A brief study about

PRESCRIPTION AUDIT ANALYSIS

SYAMA J S
M Pharm Pharmacology
Pharmacist –FHC Patyam
Cheruvanchery, kannur
INTRODUCTION

• A Prescription is a written request or an order to a pharmacist by a

physician, veterinarian, dentist or any other properly registered
medical practitioner for medications.

• Prescriptions are very important because they become a medico-legal

document once they are signed by the legal prescribing authority and
thus they are mandatory to be

written completely and also free of error

• Medication errors may be committed by both experienced and in-
experienced professionals including doctors, pharmacists, nurses,
supportive personnel (eg: ward clerks), administrators, drugs
manufactures, patients and their caregivers and others .
PRESCRIBING ERROR

• Prescribing error is an error that occurs as a result of prescribing

writing ,which might result in accidental, significant reductions in the
therapeutic outcome of treatment and might also increase the risk of
harm.

• Prescribing error omission error

commission error
• Omission errors : Include those errors in which there is incomplete or
missing information in the prescriptions, which are unreadable and
prescriptions that do not conform to legal requirements.

• Commission errors : which include incorrect or wrongly written

information in the prescriptions.

• Error can arise from any step of prescribing

such as
The choice of drug
Dose
Route of administration and
Wrong frequency or duration of treatment
• Inaccuracy in writing and poor legibility of handwriting or incomplete
writing of a prescription can lead to misinterpretation, thus leading to
errors in dispensing and administration.

• Health professionals must take account of appropriateness, effectiveness,

side effects, contraindications
. and cost when prescribing any medicine.

• Special care and precautions are needed in prescribing the drugs with
abuse potentials to avoid their misuse.

• Irrational prescribing may account to professional and legal threat to a

prescriber if done injudiciously as it indicates the prescriber’s
responsibility towards clinical care and safety of patient.
• Every country has its own standards and regulations for prescription
writing.

• There is no global standard for prescription writing which may suggest

a need for introduction of universal guidelines.
PRESCRIPTION AUDIT
 Prescription audit is a part of holistic clinical audit & a quality
improvement process that seeks to improve patient care .

 It is a tool as well as a technique and its application is science as well

as an art.

 It is based on documented evidences to support diagnosis, treatment and

justified utilization of hospital facilities.

 Effective prescription audit is important for health professionals, health

service managers, patients, and the public.

 It supports health professionals in making sure their patients receive the

best possible care.
OBJECTIVES OF CONDUCTING PRESCRIPTION AUDIT

•To assess the extent of irrational prescribing.

• Detection of prescribing errors with their reasons.
• To assess & reduce the irrational usage of antibiotics, syrups,
injections etc.
• To identify opportunities for the improvement and developing
benchmarks.
• To channelize the good practice of writing complete, legible and
rational prescriptions.
PRESCRIPTION AUDIT METHODOLOGY
 REMEMBER

• Audit is not a FAULT-FINDING Exercise But a FACT-FINDING

Exercise.

• Audits are not For POLICING But for POLISHING .

• An internal mechanism for Quality Improvement .

• Audit is not an external Quality Assurance method.

• OVERVIEW OF PRESCRIPTION AUDIT METHODOLOGY
Constituting prescription
audit committe

Calculate sample size

Re- audit Collect Data

Make improvements Analyse data indicators

Identify low scoring

attributes
STEP 1: FORMULATING AN AUDIT COMMITTEE

• Audit Committee is part or subcommittee of ‘Medicines and Therapeutic Committee’.

• The prescription audit committee should cover the practice of the different clinical and
managerial disciplines .

• Committee should know the aim of the audit & their role.

• Suggested members of the Audit Committee:

At DH/SDH and CHC level:
 Hospital In-charge (MS/CMO) (overall Responsibility)
 Hospital Administrator/Manager (wherever available, for conducting and analysing Prescriptions’
findings),
 One Clinician from each department,
 In charge Nursing Services/Matron,
 Chief Pharmacist/Senior most pharmacists managing dispensary and Medical Store.
• In small healthcare facilities like UPHC and PHCs, Medical Officer, Pharmacist and
one senior nurse may be part of the Audit Committee.

• Specific details (like antibiotics prescribed, medicines prescribed as per STGs, no

medicines given, etc.) can be audited through peer review by another Medical Officer
of neighbouring health facility.

• OR Scanned copies of minimum 30 prescriptions can be sent to District Quality

Assurance Unit (DQAU) for review.
1. PRESCRIPTION AUDIT - STUDY DESIGN
• This observational study was conducted over a period of one month.
• 30 OPD prescriptions were randomly collected from the pharmacy
counter of the OPD during a month.
• Each prescription slip was audited on a 15-characteristics’ pre-
structured proforma.
• All patients were receiving treatment in the OPD for various medical
ailments.
• All the 30 OPD prescriptions were taken and analyzed as per the
prescribing indicators.
• The audit was carried out by the pharmacist of the hospital, and a
copy of the prescription is retained for validation of the result.
A) Demographics characteristics of patient involved.

1) Complete name of patient

2) Sex of the Patient
3) Age in years
4) OPD No
5) Complete address of patient
6) Legible handwriting
• Complete Name of the patient is written: It should have first, middle (if
have) and last name of the patient written on the prescription.

