Evaluating Prescription Practices in a Secondary Healthcare Hospital: A Cross-Sectional Study during the District Residency Program

Mitali Ganapati; Suvendu Kumar Panda; Rashmi Ranjan Bhadra; Jasmine Mahanta

doi:10.51168/022dev34

Authors

Dr . Mitali Ganapati Senior Resident, Department of Pharmacology, Saheed Laxman Nayak Medical College and Hospital, Koraput, Odisha, India.
Dr. Suvendu Kumar Panda Assistant Professor, Department of Pharmacology, MKCG Medical College and Hospital, Berhampur, Odisha, India.
Dr. Rashmi Ranjan Bhadra Senior Resident, Department of Pharmacology, MKCG Medical College and Hospital, Berhampur, Odisha, India.
Dr. Jasmine Mahanta Senior Resident, Department of Pharmacology, SLS Government Medical College, Phulbani, Odisha, India.

DOI:

https://doi.org/10.51168/022dev34

Keywords:

Prescription audit, Rational drug use, Prescription completeness, WHO prescribing indicators, Generic prescribing, Essential medicines, Antibiotic prescribing, Drug utilization, Antimicrobial stewardship

Abstract

Background: Prescription auditing is an important quality-assurance strategy for evaluating prescribing practices, identifying deficiencies, and promoting rational medicine use. This study evaluated prescription completeness and drug-utilization patterns in a public-sector secondary healthcare hospital using World Health Organization (WHO) core prescribing indicators.

Objectives: To assess outpatient prescription completeness, characterize drug-utilization patterns, and evaluate prescribing practices using WHO core prescribing indicators.

Methods: A hospital-based cross-sectional prescription audit was conducted at the District Headquarters Hospital, Ganjam, Odisha, India, from March to May 2024 during the District Residency Programme. Of 348 prescriptions screened,58 illegible prescriptions were excluded, and 290 were included. Prescription completeness was assessed using predefined parameters and summarized using a Prescription Completeness Score (PCS). Drug utilization and WHO core prescribing indicators were analyzed descriptively.

Results: The 290 prescriptions contained 1,017 medicines, with a mean of 3.5 medicines per prescription. Mean PCS was 82.4 ± 10.8%, and 181 (62.41%) prescriptions achieved PCS ≥80%. Age and department/OPD were documented in all prescriptions, whereas patient weight and prescriber registration number were absent from all. Prescriber name was documented in only 1.38%. Generic prescribing was 99.75%, and State Essential Drug List adherence was 94.48%. Antibiotics were prescribed in 97 (33.44%) encounters and constituted 12.38% of medicines. Oral formulations predominated (88.89%), while injectables accounted for 0.88%. The average number of medicines per encounter and antibiotic prescribing exceeded the selected reference ranges, whereas generic prescribing, EDL adherence, and low injection use were favourable.

Conclusion: Prescribing practices showed strengths in generic prescribing, EDL adherence, and low injectable use; however, documentation deficiencies, multiple-drug prescribing, and antibiotic utilization require attention. Periodic prescription audits, structured feedback, improved documentation, and strengthened antimicrobial stewardship may further promote rational prescribing.

Recommendation: Periodic prescription audits, structured prescriber feedback, improved documentation, rational multidrug prescribing, and strengthened antimicrobial stewardship should be routinely implemented.

References

1. World Health Organization. How to investigate drug use in health facilities: selected drug use indicators. Geneva: WHO; 1993. Available from: https://apps.who.int/iris/handle/10665/60519

2. Ofori-Asenso R, Agyeman AA. Irrational use of medicines-a summary of key concepts. Pharm. 2016;4(35):35. https://doi.org/10.3390/pharmacy4040035

https://doi.org/10.3390/pharmacy4040035

3. El Mahalli AA. WHO/INRUD drug prescribing indicators at primary health care centres in Eastern Province, Saudi Arabia. East Mediterr Health J. 2012;18(11):1091-1096. https://doi.org/10.26719/2012.18.11.1091

https://doi.org/10.26719/2012.18.11.1091

4. Atif M, Sarwar MR, Azeem M, et al. Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan. BMC Health Serv Res. 2016;16(1):684. https://doi.org/10.1186/s12913-016-1932-2

https://doi.org/10.1186/s12913-016-1932-2

5. Haq N, Khan K, Iqbal Q, et al. Prescription pattern of outpatient department of a teaching hospital Quetta, Pakistan. Value Health. 2015;18:A335-A766.

