Prescription Auditing in Pediatric In-Patients at Secondary Care Hospital: A Cross Sectional Survey

Swathi J.¹, Vinitha E.¹, Sudharsana KG¹, Vijisha R.¹, Bincy Baby¹, Keerthana Chandrasekar²*

¹Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, The Nilgiris-643001, Tamil Nadu, India.

²Clinical Resident, Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, The Nilgiris-643001, Tamil Nadu, India.

*Corresponding Author E-mail: keerthana@jssuni.edu.in

ABSTRACT:

Prescription is a written communication from a registered medical practitioner to a pharmacist regarding dispensing a medication. For an effective utilization of drugs by the patients, it is essential to carry out prescription audits or evaluation which helps to quantify the errors and look for possible solutions. The parameters followed for prescription audit are patient demographics and prescribing standards. Rational prescribing can help to improve prescribing practices thus reducing prescribing errors to improve the safety of patients. This study was a cross sectional survey conducted on the prescription auditing of the pediatric inpatients. The study was conducted at Secondary Care Public Hospital over a period of six months from December 2018 to May 2019. The study was performed only with the cases present at pediatric inpatient department. A total of 110 prescriptions were audited in which (n=59) prescriptions were found to be male pediatric patients and (n=51) prescriptions were found to be female pediatric patients. The data analysis was carried out using Statistical Process Control and the total number of defects and non- defects observed during the audit were 30.75% (n=609) and 64.34% (n=1274) respectively. Thus this study helped in understanding about the prescribing patterns at secondary care public hospital and the rationale of the drugs prescribed.

KEYWORDS: Prescription - Auditing, Pediatric, Statistical Process Control (SPC), Defects, Non-Defects, Survey, Dispensing, Errors, Parameters

INTRODUCTION:

Prescription auditing is a vigilance activity beneficial for reducing the burden of diseases because of medication errors [1]. It enhances the standard of the medical treatment at all the levels of health delivery system and offers the most comprehensive overview of performance, detailing parameters as per the checklist of prescription audit, support learning and development of staff and organization and also to identify, promote and improve good professional practice and quality standards [2]. The vital need of prescription audit is to analyse the prescribed drugs in in-patients department and out-patient department respectively, and to rationalize the use of drugs and also to articulate the measures for improving the prescription practices [3]. There are various types of prescription audits like standard based audit, adverse occurrence screening, peer reviews, and patient surveys and focus groups. Statistical process control is the method of quality control used. A significant survey can be done and better patient care can be given to the patient. New process of treatment can be implemented [4]. Statistical Process Control is a method of quality control which employs statistical methods to monitor and control a process. This helps to ensure that the process operates efficiently producing more specifications and conforming products to less waste. The advantages of prescription auditing are it improves the relationship with customer, detecting error at inspection, and prevent bad prescribing habits [5]. The aim of the study is to carryout prescription auditing in pediatric in-patents at secondary care public hospital by using cross-sectional survey. To analyse demographic details and to analyse the completeness of the prescription are the objectives of the study.

MATERIALS AND METHODS:

The study is a prospective cross sectional survey and was conducted at Secondary Care Public Hospital, India. The study was conducted for a period of 6 months from December 2018 to May 2019. The data was collected in a structured data collection form consisting of demographic details and prescription details. Cases present at the pediatric in-patient department was included and the cases from other departments were excluded in the study. The statistical analysis were done using statistical process control method.

RESULT AND DISCUSSION:

A total of 110 prescriptions were audited in which (n=59) prescriptions were found to be male pediatric patients and (n=51) prescriptions were found to be female pediatric patients. The weight of the patients in this study group ranged between 0.1kg to 15 kg with the mean weight and standard deviation of 16.50±7.746. The age of the patients in this study group ranged between 0.1 years to 15 years with a mean age and standard deviation of 5.45±3.84.

Fig.1. The age wise distribution of the patients

Fig.1. Age wise distribution

In the observed cases a total number of 102 prescriptions were found to be immunized and 8 were not immunized.

Fig. 2. The disease distribution of the patients

A total number of 110 prescriptions were analyzed in which all the prescriptions (n=110) were mentioned with date and time. In the observed case 25.4% of the patients were found to have allergies and 68.1 % of the allergies were not mentioned.

Fig. 3. The percentage of drugs prescribed with generic name

In the observed case a 101prescriptions were found to be legible and 9 prescriptions were found to be illegible. About 44 prescriptions were found to have approved abbreviations and 66 were not prescribed with approved abbreviations. A total number of 52 prescriptions were prescribed with capital letters and 58 were not prescribed with capital letters. In the observed case about 109 prescriptions were prescribed with the formulation of the drug and 1 prescription was not mentioned with the formulation of the drug. In the observed cases, the dose of the drug was mentioned in 105 prescriptions and for 5 prescriptions dose of the drug was not mentioned. Total number of 105 prescriptions was prescribed with the route of drug administration and 5 were not mentioned with the route of drug administration. The frequency of the drugs was prescribed for 67 patients and 43 were not prescribed with the frequency.

