Outpatient prescription audit in a tertiary care hospital at Puducherry


  • Babu L. N. Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Puducherry, India
  • Maharani B. Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Puducherry, India
  • Lourdu Jafrin A. Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Puducherry, India
  • Priyadarshini P. Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Puducherry, India
  • Monisha P. Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Puducherry, India
  • Sivagnanam G. Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Puducherry, India




Essential medicine, Outpatient prescriptions, Prescribing indicators, Prescription audit


Background: Rational use of medicines promotes good health practices and prevents inappropriate use of medicines, polypharmacy, unnecessary use of antimicrobials, injections, and also encourages use of medicines from essential medicine list and dispensing by generic names. The aim of the study was to analyze the outpatient prescriptions of a tertiary care centre by utilizing World Health Organization (WHO) core drug use prescribing indicators.

Methods: A retrospective observational study was conducted in a tertiary care health setup at Puducherry, South India. Outpatient prescriptions from all the major clinical departments were analyzed using WHO prescribing indicators and they were compared with some similar studies.

Results: The average number of drugs per prescription was 2.74. The percentage of prescriptions with antibiotics was 20.33% and the percentage of prescriptions with injections was 0.16%. The percentage of drugs prescribed by generic names and from essential medicine list was 83.13% and 87.9 respectively. Further antibiotic utilization was found to be higher in the department of ENT (56.67%), respiratory medicine (45%) and surgery (40%). Percentage of drugs prescribed by generic names in pediatrics and respiratory medicine were found to be 67.88% and 65.27% and percentage of drugs prescribed from essential medicine list in dermatology was 69.62%.

Conclusions: Prescription pattern followed in our Institute almost adheres to the guidelines laid down by the WHO. Moreover, it is also implied that a routine audit of this type should be done in health care setups to ensure that they adhere to the WHO guidelines for better health care.


Promoting Rational Use of Medicines: Core Components - WHO Policy Perspectives on Medicines, No. 005, September 2002 [Internet]. [cited 2019 Jan 29]. Available from: http://apps.who.int/medicinedocs/en/d/Jh3011e/

Walshe K. Introduction. Evaluating clinical audit; Past lessons, future directions. London:The Royal society of Medicine press; 1995.

Millard A. Perceptions of clinical audit: a preliminary evaluation. J Clin Eff. 1996;1(3):96–9.

Gabbay J, Layton AJ. Evaluation of audit of medical inpatient records in a district general hospital. Qual Health Care QHC. 1992;1(1):43–7.

Gabbay J, McNicol MC, Spiby J, Davies SC, Layton AJ. What did audit achieve? Lessons from preliminary evaluation of a year’s medical audit. BMJ. 1990;301(6751):526-9.

Lough JR, McKay J, Murray TS. Audit and summative assessment: two years’ pilot experience. Med Educ. 1995;29(2):101-3

Firth-Cozens J, Storer D. Registrars’ and senior registrars’ perceptions of their audit activities. Qual Health Care QHC. 1992;1(3):161–4.

WHO | Promoting rational use of medicines saves lives and money, WHO experts say [Internet]. WHO. [cited 2019 Jan 23]. Available from: https://www.who.int/mediacentre/news/notes/2004/np9/en/

Suman Chattopadhyay. DB, Chandra Nath Banerjee. A study of prescription auditing in a tertiary care teaching hospital of eastern India. J Drug Deliv Ther. 2014;4(1):140–9.

Executive Board 115 (2005). Rational use of medicines by prescribers and patients: report by the Secretariat. World Health Organization. Available from: https://apps.who.int/iris/handle/10665/20236

Littlejohns PLJ. Development of an instrument to assess staff perceptions of the impact of trust-based clinical audit programmes. J Clin Eff. 1996;1:83–9.

Hazra A, Tripathi SK, Alam MS. Prescribing and dispensing activities at the health facilities of a non-governmental organization. Natl Med J India. 2000 Aug;13(4):177–82.

Banerjee I, Bhadury T. Prescribing pattern of interns in a primary health center in India. J Basic Clin Pharm. 2014;5(2):40–3.

Rishi RK, Sangeeta S, Surendra K, Tailang M. Prescription audit: experience in Garhwal (Uttaranchal), India. Trop Doct. 2003;33(2):76–9.

Gopalakrishnan S, Ganeshkumar P, Katta A. Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu. Indian J Pharmacol. 2013;45(3):252–7.

De Costa A, Bhartiya S, Eltayb A, Nandeswar S, Diwan VK. Patterns of drug use in the public sector primary health centers of Bhopal district. Pharm World Sci. 2008;30(5):584–9.

Shelat PR, Kumbar SK. Analysis of Out Door Patients’ Prescriptions According to World Health Organization (WHO) Prescribing Indicators Among Private Hospitals in Western India. J Clin Diagn Res. 2015;9(3):FC01-04.

Aravamuthan A, Arputhavanan M, Subramaniam K, Udaya Chander SJ. Assessment of current prescribing practices using World Health Organization core drug use and complementary indicators in selected rural community pharmacies in Southern India. J Pharm Policy Pract. 2017;10:1.

Rehan HS, Lal P. Drug prescribing pattern of interns at a government healthcare centre in northern India. Trop Doct. 2002 ;32(1):4–7.

Potharaju HR, Kabra SG. Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra. Indian J Pharmacol. 2011;43(2):150–6.

Dookeeram D, Bidaisee S, Paul JF, Nunes P, Robertson P, Maharaj VR, et al. Polypharmacy and potential drug–drug interactions in emergency department patients in the Caribbean. Int J Clin Pharm. 2017;39(5):1119–27.

