Prescription Notes Auditing in a Medical College and Hospital of Himachal Pradesh

With prescription audit the main aim is to improve rational use of drugs. Irrational prescriptions can lead to adverse drugs reactions or sub therapeutic treatment and antimicrobial resistance. Irrational prescribing is a universal problem. Examples include: poly pharmacy, inadequate dosage, use of antimicrobials even for non-bacterial infections and excessive use of injections when oral forms are available [1].


Introduction
With prescription audit the main aim is to improve rational use of drugs. Irrational prescriptions can lead to adverse drugs reactions or sub therapeutic treatment and antimicrobial resistance. Irrational prescribing is a universal problem. Examples include: poly pharmacy, inadequate dosage, use of antimicrobials even for non-bacterial infections and excessive use of injections when oral forms are available [1].
The World Health Organization (WHO) has formulated a set of "core prescribing indicators" for improvement in rational drug use in outpatient practice. It includes the prescribing indicators, the patient care indicators and the facility indicators [2]. Based on these indicators, studies have been carried out all over the world and even in India [3].

Material and Methodology
This was an observational, prospective study carried out over a period of 3 month between August to October 2016. The data was collected from OPDs of our hospital. These prescriptions were analyzed based on the objective of the study. Complete information i.e. specialty wise distribution, age, sex, demographic profile of patients, prescription profile and number of drugs per prescription. These were uploaded on M.S. Excel sheet. These results were analyzed and deficiencies were observed.
Evaluation of prescriptions was done by twelve questions. Each carries 2 marks so total marks were 24. Marks obtained 12 to 18= Semi rational.

Results
In total 317 drugs were prescribed in 113 prescriptions. So average number of drugs/prescription were 2.80 drugs.

Discussion
Prescription auditing is an important tool to improve rational pharmacotherapy. It is very important document for health administrators and clinicians groups for both decision making and drafting policies. In our study total drugs prescribed were 317 in 113 prescription notes. Therefore average numbers of drugs/prescriptions were 2.80. So result was quite satisfactory to the recommended limit of 2.0 [2]. This limit is to prevent drugdrug interactions and unwanted side effects. FDCs were used in 21 % of prescriptions. This figure is also quite low compared to two indian studies which reported 75% and 60 % usage of FDCs respectively [4][5][6][7][8][9][10]. FDCs sometimes may be irrational. Our study also show Poly pharmacy. 52% of prescriptions shows either 3 or more than 3 drugs. Even this poly pharmacy is a big concern and it is reported in various studies [5,9].
In 84% prescriptions oral formulation, in 9% topical and in 7% prescriptions injectable were prescribed. Although use of injectable was high from other studies but it was at par with Indian study which reported 7% [3]. We need further decrease in number of injectable, to reduced blood born infections [6]. In our study antibiotics were prescribed in 18.3% of cases. More than one antibiotics was prescribed in 7% of cases. Results were satisfactory and are much lower than other study [7] in which around 50% of patients received more than one antibiotic. Overuse of antibiotics leads to drug resistance.
In 31% of prescriptions generic drugs were prescribed. This is very low as compared to other studies, few study reported very high (73.4%) use of generic names [8]. Generic prescribing decreasing the chances of dispensing errors. Lot of deficiencies were observed in prescription writing like diagnosis not written in 38(34%), signature not done in 8(7%), and duration of treatment not written in 13(11.50%) of prescription notes. Around 24(21.23%) of prescriptions were incomplete either in dose/ frequency or duration. So there was a scope for improvements in the prescription writing.

Conclusion
From our study it is concluded that there is scope for improvement in prescribing patterns in areas of writing diagnosis, findings, signature, advise, dose, frequency and duration. Educating the clinicians about prescription writing is very important aspect. Regular updates of clinicians are also required for improving rational pharmacotherapeutics.