Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a tertiary care teaching hospital
Keywords:Antimicrobial agents, Generic name, National list of essential medicines, Prescribing pattern, WHO core prescribing indicators
Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute.
Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed.
Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52%) were the most commonly prescribed category followed by analgesics (19.60%) and Intravenous fluids (13.53%). Metronidazole (27.02%) was the most commonly prescribed antimicrobial, Diclofenac (68.04%) was the commonly prescribed analgesics and Ringer lactate (38.81%) was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%), antiemetic was Ondansetron (76.39%). Majority of drugs (72.54%) were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM) was 82.16%. Injection (57.78%) was the most common drug formulation.
Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial agents. Prescribing according to the national essential list of medicines was high, which indicates rational prescription.
Benet LZ. Goodman and Gilman’s Principles of Prescription order Writing and Patient Compliance Instructions. The pharmacological basis of therapeutics. In: Gilman AG, Rall TW, Nies AS, Taylor P. 8th ed, New York: Pergamon press. 1991;2:1640-49.
Lewis VA. Prescription writing and Drug regulation. Pharmacology and Therapeutics for dentistry. In: Yogiela JA, Dowd FJ, Neidle EA. 5th ed., India: Mosby Publishers; 2005:865-879.
Shewade D, Pradhan S. Auditing of prescriptions in a government teaching hospital and four retail medical stores in Pondicherry. Indian J Pharmacol. 1998;30:408-10.
Shankar PR, Partha P, Dubey AK, Mishra P, Deshpande VY. Intensive Care Unit drug utilization in a teaching hospital in Nepal, Kathmandu Univ Med J. 2005;3:130-7.
9th Report of the WHO expert committee: The use of Essential Drugs. WHO TRS 895, 2000. 2012.[Cited March 2012]. Available from: www.who.int/iris/bitstream/10665/42373/1/WHO_TRS_895.pdf
Patil S, Padma L, Veena DR. Drug utilization study of antimicrobials in postoperative wards in a teaching hospital Int Res J Pharm App Sci. 2012;2(5):59.
Swamy RM, Venkatesh G, Nagaraj HK. A prospective drug utilization evaluation of analgesics and pain assessment in postoperative urological patients in a Tertiary care hospital. Biomedical Research. 2010;21(4):401-5.
Ali SA, Soomro AG, Tahir SM, Memon AS. Prospective basic clinical audit using minimal clinical data set. JAyub Med Coll Abbottabad. 2010;22,1:34-6.
Khan MLZ, Arain A, Qureshi FA. Patient’s selection in limited resources a stimulus for improving care. PJS. 2008;24(4):35-8.
Alam SN, Rehman S, Zaidi SMR, Manzar S. Audit of general surgical unit: Need for self evaluation. PJS. 2007;23(2):141-4.
Javaid M, Masood Z, Iqbal SA, Sultan T. Pak J Med Sci. 2004;20(4):311-4.
Shah BK, Shah VN. Antimicrobial use by Department of Obstetrics and Gynaecology of a tertiary care hospital: Analysis for rationality and other aspects. J Obstet Gynecol Ind. 2004;54(4):387-92.
Shivong A, Phouthavane T, Lundborg CS, Sayabounthavong K, Syhakhang, Wahlstrom R. Reproductive tract infections among women attending a Gynecology outpatient department in Vientiane, Lao PDR. Sexually Transmitted Diseases. 2007;34(10):791-5.
Lofmark S, Edlund C, Nord CE. Metronidazole is still the drug of choice for treatment of anaerobic infections. Clinical Infectious Diseases. 2010;50:16-23.
Ministry of Health and Family Welfare Government of India. National Guidelines on Prevention, Management and control of Reproductive tract infections including Sexually Transmitted infections. 2012.
Adu A, Armour CL. Drug utilization review of thethird generation cephalosporins. Focus on ceftriaxone, ceftazedime and cefotaxime. Drugs. 1995; Sept;50(3):423-39.
Gupta N, Sharma. D, Garg SK, Bhargava VK. Auditingof prescriptions to study utilisation of antimicrobials in a tertiary hospital. Indian J of Pharmacol. 1997;29:411-5.
Srishyla MV, Nagarani MA, Vekantraman BV. Drug utilization of antimicrobials in the in-patient setting of a tertiary hospital. Ind J Pharmacol. 1994;26:282-7.
Uppal R, Gupta S, Shobha G. Drug utilization of antimicrobials in caesarian section. J Obstet Gynecol Ind. 1991;41:346-9.
Dashputra AV, Badwaik RT. Utilization of analgesics in perioperative cases of teaching hospital. Int J Med Pharm Sci. 2013;3:14-9.
Vlahovic-Palcevski V, Wettermark B, Bergman U. Quality of nonsteroidal anti-inflammatory drug prescribing in Croatia (Rijeka) and Sweden (Stockholm). Eur J Clin Pharmacol. 2002;58(3):209-14.
Kolawole IK. Post-operative apin management following caesarean section in university of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. WAJM. 2003;22(4):305-9.
Henry D, Lim LL, Garcia Rodriguez LA, Perez Gutthann S, Carson JL, Griffin M. Variability in risk of gastrointestinal complications with individual nonsteroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ. 1996;312(7046):1563-66.
Kehlet H, Dahl JB. Anaesthesia, surgery, and
challenges in postoperative recovery. Lancet. 2003;362(9399):1921-8.
Salman MT, Akram MF, Rahman S, Khan FA, Haseen MA, Khan SW. Drug prescribing pattern in surgical ward of a teaching hospital in North India. 2008;5(2):5-6.
Abula T, Desta Z. Drug prescribing in surgical and gynaecological wards of a teaching hospital. 1994-1995 (unpublished data).
Quick JD, Hogerzeil HV, Velasquez G, Rago L. Twenty-five years of essential medicines. Bull: WHO. 2002;80(11):913-14.
Ravi Shankar P, Partha P, Nagesh S. Prescribing patterns in medical outpatients. Int J Clin Pract. 2002;56:549-51.
Agarwal JM, Patel NM, Vaniya HV, Trivedi HR, Balat JD. Drug utilization study in post-operative patients in obstetrics and gynaecology ward of a tertiary care teaching hospital. J Clin Exp Res. 2014;2:103-9.
Patel V, Vaidya R, Naik D, Borker P. Irrational drug use in India: A prescription survey from Goa. J Postgrad Med. 2005;51(1):9-12.
Rehan HS, Lal P. Drug prescribing pattern of interns at a government healthcare centre in northern India. Trop Doct. 2002;32:4-7.
Falguni. Use of antimicrobial prophylaxis for obstetric and gynecological surgeries and sensitivity pattern of infective organisms. World journal of pharmacy and pharmaceutical sciences. 2014;3(6):1170-80.