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Objective To establish a rational drug use model of PIVAS and promote the rational drug use in clinical practices by enhancing the quality of prescription review by pharmacists. Methods The PIVAS physician orders received from 2014 to 2021 were extracted through the hospital information management (HIS) system. The types of irrational physician orders were statistically analyzed, the improvements were made by the method of quality control circle (QCC). Results The model of PIVAS rational drug use formed a standardized process. The proficiency of physician order review was improved. From 2014 to 2021, the number and proportion of unreasonable physician orders in PIVAS decreased year by year. Every type of unreasonable physician orders was improved year by year. Conclusion The professional and technical levels of pharmacist for physician order review at our hospital were improved by the model of PIVAS rational drug use. The quality of pharmaceutical service was significantly improved which ensured the safety of patients' medication.
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Background: The treatment of Type 2 diabetes mellitus (T2DM) requires many classes of drugs, combination of old and new drugs is usually recommended for intensification of therapies. Antidiabetic drug (ADD) utilization study promotes rational use of ADDs and reveals the recent trends in use. Aims and Objectives: The objective of the study was to analyze drug utilization pattern with particular attention to initiation and intensification of the treatment options in T2DM patients of a diabetes clinic run by endocrinology department of a tertiary care teaching hospital in Eastern India. Materials and Methods: This was a cross-sectional and observational study conducted at the diabetes clinic of a tertiary care Medical College and Hospital of West Bengal over a period of 12 months. After obtaining informed consent, diagnosed adult Type 2 diabetes patients receiving any ADD were included in the study. Demographic, clinical, and laboratory data, proportion of each class of ADDs, and WHO core drug use indicators were analyzed. Results: A total of 298 patients ([167, 56%] males and [131, 44%] females) were enrolled. The mean age of the patients was 52.33 ± 9.91. Metformin (287/298, 96%) was the most commonly prescribed drug, followed by glimepiride (168/298, 56.38%), insulins (116/298, 38.93%), DPP4 inhibitors (108/298, 36.24%), and pioglitazone (99/298, 33.22%). Metformin, glimepiride (53/109, 48.62%) and metformin, glimepiride, and pioglitazone (36/113, 31.86%) were the common dual and triple drug combinations. Conclusion: In Type 2 diabetes, metformin was the preferred agent for initiation of the treatment; glimepiride, insulin, DPP-4is, and pioglitazone were used in combination of metformin for intensification of therapy, consistent with current clinical practice guidelines.
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Background: Analysis of prescription of doctors is done to determine, evaluate, and improve the care of patients in a well-organized way and it estimates on-going practice against a defined standard. Aim and Objective: The aim of the study was to provide the broad outline of performance and delineate parameter as per the check list of prescription audit. Materials and Methods: An observational and non-interventional study was carried out from July 2021 to November 2021 at peripheral medical college, Gujarat. Randomly, we have selected 500 prescriptions. This prescriptions were evaluated as per World Health Organization prescribing indicators and then it were analyzed for errors in prescription writing. Results: In this study, total 500 prescriptions were analyzed and total 1839 drugs were prescribed. Average number of drugs per prescription was 3.67. The percentage of drugs prescribed by generic name was 94.6%. The percentage of encounters with an antibiotic prescribed was 29%. In our prescription audit study, 39.16% (1762 count) prescriptions were non complete and 60.84% (2738 count) prescription were having complete details. Conclusion: If the drug is prescribe by generic name and from essential drug list chances of dispensing error decrease and hand out of incorrect drug to patient is reduced. Minimizing drug per prescription attenuates chances of drug-drug interactions. Regular prescription audit should be conducted regularly which increase the awareness in prescriber and effective, safe, and economics therapeutic practice.
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Objective Analyze the pre-audit results of Chinese patent medicine prescriptions in a second-level hospital, suggest the risks of taking Chinese patent medicines and promote the safe and standardized use of Chinese patent medicines. Methods A total of 31542 outpatient and emergency prescriptions of Kongjiang hospital in April 2021 were collected, combined with the review of the instructions and relevant data, classify the toxic components of Chinese patent medicines, and summarize and analyze the problems of drug use. Results The types of problems in the prescription of Chinese patent medicine and chemical medicines were different, mainly including repeated medication and wrong usage and dosage. Insufficient warnings on toxic medicinal ingredients in the instructions of Chinese patent medicines and the imperfect knowledge base of audit software increased the risk of using Chinese patent medicines. Conclusion It is necessary to improve the knowledge base of the prescription audit system, strengthen the high-alarm management of Chinese patent medicines containing toxic ingredients, and improve the public's understanding of the rational use of Chinese patent medicines.
