prescription pattern, Tertiary care

Abstract

Background: Inappropriate drug use is a pressing global health concern, particularly in developing countries like India. Poor prescribing practices can contribute to medication misuse, reduced patient adherence, and an increased risk of adverse drug events. This study aims to evaluate prescription trends in a tertiary care teaching hospital in Eastern Uttar Pradesh, focusing on identifying prevalent errors and assessing compliance with WHO prescribing indicators.

Methods: This retrospective observational study was conducted from May to October 2023, reviewing 400 randomly selected outpatient prescriptions from the hospital's medical records. The prescriptions were examined for completeness in terms of patient and prescriber details, medication specifics, and adherence to WHO core prescribing standards. Statistical analysis was carried out using Microsoft Excel.

Results: The study found 100% completion rates in documenting patient and prescriber identifiers and medication details. However, 9.25% of prescriptions omitted the duration of treatment, 19% lacked follow-up instructions, and none included allergy status. The average number of medications per prescription was 6.28. Antibiotics were prescribed in 90.38% of cases, injections in 82%, and 84.75% of drugs were prescribed by their generic names. Furthermore, 82.75% of prescriptions followed the Essential Medicines List.

Conclusions: While the study revealed strong adherence to basic prescription documentation, there were significant gaps, such as the omission of allergy status and treatment duration. These findings highlight the need for enhanced prescriber education, particularly around the rational use of antibiotics and injections, along with improved adherence to WHO guidelines.

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References

Fijn R, Van den Bemt PM, Chow M, De Blaey CJ, De Jong‐Van den Berg LT, Brouwers JR. Hospital prescribing errors: epidemiological assessment of predictors. Br J Clin Pharmacol. 2002;53(3):326-31. DOI: https://doi.org/10.1046/j.0306-5251.2001.bjcp1558.doc.x

Sarkar PK. A rational drug policy. Indian J Med Ethics. 2004;1:11-2. DOI: https://doi.org/10.20529/IJME.2004.004

World Health Organization. The Safety of Medicines in Public Health Programmes: Pharmacovigilance an Essential Tool. WHO; 2006. Available at: http://apps.who.int/iris/bitstream/10665/43384_/1/9241593911_eng.pdf. Accessed on 17 May 2024.

World Health Organization. Global Action Plan on Antimicrobial Resistance. WHO; 2020.

Patel S, Singh P, Agarwal A. Antimicrobial stewardship programs: Impact on antibiotic prescribing practices in tertiary care settings. J Glob Antimicrob Resist. 2021;25:123-30.

Panayappan L, Jose JM, Joseph JG, Jayapal K, Saju S, Krishna Kumar K. Prescription audit and prescribing indicators: A review. J Bio Innov. 2017;6:542-7.

Solanki ND, Shah C. Prescription audit in the outpatient department of a multispecialty hospital in Western India: An observational study. Int J Clin Trials. 2015;2:14-19. DOI: https://doi.org/10.5455/2349-3259.ijct20150203

Gupta R, Agarwal S, Singh V. Impact of regular prescription audits in improving prescribing practices in Indian hospitals. Indian J Pharmacol. 2021;53(2):112-8.

Aral KD, Güvenir HA, Sabuncuoğlu İ, Akar AR. A prescription fraud detection model. Comput Methods Programs Biomed. 2012;106(1):37-46. DOI: https://doi.org/10.1016/j.cmpb.2011.09.003

Flottorp SA, Jamtvedt G, Gibis B, McKee M. Using audit and feedback to health professionals to improve the quality and safety of health care. World Health Organization. 2010;2077-1584.

Zhang L, Yang Y, Liu S. The implementation and impact of prescription audits in Chinese hospitals. J Health Inform. 2020;35(1):27-34.

Singh R, Mishra P, Chauhan P. Assessing the quality of prescription writing in a large teaching hospital in India. Indian J Med Res. 2023;157(3):321-9.

National Medical Commission, Registered Medical Practitioner (professional Conduct), Regulations 2023. Available at: https://www.nmc.org.in/rules-regulations/national-medical-commission-registered-medical-practitioner-professional-conduct-regulations-2023-reg/. Accessed on 3rd October 2024.

Srishyla MV, Mahesh K, Nagarani MA, Mary C, Andrade C, Venkataraman BV. Prescription audit in an Indian hospital setting using the DDD (defined daily dose) concept. Indian J Pharmacol. 1994;26(4):238-41.

Ahmed S, Rahman M, Kabir H. Cost-effectiveness of adhering to the Essential Medicines List in Bangladesh. BMC Health Serv Res. 2022

Rao R, Shetty A, Kapoor A, et al. Integrating electronic health records with decision-support tools: A strategy to improve adherence to essential medicines in India. Health Informatics J. 2021;27(2):189-201.

Sharma P, Thakur N, Joshi R. The impact of continuous medical education on prescribing practices in rural healthcare settings: A study from Nepal. J Educ Eval Health Prof. 2020;17:11.

Jain D, Gupta N, Singh H. Implementation of electronic prescribing systems in Indian hospitals: Impact on medication errors and adherence to best practices. Int J Med Inform. 2023;166:104174.

Verma S, Jain A, Gupta S. The role of computerized physician order entry systems in reducing prescription errors: Evidence from Indian hospitals. BMC Health Serv Res. 2020;20:475.

Parihar NB, Patel EA, Narendra S. Evaluation of prescription errors and polypharmacy practices in rural area at community pharmacy. Int J Basic Clin Pharmacol. 2020;9(12):1816-21. DOI: https://doi.org/10.18203/2319-2003.ijbcp20205539

Joshi A, Buch J, Kothari N, Shah N. Evaluation of handwritten and computerized outpatient prescriptions in urban part of Central Gujarat. J Clin Diagn Res. 2016;10(6):1. DOI: https://doi.org/10.7860/JCDR/2016/17896.7911

Kumar A, Srivastava R, Patel V. The role of AI-driven tools in reducing prescription fraud in Indian hospitals. Asian J Pharm Clin Res. 2022;15(4):28-34.

Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. DOI: https://doi.org/10.1186/s12877-017-0621-2

Patel N, Desai M, Shah S, Patel P, Gandhi A. A study of medication errors in a tertiary care hospital. Perspect Clin Res. 2016;7(4):168-73. DOI: https://doi.org/10.4103/2229-3485.192039

Field TS, Gurwitz JH, Avorn J. Risk factors for adverse drug events among nursing home residents. Arch Intern Med. 2001;161(13):1629-34. DOI: https://doi.org/10.1001/archinte.161.13.1629