Assessment of medication errors and prescribing patterns in orthopaedic inpatients at a tertiary care hospital
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20261962Keywords:
Medication errors, Orthopaedic surgery, Patient safety, Prescribing patterns, Medication safety, NABHAbstract
Background: The objectives of the study were to assess medication errors and prescribing patterns among orthopaedic inpatients at a tertiary care hospital and evaluate compliance with National Accreditation Board for Hospitals (NABH) medication safety standards across prescribing, transcribing, dispensing, and administration processes.
Methods: A cross-sectional observational study was conducted over six months in the Orthopaedic Department of a tertiary care teaching hospital. A total of 110 case records were reviewed. Medication errors were identified using NABH standards, including prescription, transcription, dispensing, and administration errors. Errors were further classified based on severity using the NCC MERP index. Data were analyzed using appropriate statistical methods.
Results: Among 21,312 medication-use opportunities evaluated, 750 medication errors were identified (overall error rate 3.52%). Prescription errors were most frequent (599;7.78%), followed by transcription (122;6.87%), dispensing (23;0.55%), and administration errors (6; 0.08%). Common prescribing errors included non-use of generic names (51.6%), omission of dosage (13.5%), and inappropriate capitalization (8.0%). Most errors were of minor to moderate severity and unlikely to cause direct patient harm. Antibiotics and non-steroidal anti-inflammatory drugs were the most commonly implicated drug classes.
Conclusion: Medication errors were predominantly related to prescribing practices. Strengthening prescription protocols, encouraging generic prescribing, and implementing regular pharmacist-led audits can enhance medication safety and improve compliance with NABH standards.
References
Aronson JK. Medication errors: definitions and classification. Br J Clin Pharmacol. 2009;67(6):599-604.
Dean B, Barber N, Schachter M. What is a prescribing error? BMJ Quality Safety. 2000;9(4):232-7.
Donaldson LJ, Kelley ET, Dhingra-Kumar N, Kieny MP, Sheikh A. Medication without harm: WHO's third global patient safety challenge. The Lancet. 2017;389(10080):1680-1.
Parthasarathi A, Puvvada R, Patel H, Bhandari P, Nagpal S, Puvvada RK. Evaluation of medication errors in a tertiary care hospital of a low-to middle-income country. Cureus. 2021;13(7).
Pote S, Tiwari P, D'cruz S. Medication prescribing errors in a public teaching hospital in India: A prospective study. Pharm Pract. 2007;5(1):17-20.
Atmaja DS, Saksono RY, Zairina E. Evaluation of medication errors in one of the largest public hospital: A retrospective study. Clin Epidemiol Glob Health. 2024;28:101640.
Cousins D, Crompton A, Gell J, Hooley J. The top ten prescribing errors in practice and how to avoid them. Pharm J. 2019;302(7922):1-20.
National Health Systems Resource Centre. Prescription audit guidelines. New Delhi: National Health Systems Resource Centre, Ministry of Health and Family Welfare, Government of India. 2021. Available at: https://nhsrcindia.org/sites/default/files /2021-07/1534_Prescription%20Audit%20Guidelines 16042021. Accessed on 05 March 2026.
Dalela R, Jain DK, Maheshwari RK. Prescription pattern and rationality of drugs study in orthopaedic outpatient department of a tertiary care teaching hospital. Int J Basic Clin Pharmacol. 2017;6:117-22.
Khanikar D, Ojah K, Borah L, Bhattacharyya M, Saikia PP, Patowary SS, et al. Evaluation of prescribing pattern in Orthopedics department in a tertiary care hospital: A prospective observational study. Int J Pharm Pharm Sci. 2024;72:9.
National Accreditation Board for Hospitals and Healthcare Providers (NABH). Accreditation Standards for Hospitals. 6th ed. New Delhi: NABH. 2025. Available at: https://portal.nabh.co/images /Standards/NABH%20Hospital%20Accreditation%20Standard%206th%20Edition%20January%202025.pdf. Accessed on 05 March 2026.
Ralte L, Saxena DC, Kumar P. Study to Conduct Prescription Audit as per Objective Elements of NABH in Medical and Surgical Wards of a Tertiary Care Teaching Hospital. J Drug Delivery Therap. 2025;15(4).
Salman MT, Akram MF, Rahman S, Khan FA, Haseen MA, Khan SW. Drug prescribing pattern in surgical wards of a teaching hospital in North India. Indian J Pract Doctor. 2008;5(2):5-8.
Navadia KP, Patel CR, Patel JM, Pandya SK. Evaluation of medication errors by prescription audit at a tertiary care teaching hospital. J Pharmacol Pharmacotherap. 2023;14(4):275-84.
Alshaikh M, Mayet A, Aljadhey H. Medication error reporting in hospitals: a systematic review. Saudi Pharm J. 2020;28(12):1518-27.
Singh T, Banerjee B, Garg S, Sharma S. A prescription audit using the World Health Organization-recommended core drug use indicators in a rural hospital of Delhi. J Educ Health Promot. 2019;8(1):37.
Butauskaite J, Zumbakyte A, Aukstikalne L, Pancere J, Zukaitiene S, Karinauske E. High prevalence of medication errors in a secondary‐level Lithuanian hospital: A prospective cross‐sectional observational study. Pharmacol Res Perspect. 2024;12(4):e1246.
Zirpe KG, Seta B, Gholap S, Aurangabadi K, Gurav SK, Deshmukh AM, et al. Incidence of Medication Error in Critical Care Unit of a Tertiary Care Hospital: Where Do We Stand? Indian J Crit Care Med. 2020;24(9):799-803.
Yan C, Ross S, Davey P, Duncan EM, Francis JJ, Fielding S, et al. Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study. PLoS One. 2014;9(1):e79802.
Fallaize R, Dovey G, Woolf S. Prescription legibility: bigger might actually be better. Postgrad Med J. 2018;94(1117):617-20.
Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, et al. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol. 2022;54(5):321-8.
Manias E, Kusljic S, Wu A. Interventions to reduce medication errors in adult medical and surgical settings: a systematic review. Therap Adv Drug Safet. 2020;11:2042098620968309.
Zheng WY, Lichtner V, Van Dort BA, Baysari MT. The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Res Soc Administrat Pharm. 2021;17(5):832-41.
Thomas B, Pallivalapila A, El Kassem W, Al Hail M, Paudyal V, McLay J, et al. Investigating the incidence, nature, severity and potential causality of medication errors in hospital settings in Qatar. Int J Clin Pharm. 2021;43(1):77-84.
Alqenae FA, Steinke D, Keers RN. Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: a systematic review. Drug Safet. 2020;43(6):517-37.
Tabatabaee SS, Ghavami V, Javan-Noughabi J, Kakemam E. Occurrence and types of medication error and its associated factors in a reference teaching hospital in northeastern Iran: a retrospective study of medical records. BMC Health Serv Res. 2022;22(1):1420.
Mekonnen AB, McLachlan AJ, Brien JA, Mekonnen D, Abay Z. Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol. BMJ Open. 2016;6(11):e012322.