SELF AUDIT OF PRESCRIPTION

WRITING

Dr. JISS FRANCIS

D4207/PGDFM/2016

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ABSTRACT

In a physician’s daily clinical practice, prescription writing is very

important. Adequately made prescription and prescription complete in
every aspect like correct drugs for the disease, specific dosage, capital
letters, proper period for taking drugs etc. are very important in daily patient
care and thereby community care.

It was a prospective study conducted among patients attending

outpatient clinic at Primary Health Centre, Thidanad, Kottayam District,
Kerala state. The period of study was from 5th December 2017 to 18th
January 2018. Starting from December 5th 2017, 5 prescriptions were
recorded randomly on each day for a period of 10 days. That formed cycle I.
Then after 3 weeks again starting from 8th January 2018, 5 prescriptions
were recorded randomly in each day for a period of 10 days. That
contributed Cycle II.

Cycle I

After analysing the Cycle I prescriptions, it was noted that

prescription were not in capital letters in all 50 prescriptions, generic name
were not there in 62% of prescription, appropriate dosage were not there in
70% of prescription, average antibiotic per prescription was 0.26, average
injections per prescription was 0.16.

After cycle I the data was analysed and compared to WHO

prescription standards.

Cycle II

When Cycle II data were analysed, there is definite improvement in

all areas of prescription writing. 100% prescriptions are in capital letters.
100% prescriptions contained generic name of the drug, correct dosage etc.

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Conclusion

There is improvement in core areas of drug prescription like capital

letters, generic names, correct dosage etc.

INTRODUCTION

Prescription writing is an important area in patient caring. Rational

prescription is very much necessary because irrational prescription may
affect patient’s health and their family budget. Also when poly pharmacy
occurs there may be drug interaction between the drugs in the same
prescription, that may affect patient’s health. Illegible writing of prescription
may entitle difficulty in reading, thereby giving wrong medicines to patient
by pharmacist. Irrelevant use of antibiotic may bring about resistance to
common antibiotics among micro organisms. Use of combination drugs in
prescription may also affect patient’s health adversely.

WHO definition of rational prescription of drugs is very relevant. It

quotes “Rational use of drugs requires that patients receive medications
appropriate to their clinical needs, in doses that meet their own individual
requirements, for an adequate period of time and at the lower cost to them
and their community” (WHO, 1985)

Irrational prescription include :-

1. Inadvertent use of antibiotics

2. Prescribing more injections
3. Prescribing more combination drugs
4. Prescribing more costly drugs

Outcome of irrational prescription is deterioration of patient health

and weakening of their family budget.

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 These kind of irrational prescription can be found out by an audit of
prescription. In the audit we can analyse the various irrational way of
prescription like poly-pharmacy, wrong choice of antibiotics, wrong route of
administration, illegible prescription, prescribing of costly drugs etc.
Thus by analysing data and making adequate changes to prescription
practices we can definitely improve patient health and thereby community
health.
MATERIAL AND METHODOLOGY
The study was carried out from 5th December 2017 to 18th January
2018 in primary Health Centre Thidanad, Kottayam District, Kerala among
the patients attending outpatient clinic.

Methods adopted in WHO guidelines :-

WHO prescription indicators

1. Drugs prescribed by generic names

2. Antibiotics prescribed

3. Fixed dose combinations

4. Injection prescribed

5. Basic information of patient

6. Legibility

7. Dosage correctly mentioned in

CONSENT
Consent obtained from patient who attained the OP clinic at PHC
Thidanad.

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SAMPLE SIZE
Fifty prescriptions in Cycle I randomly over a period of ten days.
Fifty prescription in Cycle II randomly over a period of 10 days. So total
100 prescriptions.
STUDY PROCEDURE
Prospective study started in December 5, 2017 at PHC Thidanad,
outpatient time between 9 am and 1 pm. Cycle I ended on 15th December
2017. After 3 weeks Cycle II started on 8th January 2018 and completed on
18th January 2018.
Fifty prescriptions obtained from Cycle I were analysed using spread
sheet containing following data entry parameters in accordance with WHO
guidelines:-

1. Name of the prescriber

2. Address of the prescriber

3. Date

4. Name and drug -generic

5. Strength of drug

6. Dosage- how much

7. Dosage- how many times a day

8. Dosage- how many days

9. Other instructions (eg. After meals)

10. Total number of Tablets/Syrup, Pharmacy to dispense

11. Name of patient

12. Address of patient

13. Age of patient

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 14. Legibility

15. Number of drug items on prescription

16. Number of combination drugs on prescription

17. Number of antibiotics on prescription

18. Total number of injections prescribed in this prescription

For no. 1 to no.13, scores were given either 0 or 1. For no 14 , 0,1,2

score given. For no. 15 to no.18 actual number is entered respectively.