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Based on the GAPS(goal, analyze, problem, solution) management model, the authors analyzed the problems existing in the practice of prescription audit and the strategies of continuous optimization. Multi-disciplinary team(MDT) and evidence-based practice were applied to help the continuous optimization of prescription audit practice and promote the rational drug use management of medical institutions. Through the establishment of accurate control process, the personalized management of prescription dosage of chronic diseases, perioperative drugs, special grade antibiotics and auxiliary drugs was realized. The practice of prescription audit based on the GAPS management model, on the one hand, could improve the quality and efficiency of prescription audit, gradually improve the qualified rate of prescription, strengthen clinical use intervention and promote rational drug use; On the other hand, it could reflect the value of pharmacists′ professional technicians, provide patients with more high-quality pharmaceutical care, and gradually realize the prescription audit mode of " improving quality, controlling cost and increasing efficiency" .
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China's Prescription Management Measures stipulates that pharmacists shall examine and verify the appropriateness of drug use of prescription medication. Due to the complexity and diversity of TCM decoction piece, there has been no sufficient clinical report on the application of TCM prescription preview software. TCM prescription audit now stays on pharmacists' artificial trial stage. The points of intervention are reviewed in the middle and afterwards. It cannot be implemented in the same time when the prescription is prescribed by the clinician and previewed by the clinical pharmacist, which is called the preview of prescriptions. Due to the different abilities and experience of pharmacists in TCM treatment based on syndrome differentiation and the time limit of prescription preview, unqualified prescriptions are inevitably omitted during the review. Shanghai Yangpu District Hospital of TCM developed by cooperating with Shanghai Literature Pavilion "TCM Clinical Prescription Preview Audit System" was used to realize the intellectualization of the examination in advance to put forward, formed the real-time intervention. It realizes the intellectualization of "preview" prescription, combines manual "middle" and "afterwards" review and comment, and forms the whole-process monitoring of preview real-time intervention, reviewed in the middle and afterwards intervention, which greatly improves the rational rate of TCM prescriptions. The results of artificial group reviewed in 2018 and intelligent system reviewed in 2019 were applied to the method of comparative study. "TCM clinical prescription preview audit system" has obvious advantages over manual preview of TCM prescriptions. The advantage lies in that the intervention point of prescription review is advanced to the "preview" point, and the detection rate of unqualified prescriptions is significantly improved. Compared with the manual method, the intelligent method of TCM clinical prescription preview system has a great advantage in improving the rational clinical use of TCM prescriptions.
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Background: Prescription error and irrational prescribing are the avoidable problems imposed on health care delivery system from prescriber side which must be addressed. Periodic prescription audit helps to curtail the error and irrational prescribing.Methods: A prospective observational study was conducted on patients visiting various Outpatient Department of RIMS, Ranchi, Jharkhand on all working days at 11:00 AM to 12:00 PM from 1 August 2018 to 31 July 2019. Various aspects of collected prescriptions were analyzed by using World Health Organization (WHO) prescribing indicators.Results: In this study, out of 700 prescriptions collected, 76 were excluded. Out of total 624 patients analyzed, 382 (61.28%) were male and 242 (38.72%) were female. 48 (7.69%) patients belonged to ?18, 464 (74.36%) to 19-64 and 112 (17.95%) to ?65 years of age group. Tablet (71%) was the most common dosage form. None of prescriptions were having registration number of the doctor. 242 (38.78%) prescriptions did not have a diagnosis duly written. The total no. of drugs prescribed in 624 prescriptions was 2176. Only 32 (5.13%) prescriptions were found to have medicines prescribed in block letters. Antibiotics (29%) were the most common class of drugs prescribed. Average number of drugs per prescription was 3.47. Only 48 (2.20%) drugs were prescribed by their generic name while total of injectables prescribed were 102 (4.68%). Total number of drugs from NLEM was 848 (38.97%). 196 (9.00%) drugs were fixed-dose combination.Conclusions: In our study, we found deficiencies in various parts of prescriptions. Prescribing pattern was not in accordance with WHO recommendation for prescribing practice.