Fig.4. The percentage of drug – drug interaction

The drug-drug interactions were mentioned in 25 prescriptions and in 84 prescriptions the drug-drug interactions were not mentioned. In the observed case 48 prescriptions had Si Opus Sit (SOS) order mentioned and 43 was not mentioned with Si Opus Sit (SOS). In the observed case the medication w/h or omitted were signed by the prescriber or consultant in 28 patients and were not mentioned in 34 prescriptions. The stat order time/infusion rate was mentioned in 33 prescriptions and was not mentioned in 17 prescriptions. In the observed cases 45 prescriptions had therapeutic duplications and in 62 prescriptions therapeutic duplications were not mentioned. About 100 prescriptions were in line with Standard Treatment Guidelines (STG) and 5 of the prescriptions were not found to be in line with Standard Treatment Guidelines (STG). Total number of 102 prescriptions, the prescriptions and transcriptions was written only by the medical officer and for 6 prescriptions it was not mentioned. In Statistical Process Control (SPC) analysis conducted for the prescription audit for the inpatient department, the mean (total number of defects during audit by total number of parameters) is 33.833, Upper control limit (mean+ 3×square of mean) is 51.282 and the Lower control limit (mean-3×square of mean) is 16.384. The Prescription Audit Data is shown in Table No 1.

Table 1: Prescription Audit Data

PARAMETERS	YES	NO	N/A
Date and time mentioned for each order	110	0	0
Allergies (if any) is mentioned	28	75	7
Prescription is legible	103	7	0
Approved abbreviation used	101	9	0
Prescription written in capital letters	44	66	0
Formulation of the drug mentioned	52	58	0
Dose of the drug mentioned	109	1	0
Route of drug mentioned	105	5	0
Frequency of the drug mentioned	105	5	0
Drug - drug interaction	67	43	0
SOS order if any mentioned	25	84	1
Medication w/h or omitted drugs are signed by prescriber or consultant	48	43	19
Stat order time / infusion rate mentioned	28	34	48
Therapeutic duplication	33	70	7
Drugs prescribed with generic name	45	62	3
Drugs prescribed are in the line of STG	100	5	5
Prescription and transcription should be written	102	6	2
Any corrections in the prescription counter signed by MO	69	36	5
Total Count	1274	609	97
Total Percentage of Count	64.34%	30.75%	4.89%

CONCLUSION:

The results obtained from the study shows the prevailing prescribing habit. Our survey showed that age of the patients in this study group ranged between 0.1 to 15 years with a mean of 5.45±3.84 and the weight of the patients in this study group ranged between 0.1 to 15 years with a mean of 16.50±7.746. Almost many of the prescriptions were found to be non–defective, thus this prescription audit helped us in understanding about the prescribing patterns at Secondary Care Hospital. The main limitations of the study is the appropriateness of prescription in terms of route of administration, dose of the drug were not studied, the frequency of the drug was not studied, and another limitation of our study is drug-drug interaction because prescriptions were not assessed for the drugs which would cause serious interactions.

ACKNOWLEDGEMENT:

We would like to acknowledge the support provided by Government District Headquarters Hospital, Ooty.

REFERENCES:

1. Kaushal R, Bates DW, Landrigan C et al. Medication errors and adverse drug events in pediatric inpatients. J Am Med Assoc. 2001; 285(16):2114-2120.

2. Panayyappan L, Jamcy Maria Jose, Jomin George Joseph et al. Prescription audit and prescribing indicators. J Bio Innov.2017; 6(4):542-547.

3. Pandey AA, Thakre SB, Bhatkule PR. Prescription analysis of pediatric outpatient practice in Nagpur city. Indian J Community Med. 2010; 35 (1):70-73.

4. Sirisha S, Shibi Mary Thomas, Anand Varghese et al. A Descriptive study on prescription audit in India-A Review. Indo American J of Pharm Sci. 2015; 2(3):641-647.

5. Nilay D. Solanki, Chaital Shah. Prescription audit in outpatient department of multispeciality hospital in western India: An observational study. Int J Clin Trials. 2015; 2(1):14-19.

6. Shahid Hussain, Zahida Parveen, Seema Gupta et al. A Study of prescription auditing in rural health care setting of north India. Int J of Med Sci Public Health.2016; 5(12):2461-2465.

Received on 18.09.2019 Modified on 20.11.2019

Research J. Pharm. and Tech. 2020; 13(8):3797-3800.

DOI: 10.5958/0974-360X.2020.00672.1