Prescription audit in a pharmacy of a tertiary care hospital

Balakrishnan SDepartment of Pharmacology

“Doctors who seek to exculpate themselves from serious, even

fatal, prescribing errors by appealing to undoubted difficulties

presented by the information explosion of modern times, allied

to pressures of work, are unlikely to get sympathy, and

increasingly are more likely to be told, ‘if you can’t stand the

heat, get out of the kitchen’ ( a dictum attributed to Harry S

Truman, US president 1948 – 52, though he assigns it to US

Army General Harry Vaughn).”

Pharmacists and nurses stand ready and willing to relieve Pharmacists and nurses stand ready and willing to relieve

doctors of the burden of prescribing. doctors of the burden of prescribing.

A 62 – year old man requiring a metered dose inhaler ( for

the first time ) was told to “spray the medicine to the throat” .

He was found to have been conscientiously aiming & firing

the aerosol to his anterior neck around the thyroid cartilage ,

four times a day for two weeks.

Accuracy includes legibility:A doctor wrote Intal ( sodium

cromoglycate ) for an asthmatic patient . The pharmacist

read it as Inderal ( propranolol). The patient DIED.

Some facts :

Medical errors kill an estimated 44,000 – 98,000

Americans & injure 10,00,000:

1st surgical mishaps

2nd therapeutic mishaps & diagnostic errors.

20 – 25 % of litigations are following medication errors.

??????

Methodology:

WHO approved

Random prescription audit from 10 AM to 11 AM in OPD pharmacy -5 days a week –about 25 prescriptions / day

Duration: March 27 – April 26, 2009

Total number of prescriptions collected: 516

Methodology:

Patient no. 1 2 3 4 5 6 7

Dept.              

No. of drugs              

Drugs by Generic              

Drugs by brand name              

No.drugs not dispensed              

No.drugs not requested so not stocked              

No. with doses not clear              

No. with duration not written              

No with name and designation not written              

PROFORMA FOR PRESCRIPTION AUDIT MARCH 27-APRIL26 2009

Results:

NONE OF THE PRESCRIPTIONS HAD DIAGNOSIS WRITTEN ON THEM!

Results:

No. of prescriptions with department written 151 /516 (29%)

No. of prescriptions with department not written 365/ 516 (71%)

Results:

Medicine - 20

ENT - 20

Neurology - 13

Neurosurgery - 13

OBG - 10

Dermatology - 10

Orthopedics - 10

TB Chest - 7

Nephrology - 7

Results:

Psychiatry - 6

Surgery - 6

Pediatrics - 6

Dental - 5

Ortho PMR - 4

Physical medicine- 3

Ophthal - 3 . Pediatric Surgery - 2.Urology - 1.Plastic Surgery- 1

Cardiology - 1

Results:

No. of drugs per prescription: 2.32

No. of drugs by generic: 0.69 (26.8%) 327 / 1220

Generic or brand?

Hospital generic preferred. Pharmacist will dispense whatever is held in stock

No. of drugs by brand name: 1.88 (73.2%) 893 / 1220

Results:

No. of prescriptions with name and designation not written (80.6%) 415/ 516

No. of drugs with doses not clear (47.6%) 580 / 1220

No. of drugs with duration not written (53%) 647 / 1220

No. of drugs not dispensed (5.8%) 71 / 1220

Model Prescription

1) Name: ABC 2) Date: 05.06.2009

3) Age: 70yrs. 4) Sex: male

5) Address: 20, III Cross, Eswaran koil st. Pondicherry 605 002

6) PIMS No: 0298298

7) Diagnosis: Idiopathic Parkinsonism

Model Prescription

8) Rx

9) Tab Levodopa 100mg Tab Carbidopa 25mg10) Dispense 100 combination tablets11) Take 2 tablets by mouth3 times daily with breakfast, lunch and dinner. Take with food. 12) Dr. XYZ MD, DM 13) Assistant Prof. Neurology, 14) PIMS, Pondicherry 605 014 15) Ph: 0413-2207654 16) Reg. No. 34523 17) (TN medical council)

Thanks!

Dr. Isabella Topno

Dr. Vanita Lal

Dr. S. Sandhiya

Dr. DJ Borah

Ms. Chennama

Mr. KC Arbind

Ms. Moncy ChackoMr. Jabez Raj

All staff of Pharmacy