Mediterranean Journal of Pharmacy & Pharmaceutical Sciences

www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print

Short communication

Common errors in writing of prescriptions in Benghazi

Arwa Benkhaial* , Isra Ibzaew, Shog Elkezza, Hajer Ahmed and Yasmine Abdulkader

Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benghazi, Benghazi, Libya
*
Author to whom correspondence should be addressed

Received: 11-08-2022, Revised: 26-08-2022, Accepted: 06-09-2022, Published: 30-09-2022

Copyright © 2022 Benkhaial et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

HOW TO CITE THIS

Benkhaial et al. (2022) Common errors in writing of prescription in Benghazi.
Mediterr J Pharm Pharm Sci. 2 (3): 7 - 11. https://doi.org/10.5281/zenodo.7115118

Keywords: Prescription, good prescribing, Libya, out-patient prescriptions

Abstract: Good prescription writing is essential for dispensing the right drug formulation and dose. When
prescriptions are not legible, inaccurate and do not include complete information, there is a possibility of
prescribing errors occurring, which leads to adverse events. Poor handwriting is another important issue that
makes the information unclear; especially look-alike drug names that may be confused by the pharmacist.
World Health Organization has issued a practical manual for Good Prescribing that includes the essential
information that should be included in a prescription. In this study, we attempt to investigate the problem of
bad prescribing habits in out-patient prescriptions in Benghazi, Libya. Two hundred seventy-five out-patient
prescriptions were collected from two private pharmacies on four consecutive days. These prescriptions were
scanned for any errors or missing information depending on the standard criteria established by World Health
Organization in its practical manual "Guide to Good prescribing". The collected data were processed and
statistically analyzed by using SSPSS to calculate the percentage of missing information. Eleven percent
(11.0%) of the prescriptions had no address or name of the prescriber on them while 58.0% had no date written
on them and in 21.0% the prescriber did not sign the prescription. The age of the patient was only written on
38.0% of the prescriptions. The name of the medication was not clearly written in 18.0% of the prescriptions,
while the dosage form of the medication was not written at all in 18.0% and not clearly written in 20.0% of
the prescriptions. The total amount of the prescribed drug was not written in 30.0% of the prescriptions. It is
to conclude that prescribers included in this study wrote prescriptions with a lot of missing and unclear
information as per WHO guidelines for a good prescribing. This shows the weak attitude of Libyan prescribers
toward the different aspects of “Good Prescribing”.

Introduction and regulations to define which drugs require a

prescription and who is entitled to write it [1, 2].
A prescription is a legal document that contains Good prescription writing is recommended to
instructions from a prescriber to a dispenser i.e., a ensure that the pharmacist knows exactly which
pharmacist for which both are responsible. Every drug formulation and dose to dispense and the
country has its standards for the minimum patient has explicit written instructions for self-
information required for a prescription, the laws administration of the prescribed drug. Prescriptions

Benkhaial et al. (2022) Mediterr J Pharm Pharm Sci. 2(3): 7-11. 7-11
 Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print