Rosholm JU, Bjerrum L, Hallas J, Worm J, Gram LF. Polypharmacy and the risk of drug-drug interactions among Danish elderly. A prescription database study. Dan Med Bull. 1998;45(2):210–3.

Bjerrum L, Gonzalez Lopez-Valcarcel B, Petersen G. Risk factors for potential drug interactions in general practice. Eur J Gen Pract. 2008;14(1):23–9.

Moura CS, Acurcio FA, Belo NO. Drug-drug interactions associated with length of stay and cost of hospitalization. J Pharm. Pharm. Sci. 2009;12(3):266–72.

Wu C, Bell CM, Wodchis WP. Incidence and economic burden of adverse drug reactions among elderly patients in Ontario emergency departments: a retrospective study. Drug Saf. 2012;35(9):769–81.

Taylor R, Pergolizzi VJ, Puenpatom RA, Summers KH. Economic implications of potential drug-drug interactions in chronic pain patients. Expert Rev Pharmacoecon Outcomes Res. 2013;13(6):725–34.

Antibiotic resistance [Internet]. [cited 2019 May 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance

Montefiore D, Rotimi VO, Adeyemi-Doro FA. The problem of bacterial resistance to antibiotics among strains isolated from hospital patients in Lagos and Ibadan, Nigeria. J Antimicrob Chemother. 1989;23(4):641–51.

Yevutsey SK, Buabeng KO, Aikins M, Anto BP, Biritwum RB, Frimodt-Møller N, et al. Situational analysis of antibiotic use and resistance in Ghana: policy and regulation. BMC Public Health. 2017;17:896-903.

Shrestha P, Cooper BS, Coast J, Oppong R, Do Thi Thuy N, Phodha T, et al. Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Antimicrob Resist Infect Control. 2018;7:98-107

Mott D, Cline R. Exploring generic drug use behaviour: The role of prescribers and pharmacist in the opportunity for generic drug use and generic substitution. Med Care 2002;40(8):662-74.

Khakse GM. Ajapuje P. Drug Prescription Practices among Paediatric Patients in Yavatmal, Central India. Int J Recent Trends Sci Technol. 2012;5(2):104–6.

Zipkin DA, Steinman MA. Interactions between pharmaceutical representatives and doctors in training. A thematic review. J Gen Intern Med. 2005;20(8):777–86.

Morgan MA, Dana J, Loewenstein G, Zinberg S, Schulkin J. Interactions of doctors with the pharmaceutical industry. J Med Ethics. 2006;32(10):559–63.

McKinney WP, Schiedermayer DL, Lurie N, Simpson DE, Goodman JL, Rich EC. Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives. JAMA. 1990;264(13):1693–7.

Summers A, Ruderman C, Leung F-H, Slater M. Examining patterns in medication documentation of trade and generic names in an academic family practice training centre. BMC Medical Education 2017;17:175-81.

Code of Medical Ethics Regulations, 2002 | MCI India [Internet]. [cited 2019 Jan 31]. Available from: https://www.mciindia.org/CMS/rules-regulations/code-of-medical-ethics-regulations-2002

Publishing HH. The cost of generic and name-brand drugs [Internet]. Harvard Health. [cited 2019 sep 19]. Available from: https://www.health.harvard.edu./drugs-and-medications/the-cost-of-generic-and -name-brand-drugs

Do Drug Company Payments to Doctors Influence Which Drugs They Prescribe? [Internet]. US News & World Report. [cited 2019 Mar 8]. Available from: https://health.usnews.com/health-care/patient-advice/articles/2018-08-31/do-drug-company-payments-to-doctors-influence-which-drugs-they-prescribe

Javed Khan AK, Manoj Kumar Agarwal, Rishi Kumar Sain, Rajesh Agarwal, Rajat Agarwal. The Pattern of Respiratory Diseases in a Tertiary Care Center. Int J Contemp Med Res. 2017;4(1):78–80.

Kullar P, Yates PD. Infections and foreign bodies in ENT. Surgery. 2012 30;30(11):590–6.

Das S, Chatterjee T. Pattern of skin diseases in a peripheral hospital’s skin OPD: A study of 2550 patients. Indian J Dermatol. 2007;52(2):93.

Kar C, Das S, Roy AK. Pattern of Skin Diseases in a Tertiary Institution in Kolkata. Indian J Dermatol. 2014;59(2):209.

Williams A, Bhatia A, Kanish B, Chaudhary PR, Samuel CJ. Pattern of Inpatient Dermatology Consultations in a Tertiary Care Centre from Northern India. J Clin Diagn Res JCDR. 2016;10(12):WC07-WC10.

Ierano C, Nankervis J-AM, James R, Rajkhowa A, Peel T, Thursky K. Surgical antimicrobial prophylaxis. Aust Prescr. 2017;40(6):225–9.

Dipiro JT, Bivins BA, Record KE, Bell RM, Griffen WO. The prophylactic use of antimicrobials in surgery. Curr Probl Surg. 1983;20(2):69–132.

Yang X, Xiao X, Wang L, Ao Y, Song Y, Wang H, et al. Application of antimicrobial drugs in perioperative surgical incision. Ann Clin Microbiol Antimicrob. 2018;17:2-8




How to Cite

N., B. L., B., M., A., L. J., P., P., P., M., & G., S. (2019). Outpatient prescription audit in a tertiary care hospital at Puducherry. International Journal of Basic & Clinical Pharmacology, 8(12), 2655–2660. https://doi.org/10.18203/2319-2003.ijbcp20195274



Original Research Articles