Saad Salman 1,
Muhammad Ismail1,
Naila Riaz Awan2,
Muhammad Anees3,
Jawaria IDrees4,
Fariha idrees5,
Zahid Nazar2
MASHAAL ...
Contents
 Introduction
 Aims

and Objectives
 Methodology
 Results and Discussion
 Conclusion
 References
 Prescribing

accounts for a large proportion of

errors [1]
 Errors include problems related to:







Strength ...
 Irrational

prescribing is a global problem
and may also be regarded as
"pathological" prescribing [9].

 Irrational

d...
 All

prescriptions must include the name,
address, specialty and signature of the
prescriber as well as the name, sex, a...
 To

investigate prescriptions

of Psychiatry for the
essential elements of
prescriptions.
 To

study the prescribing

t...
We collected 602 prescriptions:
 written by private specialists, general practitioners
and physicians at private medical ...
 The

prescriptions were carefully analyzed for
information about prescriber, patient and drug and
dose related informati...
Information present

Number

Percentage

Physician related
Address

510

84.71

Specialization

411

68.27

Signature

333...
600

500

Number
Percentage

400

300

200

100

0
Results and Discussion
Table 2: Variables related to drugs present on Prescriptions
Variable

Included for all
drugs in prescription

No

Include...
Variables related to drugs present on prescriptions.
90.00
80.00

Included for all
drugs in
prescription %

70.00
60.00

I...
Table 3: Prescribing trends of various drug classes
Drug Class

Number

Percentage

Central Nervous
System Drugs

1428

71...
Prescribing trends of various drug classes.
1600
1400
1200
1000
800
600
400
200
0

Number

Percentage
Table 4: Patterns of CNS drugs prescribed.
Drug class
Number
Fluoxetine
121
Sodium valproate
113
Alprazolam
111
Carbamazep...
SSRI’s were the most frequently prescribed
medication in majority of prescriptions.
Inconsistency regarding different pres...










1. Aronson JK. Medication errors: what they
are, how they happen, and how to avoid them. QJM
2009;102(8):51...








6. Lofholm PW, Katzung BG. Rational prescribing and
prescription writing. In: Katzung BG, ed. Basic and clini...









11. Hogerzeil, H. V.Promoting rational prescribing: an international
perspective. Br J ClinPharmacol., 1995....









16. Yousif E et al. Deficiencies in medical prescriptions in a
Sudanese hospital. Eastern Mediterranean Heal...
Prescription Patterns
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Prescription Patterns

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When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].

Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]

Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.