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Background: A regular and effective prescription audit is a key tool to ensure rational use of drugs and to assess drug utilization in the health care system. This study is first of its kind, in Rajendra Institute of Medical Sciences (RIMS), Ranchi, highlighting comparative assessment of prescriptions of online booked appointments in department of medicine and dermatology via online registration system (ORS) using WHO prescribing indicators. This ORS is an integral part under Digital India Initiative.Methods: This was a comparative, observational study conducted in Department of Pharmacology of RIMS, Ranchi. The study period was 6 months from 1 March 2019 to 31 August 2019. Prescriptions details of outpatient department (OPD) patients were collected from the government authorized pharmacy facility “Dawai Dost “at RIMS. 75 prescriptions from each of the departments were analyzed.Results: 75 prescriptions from patients who attended medicine and dermatology outpatient department (OPD) during the study period, after registering appointment via ORS, was collected and comparative assessment was done. This audit highlights important correctable parameters although legibility was not the major concern. Adherence to National List of Essential Medicines (NLEM) was 45% and 49% for department of medicine and dermatology respectively.Conclusions: The prescription audit process should be done regularly to assess ORS prescription to ensure high quality rational prescribing and support Digital India initiative. Adherence to NLEM of India should be 100%. The latest NLEM of India should be provided to the concerned departments and feedback should be provided to the physicians.
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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.
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Background: Medication errors are widespread public health issue. Prescription errors commonly results in medication error. Prescription error can be largely avoidable this study was performed with aim to point out the common mistake in the prescription which may endanger patients.Methods: Our study was cross-sectional and observational, performed in Index Medical College. 320 prescriptions were reviewed. Analysis was done for presence or absence of essential components of prescription like prescriber information’s, patients information’s, details of drug like its dosage form, strength, frequency, total duration of treatment, warnings or instruction for use. The observed data was expressed in number and percentage.Results: Patient information was complete 315 (98.44%) in prescriptions. Prescriber’s information were present in 284 (88.75%). Legibility was seen in 240 (75%). Use of generic drug, capital letters for drug name, warning are seen in 9 (2.81%), 39 (12.19%), 3 (0.94%) respectively. Completeness in terms of the name of drug, dose, strength, route, frequency, duration and dosage forms of prescribed drugs was seen in 252 (78.75%) prescriptions.Conclusions: Properly framed and written prescription can largely prevent medication error. Regular prescription audit must be carried out so that common mistake can be identified and corrective measure with the help of training session, workshop can be taken.
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Background & objectives: Prokinetics are extensively prescribed leading to several adverse events (AEs). The aim of this study was to assess the prescription pattern in patients receiving prokinetics, and characteristics of adverse drug reactions (ADRs) in an outpatient department set up in a tertiary care hospital in western India. Methods: Patients attending outpatient departments of a tertiary care hospital and who had received prokinetic agent for at least seven days over the last one month were enrolled. Causality assessment of AEs was done and assessed for severity, preventability, seriousness and predictability. Results: A total of 304 patients [161 males (52.96%); 143 females (47.04%)] were enrolled. Most prescriptions (299/304, 98%) included domperidone, most commonly prescribed as fixed-dose combination (FDC) with pantoprazole (274/304, 90%). Prokinetic dose was not mentioned in 251/304 (83%) prescriptions, and 18/304 (6%) did not mention frequency. Of the 378 AEs reported from 179 patients (47.35%), 306 (81%) were mild, all non-serious; 272 (72%) not preventable and 291 (77%) predictable in nature. Decreased appetite (n=31, 8.2%) and fatigue (n=27,7.14%) were most commonly reported. Causality assessment by the World Health Organization-Uppsala Monitoring Centre scale showed that 180 AEs were related to suspected drug (17 probable and 163 possible ADRs). Significant correlation was observed for AEs with increasing number of drugs per prescription (Spearman's R=+0.8, P =0.05) and with increasing therapy duration (Spearman's R=+1.00, P <0.001). Interpretation & conclusions: Our findings showed that prokinetics were often prescribed as FDCs, with incomplete prescriptions. Domperidone was found to be associated with multiple AEs. It is suggested that regular prescription monitoring should be done in hospitals to encourage rational use of drugs.
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Background: Indian markets are flooded with more than 100,000 formulations, compared to approximately 350 formulations listed in the World Health Organization (WHO) essential drug list. To promote rational drug use in developing countries, assessment of drug use patterns with the WHO drug use indicators is becoming increasingly necessary. This study was conducted to study the prescribing patterns using WHO prescribing indicators in government healthcare facilities in a district of Assam. Methods: This was a cross sectional study carried out from July to September 2017. Out of total 4 blocks in Tinsukia district one (Ketetong) was randomly selected. All the primary and secondary level government health facilities were included and visited one by one. All the prescriptions on that day of visit were digitally photographed at the pharmacy of the health institution after taking written informed consent from the patient. A total of 353 prescriptions were scrutinized and analyzed using appropriate statistical tests. Results: Out of total 353 prescriptions collected, 11 were illegible and excluded from the analysis. The average number of drugs per encounter was 3.8. In 62.3% of encounters antibiotics were prescribed and injections were prescribed in 30.1% encounters. 71.8% drugs were prescribed by generic name and 56.2% drugs were prescribed from the essential drug list (EDL). Conclusions: The average number of drugs, percentage of injections and antibiotics per encounter was higher than recommended whereas prescription by generic name and from EDL or formulary was lower than recommended. Training of healthcare workers on rational drug use is need of the hour.
