DOI: http://dx.doi.org/10.18203/2349-3933.ijam20205482

Study of the effect of pharmacotherapeutic audit meetings on prescription writing in a tertiary care center-an interventional study

Vinod Kumar, Minakshi Dhar, Shailendra Handu, Vikas Kumar, Puneet Dhamija

Abstract


Background: Rational drug prescription is a practice when an appropriate drug with correct dosage, formulation, frequency and duration is prescribed. Prescription audit with the help of regular Pharmaco-therapeutic audit meetings (PTAM) is a continuous cycle, involving observing practice, setting standards, comparing practice with standards, implementing changes and observing new practice. World health organization (WHO) and international network for rational use of drugs (INRUD) jointly provided a few prescription and drug use indicators to guide rational prescription writing practice. Aim of the study was to assess the effect of pharmaco-therapeutic audit meetings on prescription writing and its rationality.

Methods: This was a single center cross-sectional, prospective study conducted over a period of 14 months (December 2018-February 2020). Prescriptions from outpatient departments of general medicine, pulmonary medicine, physical medicine and rehabilitation (PMR), community and family medicine (CFM), pediatrics and psychiatry were collected. All the collected prescriptions were screened for rationality using WHO/INRUD core indicators and the index of rational drug prescribing was calculated. Prescriptions beyond acceptable limit were discussed in PTAM and same process was repeated over next 2 months to assess change in prescribing patterns after PTAM. Chi-square and student’s t-test was used for statistical analysis.

Results: Statistically significant change in proportions for antibiotic prescribing was 3.4% [95% CI (-1.7%-9.4%), p=0.20] and prescriptions with generic name drugs was 10.5% [95% CI (6.1-14.6%) p<0.0001 was seen while no significant change was seen in injectable preparation use 0.6% [95% CI (-0.6%-1.5%); p=0.26)] and prescriptions from essential drug list (EDL) 0.5% [95% CI (-4.2%-5.4%) p=0.83].

Conclusions: Our study showed that PTAM is an effective way to improve rationality of prescriptions and must be done regularly for improving prescribing practices.


Keywords


Prescriptions, Pharmacotherapeutic audit meeting, Tertiary care, WHO/INRUD drug prescribing indicators

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References


Proceedings of the twentieth anniversary symposium. ATC/DDD classification. WHO Collaborating Centre for Drug Statistics Methodology. WHO Drug Info. 2002;16(3).

Donaldson LJ, Kelley ET, Dhingra Kumar N, Kieny MP, Sheikh A. Medication without harm: WHO’s Third Global Patient Safety Challenge. Lancet. 2017;389(10080):1680-1.

Ryan C. The basics of the STOPP/START criteria. Second PCNE Medication Review Working Symposium. Dublin; 2011;1-35.

Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45.

World Health Organization Uppsala Monitoring Centre. The use of the WHO-UMC system for standardized case causality assessment. Available from: http://www.who.int/medicines/areas/quality_safety/safety_efficacy/whocausality_assessment.pdf. Accessed 21 March, 2020

El Mahalli AA. WHO/INRUD drug prescribing indicators at primary healthcare centers in eastern Province, Saudi Arabia Eastern Mediterr Health J. 2012;18(11):1091-6.

Saha A, Bhattacharjya H, Sengupta B, Debbarma R. Prescription audit in outpatient department of a teaching hospital of North East India. Int J Res Med Sci. 2018;6(4):1241-7.

Patel S, Patel A, Patel V, Solanki M. Study of medication error in hospitalised patients in tertiary care hospital. IJOPP. 2018;11(1):32-6.

Mishra S, Sharma P. Prescription audit and drug utilization pattern in a tertiary care teaching hospital in Bhopal. Int J Basic Clin Pharmacol. 2016;5(5):1845-9.

Ahsan M, Shaifali I, Mallick AK, Singh HK, Verma S, Shekhar A. Prescription auditing based on World Health Organization (WHO) prescribing indicators in a teaching hospital in North India. Int J Med Res Rev. 2016;4(10):1847-52.

Raman V, Sakthi G, Guru R, Ravikumar T, Manjula M, Poongodi P et al. Prescription audit in outpatient departments in tertiary care hospitals -a prospective study. Indian J Basic Appl Med Res. 2018;7(4):354-8.

Rehan HS, Lal P. Drug prescribing pattern of interns at a government healthcare centre in northern India. Tropical Doctor. 2002;32(1):4-7.

Darji NH, Vaniya HV, Doshi CM, Hedamba RH, Jadav SP, Trivedi HR. Prescription audit in the inpatients of a tertiary care hospital attached with medical college. J Clin Exp Res. 2015;3(2):197-200.

Aravamuthan A, Arputhavanan M, Subramaniam K. Assessment of current prescribing practices using World Health Organization core drug use and complementary indicators in selected rural community pharmacies in Southern India. J Pharm Policy Pract. 2017;10(1):1.

Patel V, Vaidya R, Naik D, Borker P. Irrational drug use in India: A prescription survey from Goa. J Postgrad Med. 2005;51:9-12.

Rishi RK, Sangeeta S, Surendra K, Tailang M. Prescription Audit: Experience in Garhwal (Uttaranchal), India. Tropical Doctor. 2003;33(2):76-9.

Abidi A, Gupta S, Kansal S, Ramgopal R. Prescription auditing and drug utilization pattern in a tertiary care teaching hospital of western UP. Int J Basic Clin Pharmacol. 2012;1(3):184-90.