are regulated by national and international laws and medication order is clear and unambiguous, so they
must be clearly and properly written to include are advised to write out instructions rather than
specific information [3, 4]. Different prescription- using nonstandard or ambiguous abbreviations [8,
writing guidelines have been developed to comply 9]. A culture in which prescription writing is seen
with these laws, avoid errors when the prescription as important should be created and formal review
is prepared and prevent misuse of the prescription interventions should be made by pharmacists [10].
information. World Health Organization (WHO) Researchers recommend promoting the use of
has issued a practical manual called “Guide to clinical computer systems for safe prescribing [11].
Good Prescribing” that includes all aspects related Most studies suggest that computerized tools can
to good drug prescription for different diseases [1, reduce prescribing errors [12]. It is also
2, 5]. According to this document, a good recommended that there should be computerized
prescription should include the following: name, pharmacy systems in place that enable automated
address and telephone number of the prescriber; checking for doses, duplicate therapies, allergies
date; generic name and strength of the drug; dosage and drug interactions [9]. In this study, we attempt
form and the total amount of the medication to be to investigate the problems of bad prescribing
dispensed; Label including instructions and habits in out-patient prescriptions written by
warnings; name, address, and age of the patient; Libyan prescribers in the city of Benghazi.
signature or initials of the prescriber. When
prescriptions are written in an illegible and
Materials and methods
inaccurate way and do not include complete
information, this increases the possibility of This study was carried out in Benghazi city. An
medication errors during dispensing and ethical approval has been obtained from University
administration that may lead to adverse events. of Benghazi with using an international regulations
Poor handwriting makes the information unclear to for data collection. A data were collected from 275
the pharmacist; especially look-alike or sound- out-patient prescriptions from two private
alike (LASA) medication names may be mistaken pharmacies on four consecutive days. These
for each other at the pharmacy [3, 6]. Reports of prescriptions were scanned for any errors or
injuries secondary to poor handwriting have missing information in their writing depending on
accumulated in the regulatory literature to the point the standard criteria established by WHO in its
that the Institute for Safe Medication Practices practical manual “Guide to Good prescribing”.
(ISMP) published a call to action to eliminate These criteria were: 1) name and address of the
handwritten prescriptions by 2003 [7]. Prescribing prescriber, with the phone number (actually the
errors result in serious patient morbidity or address of the clinic from where the prescription
mortality. Thus, they must not be taken lightly and was issued, which was considered as the address of
effective systems for ordering and dispensing the prescriber); 2) date of prescription; 3) name and
medications should be established with safeguards strength of the medication; 4) dosage form and total
to prevent their occurrence. amount; 5) information for package label; 6)
prescriber’s initials and signature; 7) name, address
In order to be complete prescriptions should of the patient and age (for children and the elderly)
include the patient's name, generic drug name, [1]. Data collected from these prescriptions were
trademark name (if a specific product is required), processed and descriptive statistical analysis by
route and site of administration, dosage form, dose, using SSPSS (11.5) to calculate the percentage of
strength, quantity, frequency of administration and missing information and the results.
prescriber’s name. In some cases, a dilution, rate
and time of administration should be specified.
Results
Prescriptions should be reviewed for accuracy and
legibility immediately after they have been written. The collected prescriptions had 725 prescription
Prescribers should be careful that the intent of the items. Eleven percent (11.0%) of the prescriptions

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www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print

did not contain the address or name of the prescription (Figure 1). The age of the patient was
prescriber while 58.0% had no date written on them only written on 38.0% of the prescriptions while
and in 21.0% the prescriber did not sign the the rest had no age written on them.

100.00%
90.00%
80.00% 100.00%
70.00%
60.00% 80.00%
50.00%
40.00% present 60.00%
30.00% not present
20.00% 40.00%
10.00%
0.00% 20.00%
Name and Date of Signature of
address of prescription the
0.00%
Clearly written not clearly written
prescriber prescriber

Figure 1: Prescriptions with name and address of the Figure 2: Prescriptions with name of the prescribed
prescriber drug

In Figure 2, name of the medication was not are shown. Data revealed that about 50.0% were
clearly written in 18.0%, while the dosage form of given and the rest are absent. On the other hand,
the medication was not written at all in 18.0% of total amount of the medication was written only in
the cases and not clearly written in 24.0%. In Table 66.0% of the prescriptions and the rest are not clear
1, strength and dosage form of the prescribed drug or absent.