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Background: Psychiatric illness is a major but often underreported health burden. The field of psychopharmacotherapy is continuously evolving therefore needs monitoring to prevent irrationality. In this setting, authors analyzed the prescribing pattern of psychotropic drugs while simultaneously monitoring prescription quality in a tertiary care teaching private hospital.Methods: A 6 month-prospective observational study was conducted in psychiatry out-patient department. Prescription pattern was analyzed using World Health Organization (WHO) drug use indicators. The quality of the prescriptions was assessed as per prescription writing guidelines issued by The Department of Health and Family Welfare, Government of West Bengal.Results: Of the 745 prescriptions analyzed, depression and psychosis constituted the bulk of diagnosed cases irrespective of any gender predominance. The average number of psychotropic drugs per prescription was 2.85±1.48. Antidepressants, sedative-hypnotic and anxiolytics are most commonly prescribed drugs. 37.58% of psychotropic drugs were given as fixed dose combination, most common being risperidone with trihexyphenidyl. Only 2.91% of the drugs were prescribed in generic name whereas 53.99% were enlisted in national essential medicine list 2015. Polypharmacy and therapeutic duplication were noted in 41% and 26.84 % of prescriptions and dose, duration and frequency were not mentioned in 2.68%, 53.02% and 19.00% of the prescription respectively.Conclusions: Use of psychotropic drugs follows closely with different treatment guideline, though routine uses of central anticholinergics with atypical antipsychotics are not recommended. Despite high utilization of NLEM, more generic prescribing, correct prescription dosing schedule, avoidance of polypharmacy and non-Judicious use of multivitamin FDCs may significantly improve treatment outcome.
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OBJECTIVE： To optimize prescription audit platform of PIVAS in our hospital， and to provide reference for rational drug use in pediatric department. METHODS： The records of irrational drug use and prescription comment record of physicians were collected and sorted out. Retrieved from drug instruction， China’s National Prescription Collection： Chemicals and Biological Products Volume （Children’s Edition） （2013） and other data， PIVAS prescription audit guideline of our hospital was filed. Based on it， PIVAS prescription audit platform was optimized. The efficiency and accuracy of prescription audit were evaluated using average daily medical order audit time， the number of audit pharmacists， average daily number of telephone communication with clinicians， average daily number of irrational medical orders， the detection rate of irrational medical order as indexes. RESULTS： The revised PIVAS prescription audit guideline is simple and easy to consult. After optimizing and implementing PIVAS prescription auditor platform， average daily medical order audit time， the number of audit pharmacists， average daily number of telephone communication with clinicians， average daily number of irrational medical orders decreased by 33.33 ％， 50.00 ％， 57.89 ％， and 57.14 ％， respectively； the detection rate of irrational medical orders decreased from 1.38％ to 0.54％， with statistical significance （P＜0.05）， which indicated the efficiency and accuracy of prescription audit were improved significantly. CONCLUSIONS： The optimized PIVAS prescription audit platform can significantly improve the standardization of medical order audit and the level of rational drug use， and contribute to rational drug use in pediatric department.
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Objective To improve the accuracy of prescription checking and provide reference for rational drug administration. Methods Intervention mistakes exsisting in prescription checking in 2016 were retrospectively studied to analyze pharmacist' s misunderstanding during prescription checking. Results The error rate of prescription intervention was higher in department of cardiology, department of general internal medicine and department of neurology, accounting for 0.6％, 0.24％ and 0.23％, respectively.Inaccurate prescriptions for intervention, inaccurate medication and inaccurate repeat injections ranked the top 3 of erroneous prescriptions, with the proportions of 25.11％, 22.98％ and 17.45％, respectively. Conclusion Pharmacists should regularly summarize the misconceptions existed in the prescription audit, take individualized medication thoughts as guidance, strengthen the multi-disciplinary knowledge learning.
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This paper introduces the construction and application of "TCM combined outpatient" in the first affiliated hospital of suzhou university. The joint outpatient is set up with senior specialists and clinical pharmacists, and independently developed the traditional Chinese medicine prescription audit system and the pharmaceutical service intelligent platform based on mobile internet technology. The multi-channel doctor- patient-pharmacist exchange platform is set up to assist doctors in drugs selection and patients management with certain achievements.
