Significance of prescription elements and determination of prescription errors in psychiatry outpatient department of a tertiary care hospital
Keywords:Elements of prescription, Prescription errors, Prospective, Psychiatry
Background: Prescription is a paper or electronic document issued by licensed medical practitioner detailing the medicine or medicines to be dispensed for an individually named patient. Psychopharmacology is a rapidly growing field and psychiatrists are exposed to lots of newly introduced drugs. Therefore, this study was carried out to determine the Errors in elements of Prescription in Psychiatry Outpatient Department.
Methods: A cross sectional descriptive, non-interventional study in OPD of Psychiatry Department for 12weeks, 300 prescriptions was analyzed.
Results: Superscription transcription and subscription was included in almost all the prescriptions. In 244 (81.33%) signature was present. Registration number was written in 177 (59.0%) prescriptions. Only 56 (18.70%) prescriptions were written in generic name and 49 (16.34%) in capital letter. The dose was written in 241 (80.34%) of the total prescription. The frequency was written for all the drugs in 273 (91.0%) and some drugs in 46 (15.34%) and none of the drugs in 13 (4.33%) of the total prescriptions. Instructions for use was written for all the drugs in 216 (72.0%) and some drugs in 39 (13.0%) and none of the drugs in 45 (15.0%) of the total prescription. Total quantity to be dispensed was written for all the drugs in 284 (94.66%) and some drugs in 9 (3.0%) and none of the drugs in 7 (2.33%) of the total prescription. Polypharmacy was observed only in a quartile of the total prescriptions.
Conclusions: The results of the present study show varied compliance to different elements of prescription writing. Low level of generic prescription observed in this study is a matter of concern. Increased generic prescribing will reduce the cost of medications and promote medication adherence.
WHO. How to Investigate Drug Use in Health Facilities: selected Drug Use Indicators, WHO/DAP/93. Volume. 1. Geneva: World Health Organisation; WHO. Drugs and therapeutics committees - a practical guide. Geneva: World Health Organization. 2003;1993:1-87.4. Available from URL: http://apps.who.int/medicinedocs/en/d/Js4882e/.
Joyce GF, Carrera MP, Goldman DP, Sood N. Physician prescribing behavior and its impact on patient-level outcomes. Am J Manag Care. 2011;17:462-71.
Lofholm PW, Katzung BG. Rational prescribing and prescription writing. In: Katzung BG, editor. Basic and clinical Pharmacology. 8th ed. New York: McGraw-Hill; 2001:1104-12.
Prescription writing. In: British national formulary. London: British Medical Association & Royal Pharmaceutical Society of Great Britain; 2000.
Belknap SM, Moore H, Lanzotti SA, Yarnold PR, Getz M, Deitrick DL et al. Application of software design principles and debugging methods to an analgesia prescription reduces risk of severe injury from medical use of opioids. Clin Pharmacol Ther. 2008;84(3):385-92.
Laporte JR. Towards a healthy use of pharmaceuticals. Dev Dialogue. 1985;(2):48-55.
Bhattacharya A, Gupta H, Dewangan MK. Prescription Pattern Study Of The Drugs Used In Tertiary Hospitals Of The Bilaspur Region. Asian J Pharm Clin Res. 2012;5(4):73-6. Available from URL: http://www.ajpcr.com/Vol5Suppl4/1352.pdf.
Selvi PA, Rajkumar S. Branches of Clinical Pharmacology- A Review. Int J Curr Pharm Res. 2012;2(1):14-28. Available from: URL:www.ijcpcr.com/download.php?id=97&f=97_14-28.pd.
Khan IN. Systematic review of Prescription writing revisited. Med Pulse-Int Med J. 2014;1(6):262-6.
Potter, Samuel OL. Prescription Writing. A Compend of Materia Medica, Therapeutics, and Prescription Writing (sixth ed.). P. Blakiston's Son. 1902.
Kumari R, Idris MZ, Bhushan V, Khanna A, Agrawal M, Singh SK. Assessment of Prescription Pattern at the Pubic Health facilities of Lucknow district. Indian J Pharmacol. 2008;40(6):243-7. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/21279178.
Anderson S. Making Medicines: A Brief History of Pharmacy and Pharmaceuticals. London: Pharmaceutical Publishing; 2005 [cited 2016 Aug 2]. Available from: Google books
Chakraborty S. Gender bias in South Asia. Econom Politic Weekly. 2001;36(42):3993-5.
deGirolamo G, Williams P, Cappiello V. Psychotropic drug utilization and audit in two Italian psychiatric services. Psychol Med. 1987;17:989-97.
Yosselson SS, Sternik D, Liebenzon D. Prescribing patterns in psychiatric hospitals in Israel. Acta Psychiatr Scand. 1979;60(5):477-82.
Banahan BF, Kolassa EM. A physician survey on generic drugs and substitution of critical dose medications. Arch Intern Med. 1997;157:2080-8.
Mott DA, Cline RR. Exploring generic drug use behavior: the role of prescribers and pharmacists in the opportunity for generic drug use and generic substitution. Med Care. 2002;40:662-74.
Suh DC. Trends of generic substitution in community pharmacies. Pharm World Sci. 1999;21:260-5.
Hemminki E, Enlund H, Hellevuo K, Laurila R, Turakka H. Trade names and generic names. Problems for prescribing physicians. Scand J Prim Health Care. 1984;2:84-7.
Bower AD, Burkett GL. Family physicians and generic drugs: a study of recognition, information sources, prescribing attitudes, and practices. J Fam Pract. 1987;24:612-6.
Berberich FR. Cephalosporin trade names. Pediatr Infect Dis J. 2003;22:388-9.
Caves R, Hurwitz M. Persuasion or information: promotion and the shares of brand name and generic pharmaceuticals. J Law Econ. 1988;31:299-320.
Meredith P. Bioequivalence and other unresolved issues in generic drug substitution. Clin Ther. 2003;25:2875-90.
Nightingale SL, Morrison JC. Generic drugs and the prescribing physician. JAMA. 1987;258:1200-4.