• Gender of the patient: Male/Women/Others.

• Age: It should be written in years (≥ 5 in years) in case of < 5 years (in

months).

• Complete address of patient : Address & contact details

• OPD Registration Number mentioned: A Unique Health Identification

Number (UHID) is given to each patient.

• Legibility: Prescription should be written in Capital letter for clear

understanding of the pharmacist.
B) Medicines and Prescription details

7) Chief complaints mentioned

8) Presumptive diagnosis
9) Clinical examination findings
10) Investigation advised
11) Drugs prescribed by generic name
12) Dose of drugs & Dosage of drugs
13) Follow up advice or referral notes
14) As per the EDL
15) Name of doctor, signature and date
• Brief history written: For dispensing of correct and proper medication
to the patient.
• Allergy status mentioned: Mention about a drug that has caused
allergy/side effects/unexpected outcome.
• Salient features of Clinical Examination recorded: It includes
Temperature, Pulse, Blood Pressure, Respiratory rate, etc
• Presumptive/definitive diagnosis written: For dispensing of correct
and proper medication to the patient.

Medicines prescribed are in line with STG or as per National/State

programme guidelines

• Medicines are prescribed by generic names: Medicines are not

prescribed by brand/trade name.
• Medicine schedule/doses/duration of treatment clearly written: Write the
quantity of tablets/capsules/liquid & number of times the medicine
needs to be taken.

• Medicines Prescribed are as per EML/Formulary: Medicines advised are

available in the dispensary.

• Date of next visit (review) written with follow-up instructions: Oral

instructions to be followed by the patient are written on the prescription.

• In case of referral, the relevant clinical details and reason for referral
given: It should include the name of the referral health facility,
department referred to, name of the doctor/speciality to be visited, along
with the detailed reason for referral.
• Prescription duly signed (legibly): Signed by consulting doctor along
with the stamp marked to confirm the authenticity of prescription and
to avoid misuse of blank prescription.
 RANDOMLY SELECTED
PRESCRIPTION

IN PRESCRIPTION CHECK ALL THE

PARAMETERS OF AUDIT AS PER
CHECLIST

AFTER CHECKING THE PRESCRIPTION

FILL THE PRESCRIPTION AUDIT

CHECK LIST

ANALYZE THE FILLED DATA

REPORT SUBMITTED TO
DEPARTMENT & QUALITY
COMMITTE
2 ) MARKING & EVALUATION SYSTEM

• For audit parameters 1 to 15

2 is given for a ‘Yes’

0 for a ‘No’.

1 for “Mentioned but

incomplete “

• The total score for each prescription is calculated and sum up

the total of 30 prescriptions.
3 ) DATA ANALYSIS:

The data of the prescriptions audit was analyzed using tables and
graphs.
Table-1 : The detail analysis of the prescription audit.
Table- 2 : The parameter and average
Graph 1 : Parameter score vs average graph
Table-1 The detail analysis of the prescription audit
 Graph 1: Parameter score vs average graph

Table -2 : The parameter and average

 Prescription Audit Analysis
Prescription Audit
1.8
Analysis 1.6
1.6

SL 1.3
1.4
MONTH AVERAGE 1.4
NO 1.2 Prescription Audit Analysis
AVERAGE
1.0
1 Nov-21 1.3 0.8
0.6
2 Dec-21 1.4 0.4
0.2
0.0
3 Jan-22 1.6
HOW TO IMPLEMENT
STEP 1 PLAN: Analyse
STEP 2.DO : Implement the
current situation to establish
plan on a small scale (eg:
a plan for improvement(eg:
provide feedback on possible
analyse current prescription
overuse,underuse or drug
patterns of individual
misuse of individual drugs or
prescribers,or health
therapeutic groups )
facilities)

STEP 4: ACT Revise STEP 3 CHECK: Check to

plan or implement plan see if expected results are
on large scale ( eg: guide obtained (eg.evaluate
national implementation whether prescription
plan) patterns really improve)
• To ensure patient safety and to abide by the Quality Policy of the
Hospitals , it is recommended that a quality improvement cycle should
be implemented by the Quality Team of the corresponded hospitals as
depicted in the Process cycle below.
PDCA cycle for quality improvement in patient safety (rational prescription)
• CONCLUSION

Prescription should be “Effective,

Safe, Suitable & Cost Efficient” for a
patient
 REFERENCES
• A Descriptive Study on Prescription audit of prescribing patterns in primary, secondary, tertiary
healthcare facilities in India by Debraj Mukhopadhyay , Dr. Vibhor Dudhraj , Dr. Dattatreya
Mukherjee. Department of Public Health, School of Allied Health Sciences, Delhi Pharmaceutical
Sciences and Research University (DPSRU), Govt. of NCT Delhi, New Delhi – 110017
• PROJECT WORK ON PRESCRIPTION AUDIT by Dr.Sambha Shisha Surong ,Medical and
Health officer Nartiang PHC, West Jaintia Hills District, Meghalaya .
• PRESCRIPTION AUDIT GUIDELINES -NHM