Prescription audit in a pharmacy of a tertiary care hospital Balakrishnan S

2. Prescription audit in a pharmacy of a tertiary care hospital Balakrishnan S Department of Pharmacology

3. “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 doctors of the burden of prescribing.

5. 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.

6. Accuracy includes legibility:A doctor wrote Intal ( sodium cromoglycate ) for an asthmatic patient . The pharmacist read it as Inderal ( propranolol). The patient DIED.

7. 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.

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9. 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

10. Methodology: PROFORMA FOR PRESCRIPTION AUDIT MARCH 27-APRIL26 2009

11. Results: NONE OF THE PRESCRIPTIONS HAD DIAGNOSIS WRITTEN ON THEM!

12. Results: No. of prescriptions with department written 151 /516 (29%) No. of prescriptions with department not written 365/ 516 (71%)

13. Results: Medicine - 20 ENT - 20 Neurology - 13 Neurosurgery - 13 OBG - 10 Dermatology - 10 Orthopedics - 10 TB Chest - 7 Nephrology - 7

14. 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

15. 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

16. 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

17. Model Prescription • 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

18. Model Prescription 8) Rx 9) Tab Levodopa 100mg Tab Carbidopa 25mg 10) Dispense 100 combination tablets 11) 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)

38. Thanks! Dr. Isabella Topno Dr. Vanita Lal Dr. S. Sandhiya Dr. DJ Borah Ms. Chennama Mr. KC Arbind Ms. Moncy Chacko Mr. Jabez Raj All staff of Pharmacy