Then the percentage and average is calculated for each parameter.

After analysing Cycle I prescription, areas to be improved were
noted. Decision taken to improve the prescription practises based on WHO
prescription guidelines. Necessary preparations was made and changes
implemented.
Then Cycle II containing 50 prescriptions, 5 randomly per day
started on January 8, 2018 and completed in Jan 18, 2018. The data then
obtained also tabulated into the spread sheet and analysed based on the same
parameters as Cycle I. Definite improvement accomplished in all areas of
WHO prescription indicators and same noted down.

OBSERVATION AND RESULTS

Cycle I- Table
Sl. No Details Total Percentage
1. Name of prescriber 50 100
2. Address of prescriber 50 100
3. Date 50 100
4. Name of drug generic 19 38

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 5. Strength of drug 14 28
6. Dosage- how much 15 30
7. Dosage- how many times a 50 100
day
8. Dosage- how many days 50 100
9. Other instructions 0 0
10. Total no of tablets, pharmacy 0 0
to dispense
11. Name of patient 50 100
12. Address of patient 50 100
13. Age of patient 50 100
14. Legibility 50 1
15. No of drug items 157 3.14
16. No of combination drugs 1 0.02
17. No of antibiotics 13 0.26
18. No of injection 8 0.16

Generic names of the drugs was prescribed only in 19 prescriptions of

cycle I (38%). Strength of the drug was prescribed only in 14 prescription
(28%). Dosage amount is prescribed only in 15 prescriptions out of 50 of
cycle I (30%.) No prescription contained other instructions like before
food/after food (0%) and also total no of tablets, pharmacy to dispense 0%
in cycle I. The legibility score was just legible. Regarding the no. of drug
items per prescription the average was 3.14. Only one prescription had
combination drug and the average is 0.02. Regarding the no. of antibiotics
per prescription the average is 0.26. Regarding the no. of injections per
prescription the average is 0.16.
Then the areas of prescription writing to be improved are identified
and as follows:-

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 1. Generic name

2. Strength of drug

3. Dosage

4. Other instruction

5. Total no. of tablets, pharmacy to dispense

6. Legibility

7. No of drug items per prescription

8. Number of combination drugs per prescription

9. Number of antibiotics per prescription

10. Number of injections per prescription

Cycle II- Table

Sl. No Total Percentage/Average

1. 50 100
2. 50 100
3. 50 100
4. 50 100
5. 50 100
6. 50 100
7. 50 100
8. 50 100
9. 50 100
10. 50 100
11. 50 100
12. 50 100

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 13. 50 100
14. 2
15. 140 2.8
16. 0 0
17. 12 0.24
18. 11 0.22

Based on the cycle II analysis all the areas that improvement needed
are definitely improved.

DISCUSSION
Rational prescription is very important in day to day clinical practice.
It is the duty and responsibility of practicing physicians that his/her
prescriptions should be rational and legible in all aspects.
In the study it is found that name of the patient, age of the patient,
address of the patient are there in every prescription. Also the name of the
physician and his signature is also present in all prescriptions. Prescription
in cycle I lacked in dose, strength, generic names, no of drugs per
prescription etc. WHO recommends 2 drugs per prescription. Also
percentage of antibiotics WHO recommendation is 20-25%.
After analysing cycle II there is definite improvement in all the core
prescribing indicators as envisaged by WHO. Thus the study definitely
improved the prescription qualities. It also shows frequent auditing of
prescriptions are necessary for good clinical practice.

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CONCLUSION

Rational prescription is very important and prescribing errors will

result in patient harm and thereby community harm.
Overall the study has improved the prescription quality in my daily
outpatient clinic. Frequent audits should be performed in the coming years
as routine also to ensure good patient care and thereby good community
care.

REFERENCE

1. The link for WHO site for prescribing indicators

http://apps.who.int/medicinedocs/en/d/Js2289e/3.1.html
2. The link for national list of essential medicines
http://apps.who.int/medicine.docs/en/d/Js23088en/