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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 85-87

An audit of prescription forms of patients from obstetrics and gynecology clinics in tertiary care hospitals: An exploratory study


1 Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
2 Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India

Date of Submission27-Dec-2019
Date of Decision03-Feb-2020
Date of Acceptance08-Feb-2020
Date of Web Publication05-Mar-2020

Correspondence Address:
Dr. Neha Varun
A-2a/35, West Janakpuri, New Delhi - 110 058
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_157_19

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  Abstract 


Objective: The main aim is to analyze the prescription forms to evaluate the completeness of these forms, and we also aim to bring to light the factors which need to be emphasized on while writing a prescription. Materials and Methods: This is a prospective cross-sectional study. Prescriptions of 200 patients visiting the gynecology and antenatal outpatient department (OPD) were evaluated using a specially designed questionnaire containing specific questions pertaining about OPD prescriptions, and a score of 0, 1, or 2 was allotted to each question. Results: In an audit of 200 OPD prescription papers, complete name, age, date of consultation, sex, and OPD registration number of the client were present in 100% prescriptions as it was preprinted. Legible handwriting was seen in 93%. Essential medicines advised were available in the hospital dispensary in 77%. Dosage schedule/doses were clearly written in 85%. Prescription duly signed and the name is written (legibly)/stamped in 87%. The highest score for a prescription was found to be 17/17 and the lowest score for a prescription form was 8/13. Conclusion: Many areas are lagging in prescription writing, especially writing presumptive diagnosis and salient features of clinical examination. Physicians need to improve their prescription writing skills for the benefit of patients.

Keywords: Audit, essential medicines, outpatient department, prescription papers


How to cite this article:
Singh N, Varun N, Garg M. An audit of prescription forms of patients from obstetrics and gynecology clinics in tertiary care hospitals: An exploratory study. Indian J Med Spec 2020;11:85-7

How to cite this URL:
Singh N, Varun N, Garg M. An audit of prescription forms of patients from obstetrics and gynecology clinics in tertiary care hospitals: An exploratory study. Indian J Med Spec [serial online] 2020 [cited 2020 Aug 13];11:85-7. Available from: http://www.ijms.in/text.asp?2020/11/2/85/280110




  Introduction Top


A prescription is a direction from a medical practitioner to a person who dispenses medicines. Every country has its own standards of information required for prescription writing and specific laws and regulation that which particular drug needs a prescription and who is eligible to prescribe the drug. The main requirement in the prescription is that it should be clear, legible, and indicate exactly what should be given.

Quality of life can be improved by enhancing the standards of medical treatment and that can only be evaluated by prescription audit because it is based on documented evidence to support identification, treatment, and even utilization of hospital facilities. It supports health-care professionals in making sure their patients receive the best possible care. The World Health Organization (WHO) has proposed core-prescribing indicators for prescription audits and drug utilization studies.[1]

With this background, this study was conducted in the tertiary care medical college in India. The main objective of this study is to evaluate the completeness of outpatient department (OPD) prescription forms, and we also aim to bring to light the factors which need to be emphasized on while writing a prescription, thus improving the quality of care in the institution.


  Materials and Methods Top


This is a cross-sectional prospective observational study conducted in a tertiary care medical college, Delhi, in the department of obstetrics and gynecology. Before the conduct of the study, ethical clearance was taken from the institutional ethical committee. A total of 200 prescriptions were randomly sampled, irrespective of patient characteristics and diagnosis, over 1 month. A specially designed questionnaire including 13 variables, as included in [Table 1], had been formed for the evaluation of OPD prescriptions of new cases only, as our study aimed at “first encounter prescriptions.” The questionnaire variables are the specific questions pertaining about OPD prescriptions, and a score of 0, 1, or 2 was allotted to each question, depending on the absence, inadequacy or presence of that particular variable. Score 0 was given if the variable was absent, score 1 was given when the variable was present but inadequate, and score 2 was given when the variable was present and adequate.
Table 1: Distribution of outpatient department prescription papers according to the questionnaire variables

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Statistical analysis

Data entry and statistical analysis were done. The analysis was performed in the form of percentages and represented as tables wherever necessary.


  Results Top


A total of 200 OPD prescription papers were evaluated using a questionnaire, and the score was evaluated. Complete name, age, date of consultation, sex, and OPD registration number of the client were present in 100% prescriptions, as it was preprinted. Legible handwriting was seen in 93%, presumptive/definitive diagnosis was written in 67%, brief history was written in 91%, salient features of clinical examination was noted in 60%, and investigations were advised in 87%.

Essential medicines advised were available in the hospital dispensary in 77%, nonessential medicines advised were available in the hospital dispensary in 23%, and nonessential medicines advised which are not available in the hospital were not prescribed to any.

Dosage schedule/doses were written in 85%. The duration of treatment was written in 100%. Date of the next visit (review) was written in 67%. In the case of referral, the relevant clinical details and reason for referral were given in 75%. The required precautions/do's and don'ts recorded in 40%. Prescription duly signed and the name is written (legibly)/stamped in 87% [Table 1].

