An in-depth study of drugs prescribing pattern in the Surgery Department of a Tertiary Care Teaching Institute in Northern India
Keywords:Prescription audit, Prescribing indicators, Essential medicines list, Anti-microbial agents, Post-operative patient, Generic medicines
Background: In surgical patients, a number of drugs are prescribed to prevent post-operative infections and to relieve pain. Therefore, prescription audit should be periodically performed in Department of Surgery to analyze the present scenario of drugs prescribed for the surgical/post-operative patients. This will help us to use the medicines rationally and decrease the adverse effects in surgical patients. The main aim of the study was to evaluate the drugs prescribing pattern in the Surgery Department in Tertiary Care Teaching Institute.
Methods: Patients’prescriptions or case record forms were randomly collected over a period of 1 year from the Department of Surgery at GGS Medical College and Hospital, Faridkot, Punjab (India) for analysis and rationalization.
Results: A total of 900 prescriptions was collected and analyzed for drugs used in surgical patients. Average number of drugs prescribed is 4.26. The most commonly prescribed drugs were anti-microbial agents (AMAs), gastrointestinal tract (GIT) related, non-steroidal anti-inflammatory drugs (NSAIDs) and multivitamins and trace elements, and their percentages were 37.90%, 23.36%, 14.14 %, and 9.11% respectively. About 95% drugs were prescribed by non-generic (Trade) names. Drugs prescribed from National Essential Medicines List (EML) and World Health Organization EML were 69.25% and 45.31% respectively. Average cost per prescription per day was Rs. 610/- (INR) or $10.34 USD in a surgical patient.
Conclusions: There is a high tendency and frequency to prescribe four and more than four drugs to post-operative patients. Most drugs prescribed were AMAs, GIT related, NSAIDs and Multivitamins and trace elements. There is an urgent need to develop proper prescription writing skills in budding doctors regarding the use of EML/drugs list and generic medicines to reduce the cost of treatment.
Lfoholm PW, Katzung BG. Rational prescribing and prescription writing. In: Katzung BG, Masters SB, Trevor AJ, editors. Basic and Clinical Pharmacology. 11th Edition. New Delhi: Tata McGraw-Hill Education Private Limited.; 2009: 1127-36.
Badyal D. Practical Manual of Pharmacology. 1st Edition. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2008: 159-61.
Ramesh KV, Shenoy A, Chowta MN. Practical Pharmacology for MBBS. 1st Edition. New Delhi: Arya Publishing Company; 2006: 106-7.
World Health Organization. Teachers Guide to Good Prescribing. World Health Organization Department of Essential Drugs and Medicine Policy. Geneva: World Health Organization; 2001.
World Health Organization. Introduction to Drug Utilization Research. Geneva: World Health Organization; 2003.
Krishnaswamy K, Kumar BD, Radhaiah G. A drug survey – precepts and practices. Eur J Clin Pharmacol. 1985;29(3):363-70.
Pradhan SC, Shewade DG, Shashindran CH, Bapna JS. Drug utilization studies. Natl Med J India. 1988;1:185-9.
Bhansali NB, Gosai TR, Dholaria NK, Suthar SD, Chacko J, Chavda DA, et al. Drug utilization study in post-operative patients in surgical ward of a tertiary hospital attached with medical college. Der Pharm Lett. 2013;5(1):251-7.
Sharma N, Bhargava M, Mahawar D, Parakh R, Sharma D. Usage of antibiotics in postoperative patients in a tertiary care teaching hospital in India. Int J Pharm Res Bio Sci. 2014;3(2):99-105.
Shankar RP, Pranab KS, Upadhyay DK, Dubey AK, Subash P. Drug utilization among surgical outpatients. TMJ. 2006;56(2-3):230-4.
Parveen A, Shaheen K, Qamer Shaik M, Ali SW, Hussain M, Ali SA, et al. Prescribing patterns of antibiotics in post operative patients in a teaching hospital. Indo Am J Pharm Res. 2014;4(1):527-32.
World Health Organization. WHO Model List of Essential Medicines. 17th Edition. Geneva: World Health Organization; 2011. Available from: http: www.who.int/medicines/publications/essentialmedicine/en/index.html. [Last assessed on 2014 Feb 06].
Tripathi KD. Essentials of Medical Pharmacology. 7th Edition. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2013: 957-61.