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Background: Irrational use of antimicrobial agents (AMAs) has led to large scale development of drug resistance and adverse drug reactions (ADRs) which has become a growing world -wide concern. The study was conducted to analyze the prescribing pattern of AMAs and to evaluate the reported ADR of the AMAs prescribed.Methods: A prospective study was conducted by analyzing 900 case sheets receiving AMAs in a tertiary care hospital. The study plan included analysis of average number of AMA prescribed, morbidity profile of patients, types of AMAs used, drug prescribed by generic/brand name, injectable AMA preparations and appropriateness of indication of AMA used. Thirty reported cases of ADR were evaluated for their casualty by Narnajo’s scale and severity by Hartwigs scale.Results: Average number of drugs per prescription was 1.54. Most common morbidity was fever due to various causes. 86.2% of AMA used was antibiotics. About 72.0% of AMAs were prescribed by generic name. Percentage of injectable preparation was 85.0%. 65.0% of drugs were prescribed from Essential drug list (EDL). Most offending drug for ADR was fixed drug combination (FDC) 30.0%. Common organ system involved was skin (63.3%). Most of the ADR were possible (80.0%) and mild (76.6%) in nature.Conclusions: Average number of AMAs per prescription was1.54. Percentage of drug prescribed by generic name is encouraging. However use of injectable preparation was very high. Majority of AMAs prescribed were antibiotics which is also very high. Periodic prescription audit will provide feedback to the prescribers and help in reducing the prescribing error and ADR cases.
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Objective A discussion of practical models for auditing the prescription of parenteral nutrition by clinical pharmacists of nutrition.Methods A three-dimensional approach to prescription audit of parenteral nutrition by clinical pharmacists,focusing on the stability of the nutritional solution,its pharmacological rationality and the patient's individual need.Results Establishment of this three-dimensional approach.Conclusion This three-dimensional approach ensures the safety and rationality of parenteral nutrition and gives play to clinical pharmacists.
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OBJECTIVE:To provide reference for prescriptions audit before payment in hospital pharmacy. METHODS:The management measures of prescriptions audit and intervention before payment in our hospital were introduced. 1 200 outpatient pre-scriptions within 1 year before and after management were subjected to a statistical analysis. The effects of prescriptions audit be-fore payment were evaluated through analyzing and comparing qualification rate of prescription and unqualified prescriptions. RE-SULTS:Our hospital adopted a series of measure to realize prescriptions audit and intervention before payment by clinical pharma-cists,such as using information audit system,formulating audit standard,educating pharmacists,establishing audit job system, prescriptions review and feedback system,setting up communication system,etc. Of the total audited 189 665 prescriptions, 14 581(7.69%)failed to audit and 606 prescriptions hadn’t been revised after 1 year management,with effective intervention rate of 95.84%. Compared with before management,the prescription qualification rate increased from 88.83% to 98.67% after manage-ment(P<0.01). The quantity of overdose,inconformity with medical insurance,overload and other conditions reduced to 0. CON-CLUSIONS:It is feasible for pharmacists to audit and intervent prescriptions before payment in hospital pharmacy to improve pre-scription qualification and promote rational drug use in the clinic.
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Studying the prescribing audit is that part of the medical audit which seeks to monitor, evaluate and if necessary, suggest modifications in the prescribing practices of medical practitioners. Our objective was to study the Prescription Audit in Out Patient Department of in Multispecialty Hospital in western India. Methods: An Observational study was carried out during the period of 2012-2013. Total 150 prescriptions of Out-patient department were collected, scrutinized and statistically analyzed with Reporting procedures to pharmacy and quality department. We have also considered Statistical Process control (SPC) to provide the guidance on how the process may be improved by reducing variation & to assess the performance of a process. Results: Total 150 patients were evaluated for Prescription Audit, out of which 60% were Male & 40% were Female cases. In the same mainly 13 parameter were assessed according to the checklist provided by the Hospital with total 1950 (150*13) counts; from this 1126 Counts were under compliance, 74 Counts were non-compliance & 750 Counts were not applicable. 50 cases were analyzed for 3 months, showed better compliance rate of prescription audit parameters in February 2013 compared to December 2012, while non-compliance rate in prescription audit was reduced as time progresses. Conclusions: A definite role of clinical pharmacist, in the process control by utilizing SPC during prescription audit. The members of the hospital and Quality committee need to focus on findings of it, which help them during accreditation by regulatory authority.