The qualification of prescribing physician was analyzed, and these include 2% consultants, 20% senior residents, and 78% postgraduates. In view of small data, subgroup analysis was not done. The highest score for a prescription was found to be 17/17, and the lowest score for a prescription form was 8/13.


  Discussion Top


There are no worldwide standards for prescriptions and every country has its regulations. A perfect design was given by the WHO to write a prescription [Table 2].[2]
Table 2: The ideal format by the World Health Organization to write a prescription

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A medical audit is a structured approach to closely evaluate medical care to recognize chances for refinement and impart a mechanism for registering them.[3] A prescription audit is a section of the medical audit.[4] Effectual prescription audit is paramount for health-care professionals, health facility managers, and the patients. It can apprise health facility managers about the requirement for regulatory changes, or new speculation to reinforce health-care professionals in their practice. In principle, it is an impartial and integral way of analyzing the standard of treatment and care imparted by the physicians. The result of the prescription auditing is to upgrade the patients' care and justification of medical prescription.

Prescription auditing has a huge prospective to encourage the reasonable utilization of drugs and essential medicine. WHO has strenuously encourage the reasonable use of drugs through the action program on essential drugs.[5]

In this study total, 200 prescriptions were evaluated. Dosage schedule or duration was not written in 14%, and information was inadequate in 1%, necessary precautions (do's and don'ts) were not written in 60% of prescriptions. In a similar study conducted by Debasis et al. in 2014, 56.1% of the prescription contains an error in the instruction to the patient.[3]

Follow-up visit was not mentioned in 33% of patients and in a similar study conducted by Debasis et al. and Potharaju and Kabra, it was not mentioned in 97.87% and 82% of patients, respectively.[6] Follow-up advice is very important to facilitate the continuation of treatment and to change treatment wherever necessary.

In 77% of prescriptions, drugs were prescribed from the essential medical list and in the study conducted by Debasis et al., Potharaju et al, Tripathy et al., and Kafle et al, it was seen in 60.98%, 46%, 84%,[7] and 86%,[8] respectively. Nearly 93% had legible handwriting in the OPD prescription papers and one recent study conducted by Singh et al. in 2019, 95.8% had legible handwriting.[9] Presumptive/definitive diagnosis was written in 67% of patients, while in the study by Singh et al., it was written in only 64.2% of patients.[9] The relevant clinical details and reason for referral were mentioned adequately in 60% of patients, while in a study by Singh et al., it was mentioned only in 35.7%.[9] Reason for referral was not mentioned in 24% of prescriptions, which is very important for proper and complete treatment of the patient.

However, based on the findings of the study, there is a huge scope for improvements in the prescription patterns in our institution. In 33% of patients, presumptive or definitive diagnosis was absent indicating a definitive practice of polypharmacy. This may increase the chances of adverse drug reactions and interactions. Complete name, strength, dose, and duration of the drug are the main part of prescription writing, and it was absent/inadequate in 15% of prescription papers. This part of prescription writing needs to be improved. Nonessential medicines, which were prescribed, were not available in hospital dispensary in 77% of patients, and we should ensure that drugs should be prescribed from the essential medicine list, so that it will be available in the institution. Nonavailability of drugs in the institute may result in the prescription of other alternatives and brand/nongeneric names.


  Conclusion Top


Prescription auditing is an important tool to improve the quality of prescriptions, which, in turn, it improves the quality of healthcare provided by the physician. Prescription audit data may help the health administrators to take interventions to check and scope of further study to see any impact. Our study highlights the need to train our prescribing doctors on writing rational prescriptions for quality improvement.

Limitation of the study

Small sample size is a limitation of the study, but is an exploratory study to improvise the practices and take learning points; a convenient small sample was taken.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
How to Investigate Drug use in Health Facilities, Selected Drug Use Indicators, WHO/DAP/93 (1);10. Geneva: World Health Organization; 1993.  Back to cited text no. 1
    
2.
de Vries TPGM, Henning RH, Hogerzeil HV, Fresle DA. Guide to good prescribing (A Practical Manual) - WHO Action Program on Essential Drugs. Geneva: WHO/DAP/94.11.  Back to cited text no. 2
    
3.
Debasis B, Banerjee CN, Chattopadhyay S, Singha P. A study of prescription auditing in a tertiary care teaching hospital of Eastern India. J Drug Deliv Ther 2014;4:140-9.  Back to cited text no. 3
    
4.
Sellu D. Time to audit. BMJ 1996;312:128-9.  Back to cited text no. 4
    
5.
World Health Organization. Promoting Rational Use of Medicines: Core Components. WHO Policy Perspectives on Medicines, Number 5. Geneva: World Health Organization; 2002.  Back to cited text no. 5
    
6.
Potharaju HR, Kabra SG. Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra. Indian J Pharmacol 2011;43:150-6.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Tripathy JP, Bahuguna P, Shankar P. Drug prescription behavior: A cross-sectional study in public health facilities in two states of North India. Perspect Clin Res 2018;9:76-82.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Kafle KK; MEMBERS of INRUD Nepal Core Group. INRUD drug use indicators in Nepal: Practice patterns in health posts in four district. INRUD News 1992;3:15.  Back to cited text no. 8
    
9.
Singh T, Bratati 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;8:37.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]



 

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