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Prescription Patterns

  1. 1. Saad Salman 1, Muhammad Ismail1, Naila Riaz Awan2, Muhammad Anees3, Jawaria IDrees4, Fariha idrees5, Zahid Nazar2 MASHAAL ARIFULLAH6 1Department of Pharmacy, University of Peshawar, Pakistan 2Lady Reading Hospital, Post Graduate Medical Institute, Pakistan 3Khyber Medical College, Peshawar, Pakistan 4Department of Zoology, Islamia College University Peshawar, Pakistan 5Department of Chemistry, Islamia College Peshawar, Pakistan Jinnah College for Women, University of Peshawar. Presenter Mashaal Arifullah
  2. 2. Contents  Introduction  Aims and Objectives  Methodology  Results and Discussion  Conclusion  References
  3. 3.  Prescribing accounts for a large proportion of errors [1]  Errors include problems related to:       Strength of medication, Frequency of medication, Quantity per dose, Instructions for use, Total quantity to be dispensed, Dosage form; and if absent, can cause great deal of patients’ harm. [1-4].
  4. 4.  Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].  Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8]
  5. 5.  All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–12].
  6. 6.  To investigate prescriptions of Psychiatry for the essential elements of prescriptions.  To study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
  7. 7. We collected 602 prescriptions:  written by private specialists, general practitioners and physicians at private medical centers.  Prescriptions were collected from 1st of April to 4th of September from the patients admitted in Psychiatry ward.  Information present on the prescription was transferred directly into the electronic form.
  8. 8.  The prescriptions were carefully analyzed for information about prescriber, patient and drug and dose related information using a checklist for the items mentioned above.  Types of drugs prescribed were analyzed to determine the most commonly prescribed drug classes.
  9. 9. Information present Number Percentage Physician related Address 510 84.71 Specialization 411 68.27 Signature 333 55.32 Date 311 51.66 0 0 Licence Number Patient related Name 517 85.88 Age 501 83.22 Sex 227 37.71 Address 139 23.09 Weight 13 2.159
  10. 10. 600 500 Number Percentage 400 300 200 100 0
  11. 11. Results and Discussion
  12. 12. Table 2: Variables related to drugs present on Prescriptions Variable Included for all drugs in prescription No Included for some drugs in prescription % No Not included for any drug in prescription % No % Frequency 499 82.89 93 15.45 27 4.49 Quantity per dose 487 80.90 81 13.4551 31 5.15 50 79 13.1229 53 8.80 Instructions for 301 use Total quantity to be dispensed 111 18.44 33 5.4817 0 0 Strength 409 67.94 317 52.6578 177 29.40
  13. 13. Variables related to drugs present on prescriptions. 90.00 80.00 Included for all drugs in prescription % 70.00 60.00 Included for some drugs in prescription % 50.00 40.00 30.00 Not included for any drug in prescription % 20.00 10.00 0.00 Frequency Quantity per dose Instructions for Total quantity to be dispensed Strength use
  14. 14. Table 3: Prescribing trends of various drug classes Drug Class Number Percentage Central Nervous System Drugs 1428 71.0094* NSAIDs/analgesics 319 15.8627 Antimicrobials 125 6.2158 Vitamins 81 4.0278 Gastrointestinal Medicines 37 1.8398 Cough syrups 12 0.5967 Others 9 0.4475
  15. 15. Prescribing trends of various drug classes. 1600 1400 1200 1000 800 600 400 200 0 Number Percentage
  16. 16. Table 4: Patterns of CNS drugs prescribed. Drug class Number Fluoxetine 121 Sodium valproate 113 Alprazolam 111 Carbamazepine 107 Escitalopram 97 Diazepam 94 Citalopram 87 Lithium 85 Olanzepine 56 Methyl phenidate 9 Others 1131 Percentage 8.4* 7.9* 7.7* 7.4 6.7 6.5 6.1 5.9 3.9 0.6 56.2
  17. 17. SSRI’s were the most frequently prescribed medication in majority of prescriptions. Inconsistency regarding different prescription components was observed. Such as strength of medication, frequency or instruction for medication use etc.
  18. 18.      1. Aronson JK. Medication errors: what they are, how they happen, and how to avoid them. QJM 2009;102(8):513-521. 2. Haas R, Maloney S, Pausenberger E, Keating JL, Sims J, Molloy E, et al. Clinical decision making in exercise prescription for falls prevention. Phys Ther (Published online January 2012). 3. Joyce GF, Carrera MP, Goldman DP, Sood N. Physician prescribing behavior and its impact on patient-level outcomes. Am J Manag Care 2011;17(12):e462-471. 4. Griffith R, Tengnah C. Prescription of controlled drugs by nonmedical prescribers. Br J Community Nurs 2011;16(11):558-562. 5. De Vries TP et al., eds. Guide to good prescribing: a practical manual. Geneva, World Health Organization, 1995:51–55 (WHO/DAP/94.11).
  19. 19.      6. Lofholm PW, Katzung BG. Rational prescribing and prescription writing. In: Katzung BG, ed. Basic and clinical pharmacology, 8th ed. New York, McGraw-Hill, 2001:1104–1112. 7. Prescription writing. In: British national formulary, No. 41. London, British Medical Association & Royal Pharmaceutical Society of Great Britain, 2000:4–5. 8. Safe writing. In: Lacy CF et al., eds. Drug information handbook, 9th ed. Cleveland, Ohio, Lexi-Comp, 2001:12. 9. Gilley, J. Towards rational prescribing. BMJ., 1994. 308(6931): 731-732 10. Millennium Research Group. Medical error is the fifth leading cause of death in the U.S. [Online] 2008 [Cited on 2008 February 01] Available from: URL: http:// www.newsmedical.net/?id=26815.
  20. 20.      11. Hogerzeil, H. V.Promoting rational prescribing: an international perspective. Br J ClinPharmacol., 1995. 39(1): 1-6 12. Barber, N. What constitutes good prescribing?.BMJ., 1995. 310: 923 13. Blatt A, Chamban R, Lemardeley P. Forme lègale et coût des prescriptions à l’Hôpital Central de Yaoundé, Cameroun [Legal format and costs of prescriptions at the Central Hospital in Yaounde, Cameroon]. Médecine Tropicale, 1997, 57(1):37–40. 14. François P et al. Evaluation of prescription-writing quality in a French university hospital. Clinical Performance and Quality Health Care, 1997, 5(3):111–115. 15. Irshaid YM et al. Compliance with good practice in prescription writing at outpatient clinics in Saudi Arabia. Eastern Mediterranean Health Journal, 2005, 11(5–6):922–928.
  21. 21.      16. Yousif E et al. Deficiencies in medical prescriptions in a Sudanese hospital. Eastern Mediterranean Health Journal, 2006,12(6):915–918. 17. Chareonkul C, Khun VL, Boonshuyar C. Rational drug use in Cambodia: study of three pilot health centers in Kampong Thom Province. Southeast Asian Journal of Tropical Medicine & Public Health, 2002, 33(2):418–424. 18. Hazra A, Tripathi SK, Alam MS. Prescribing and dispensing activities at the health facilities of a non-governmental organisation. National Medical Journal of India, 2000, 13(4):177–182. 19. The world drug situation. Geneva, World Health Organization, 2004. 20. Karande S, Sankhe P, Kulkarni M. Patterns of prescription and drug dispensing. Indian Journal of Pediatrics, 2005, 72(2):117–121.

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