Table 1: Prescriptions with important drug dosing features

Drug dosing information not not written but

written
written available not clear

Strength of drug 52.2% 20.4% 17.9% 09.5%

Dosage form of prescribed drug 58.2% 17.9% -- 23.9%

Total amount of prescribed drug 65.7% 34.3% -- --

Discussion
Prescriptions are legal documents that should be address of the clinic pre-printed on the prescription
legible, complete and clear. WHO has set some pad. This is in line with the results found in the
minimum required information that should be study by Ansari and Neupane where no error was
mentioned in a prescription to avoid any found in writing the name, age, sex and address of
misunderstanding that may lead to prescribing patients in the prescriptions [13]. In this present
errors? In this study, we aimed to detect how study, there were few prescriptions without the
“good” prescribers in Benghazi-Libya`s outpatient address of the prescriber written on them. These
sector write prescriptions. In this study, most of the prescriptions were issued from outpatient
prescriptions had the address of the prescriber departments of the public sector clinics or
written on them. This is because most of the hospitals. As seen, this is a major problem that
prescriptions were from outpatient departments of needs to be solved in these clinics by providing
private clinics that usually have the name and prescribers with pre-printed prescription pads.

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www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print

The importance of writing the date on the so because they can be considered as potential
prescriptions is for their validity, hence in some prescribing errors. Finally, this study had some
countries pharmacists do not dispense drugs on drawbacks and the main one was its retrospective
prescriptions older than three to six months [1, 2, design. This made it impossible to detect if these
14]. In this study, more than half of the potential prescribing errors have actually caused
prescriptions had no date written on them showing any harm to the patients administering these
the weakness in the attitude of prescribers in Libya medications i.e., adverse drug events. An
towards writing the date on the prescription. While additional drawback is that a small sample size of
prescribers are legally obliged to write the collected data. Nevertheless, this study was a
prescriptions clearly [1, 2], more than 20.0% of the preliminary to emphasize the problem of illegible
prescribed drugs in this study were not clearly prescribing in Libya. Further studies with a larger
written. This legal duty for prescribers is to ensure data sets are warranted for more accurate
that prescriptions are with sufficient legibility not evaluation of the problem. More studies like
to allow mistakes by busy dispensers to occur [1, surveys can be conducted to prove or disprove
2]. Unclear handwriting can cause misreading the these findings. Hospitals and clinics should put
prescribed drug which may lead to dispensing the regulations that enhance “good prescribing” and
wrong medication resulting in injury, exacerbation lead to the prevention of such bad prescribing
or prolongation of illness, distress and harm to the habits. For instance, hospitals and clinics should
patient and higher costs [15]. have pre-printed prescription forms. This enhances
the quality of information written on prescriptions,
About 20.0% of the cases the dosage form of the
where there is a place for each required
prescribed drug was not written and in 25.0% was
information. Also, implementing e-prescribing is a
not clearly written. This can lead to confusion
challenge that should be considered. Regulating
during the dispensing process while the pharmacist
authorities should also play a major role by
may try to guess the intended dosage form leading
establishing policies that emphasize the importance
to bigger mistakes. This kind of error is a common
of writing “good prescriptions” and prevent the
type that contributes to about 10.0% of prescribing
dispensing of unclear prescriptions.
errors and may lead to adverse drug events [16]. In
the previously published study, the dosage form, Conclusion: The prescribers in Libya write
quantity, dose, frequency and route of prescriptions with a lot of missing or unclear
administration were not mentioned in 12.0%, information, although this information is an
60.0%, 19.0%, 10.0% and 63.0% of the important factor and the guidelines have
prescriptions, respectively. However, it is to considered it as a criterion for “Good Prescribing”.
mention, that we called all the detected “mistakes” This shows the weak attitude of Libyan prescribers
prescribing errors, although many would argue that toward the different aspects of “Good Prescribing”.
they are only “bad” handwriting or slips, but we did

Data availability statement: The raw data that support the findings of this article are available from the corresponding author
upon reasonable request.
Author contributions: AB contributed to the conception, design of the study, analysis and interpretation of the data, II, SE,
HA & YA collected data and drafting the manuscript. All authors approved the final version of the manuscript and agreed to be
accountable for its contents.
Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial
relationships that could be construed as a potential conflict of interest.
Ethical issues: Including plagiarism, informed consent, data fabrication or falsification and double publication or submission
have completely been observed by authors.
Author declarations: The authors confirm that all relevant ethical guidelines have been followed and any necessary IRB and/or
ethics committee approvals have been obtained.

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