Prescription auditing and drug utilization pattern in a tertiary care teaching hospital of western UP

Afroz Abidi, Surabhi Gupta, Saurabh Kansal, Ramgopal .

Abstract


Background: In India, a proper reporting of medication errors in the hospital is not available. Drugs worth crores of rupee are consumed every year but a substantial part of these drugs are irrationally prescribed. In order to promote rational drug usage standard policies on use of drugs must be set, and this can be done only after the current prescription practices have been audited. The prescriptions were analyzed based on the objectives of the study in order to promote rational use of drugs in a population.

Methods: The study was carried out prospectively over a period of two months and 15 days in general medicine OPD of our tertiary care hospital. A specially designed performa was used with pre-inserted carbons.

Results: Two hundred and thirty seven prescriptions were analyzed. Total no. of drugs in 237 prescriptions were 1001. Therefore average number of drugs/prescription is 4.22. Drugs were prescribed by generic names in 3.79% of cases, drugs on EDL are only 53.25% and fixed dose combinations are 26.87% of total drugs. Dosage forms used were mostly oral -93.51%. Injectables were only 6.19% and topical forms were least 0.299%. Doctors profile indicates that maximum number i.e. 93.67% were general practitioners. Basic information of patient was written in 72.57% prescriptions. Complete diagnoses were written in 70.04% prescriptions. Only 88.61% prescriptions were legible and only 76.79% prescriptions were complete in terms of dose, route, strength, frequency and dosage forms. Disease pattern seen was variable. Diseases of respiratory system were maximum 44.72 % followed by infectious and parasitic diseases - 16.03 % and diseases of digestive system - 13.92 %. The most common drug groups prescribed were NSAIDs± serratiopeptidases, antibiotics, antihistaminics, multivitamins, minerals, enzymes and expectorants & bronchodilators. The incidence of polypharmacy was also common with maximum number of drugs which were prescribed per prescription were four in 39.24% of prescriptions. The prescriptions also had other minor anomalies.

Conclusions: This study showed that there is scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions. Polypharmacy was also evident from our study. Establishment and implementation of appropriate clinical guidelines, use of essential medicines list, public education about medicines and regular update to the clinicians will help in implementing the principles of rational pharmacotherapeutics.


Keywords


Prescription auditing, Drug utilization pattern, Rational pharmacotherapy

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References


Hogerzeil HV. Promoting rational prescribing: an international perspective. Br J Clin Pharmacol 1995;39:1-6.

WHO. How to investigate drug use in health facilities: Selected drug use indicators. Geneva: World Health Organization; 1993. WHO/DAP 1993;1:1-87.

Biswas NR, Jindal S, Siddiquei MM, Maini R. Patterns of prescription and drug use in ophthalmology in a tertiary hospital in Delhi. Br J Clin Pharmacol 2001;51:267-9.

Devi DP, George J. Diabetic Nephropathy: Prescription trends in tertiary care. Indian J Pharm Sci 2008;70:374-8.

Rishi RK, Sangeeta S, Surendra K, Tailang M. Prescription audit: experience in Garhwal (Uttaranchal), India. Trop Doct 2003;33:76-9.

Maini R, Verma KK, Biswas NR, Agrawal SS. Drug utilization study in dermatology in a tertiary hospital in Delhi. Indian J Physiol Pharmacol 2002;46:107-10.

Rehan HS, Lal P. Drug prescribing pattern of interns at a government healthcare centre in northern India. Trop Doct 2002;32:4-7.

Hazra A, Tripathi SK, Alam MS. Prescribing and dispensing activities at the health facilities of a non-governmental organization. Natl Med J India 2000;13:177-82.

Karande S, Sankhe P, Kulkarni M. Patterns of Prescription and Drug Dispensing. Indian J Pediatr 2005;72:117-21.

Hutin YJF, Hauri AM, Armstrong GL. Use of injections in healthcare setting worldwide, 2000: literature review and regional estimates. BM] 2003;327:1075-9.

Kastury N, Singh S, Ansari KU. An audit of prescription for rational use of fixed dose drug combinations. Indian J Pharmacol 1999;31:367-9.

Chakrabarti A. Prescription of fixed dose combination drugs for diarrhoea. Indian J Med Ethics 2007;4:165-7.

Gupta N, Gupta, D, Sharma, Garg SK, Bhargava VK. Auditing of prescriptions to study utilization of antimicrobials in a tertiary hospital. Indian J Pharmacol 1997;29:411-5.

Patel V, Vaidya R, Naik D, Broker P. Irrational drug use in India. J Postgrad Med 2005;51:9-12.

Vengurlekar S, Shukla P, Patidar P, Bafna R, Jain S. Prescribing pattern of antidiabetic drugs in Indore city hospital. Indian J Pharm Sci 2008;70:637-40.