https://doi.org/10.1016/j.jval.2015.09.1850

6. Akhtar MA. Self medication. Pak J Med Sci. 2012;28(3):349-51.

https://doi.org/10.12669/pjms.281.1360

7. Verma N, Vinayagam S, Mittal N, Mittal R, Bansal N. Prescription audit in outpatient pharmacy of a tertiary care referral hospital in Haryana using World Health Organization/International Network of Rational Use of Drugs (WHO/INRUD) core prescribing indicators: a step towards refining drug use and patient care. Pharmacy (Basel). 2025;13(2):48. doi:10.3390/pharmacy13020048.

https://doi.org/10.3390/pharmacy13020048

8. Idris SA, Hussien TMA, Al-Shammari FF, Nagi HA, Bashir AI, Elhussein GEMO, et al. An evaluation of drug prescribing patterns and prescription completeness. Healthcare (Basel). 2024;12(22):2221. doi:10.3390/healthcare12222221.

https://doi.org/10.3390/healthcare12222221

9. Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, Basker J, Govindraj L, Chugh PK, Tripathi CD, Badyal DK, Balakrishnan S, Jhaj R, Shukla AK, Atal S, Najmi A, Banerjee A, Kamat S, Tripathi RK, Shetty YC, Parmar U, Rege N, Dikshit H, Mishra H, Roy SS, Chatterjee S, Hazra A, Bhattacharya M, Das D, Trivedi N, Shah P, Chauhan J, Desai C, Gandhi AM, Patel PP, Shah S, Sheth S, Raveendran R, Mathaiyan J, Manikandan S, Jeevitha G, Gupta P, Sarangi SC, Yadav HN, Singh S, Kaushal S, Arora S, Gupta K, Jain S, Cherian JJ, Chatterjee NS, Kaul R, Kshirsagar NA. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol. 2022 Sep-Oct;54(5):321-328. doi: 10.4103/ijp.ijp_976_21. PMID: 36537400; PMCID: PMC9846909.

https://doi.org/10.4103/ijp.ijp_976_21

10. Kasabi GS, Subramanian T, Allam RR, Grace CA, Reddy S, Murhekar MV. Prescription practices & use of essential medicines in the primary health care system, Shimoga district, Karnataka, India. Indian J Med Res. 2015;142(2):216-9. doi:10.4103/0971-5916.164261.

https://doi.org/10.4103/0971-5916.164261

11. Potharaju HR, Kabra SG. Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra. Indian J Pharmacol. 2011 Apr;43(2):150-6. doi: 10.4103/0253-7613.77350. PMID: 21572648; PMCID: PMC3081452.

https://doi.org/10.4103/0253-7613.77350

12. Singh T, Banerjee B, Garg S, Sharma S. A prescription audit using the World Health Organization-recommended core drug use indicators in a rural hospital of Delhi. J Educ Health Promot. 2019 Feb 15;8:37. doi: 10.4103/jehp.jehp_90_18. PMID: 30993130; PMCID: PMC6432812.

https://doi.org/10.4103/jehp.jehp_90_18

13. Meenakshi R, Selvaraj N, Anandabaskar N, Dhamodharan A, Badrinath AK, Rajamohammad MA. Prescription audit of a teaching hospital in South India using World Health Organization core prescribing indicators - A cross-sectional study. Perspect Clin Res. 2022 Jul-Sep;13(3):132-136. doi: 10.4103/picr.PICR_172_20. Epub 2021 Jan 8. PMID: 35928646; PMCID: PMC9345256.https://doi.org/10.4103/picr.PICR_172_20

14. Chenchula S, Gupta R, Gupta SK, Padmavathi R, Pathan S. Assessment of WHO core drug use indicators at a tertiary care Institute of National importance in India. Bioinformation. 2022 Oct 31;18(10):888-893. doi: 10.6026/97320630018888. PMID: 37654843; PMCID: PMC10465770.

https://doi.org/10.6026/97320630018888