This study analyzed 397 prescriptions from an outpatient pharmacy department to identify errors related to prescription writing requirements and prescribing errors. The key findings were:
1) 96.7% of prescriptions had one or more errors of omission, such as missing information on patient age, date, dosage, strength, or quantity to supply.
2) There were also errors of commission, such as wrong dosage form, in 8.4% of prescribed drugs. A total of 39 drug-drug interactions were identified.
3) The results show a low compliance rate with legal and procedural prescription writing requirements. This indicates a need for improved education for prescribers on clear and complete prescription writing to reduce errors.
FACTORS ASSOCIATED WITH UNNECESSARY DRUG THERAPY AND INAPPROPRIATE DOSAGE IN ...Jing Zang
To assess factors associated with unnecessary drug therapy and inappropriate dosage in hospitalized patients. A hospital based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, which is 345 Km from South west of Addis Ababa. All patients who were admitted to medical ward from February 5 – March 21, 2011 were included in the study. Data on socio-demographic variables, past medical history, past medication history, current diagnosis, current medications, vital signs and relevant laboratory data were collected by using bed side patient interview guided semi-structured questionnaire and data abstraction formats for card review. The data were analysed by using SPSS version 16 for windows. Descriptive statistics, cross-tabs, chi-square and logistic regression were done. Out of 257 study participants 140(54.5%) had unnecessary drug therapy or inappropriate dosage. The only independent factors which predicted the unnecessary drug therapy in study population was polypharmacy while not considering organ function test, polypharmacy and clinically significant potential drug-drug interaction were independent factors associated with inappropriate dosage . The prevalence of unnecessary drug therapy or inappropriate dosage is significantly high.
FACTORS ASSOCIATED WITH UNNECESSARY DRUG THERAPY AND INAPPROPRIATE DOSAGE IN ...Jing Zang
To assess factors associated with unnecessary drug therapy and inappropriate dosage in hospitalized patients. A hospital based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, which is 345 Km from South west of Addis Ababa. All patients who were admitted to medical ward from February 5 – March 21, 2011 were included in the study. Data on socio-demographic variables, past medical history, past medication history, current diagnosis, current medications, vital signs and relevant laboratory data were collected by using bed side patient interview guided semi-structured questionnaire and data abstraction formats for card review. The data were analysed by using SPSS version 16 for windows. Descriptive statistics, cross-tabs, chi-square and logistic regression were done. Out of 257 study participants 140(54.5%) had unnecessary drug therapy or inappropriate dosage. The only independent factors which predicted the unnecessary drug therapy in study population was polypharmacy while not considering organ function test, polypharmacy and clinically significant potential drug-drug interaction were independent factors associated with inappropriate dosage . The prevalence of unnecessary drug therapy or inappropriate dosage is significantly high.
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
Scope on medicatio error in a sample of iraqi two cities samawa and diwania.Ali Al Samawy
Summery
Introduction:
The pregnancy is sensitive period and administration of drugs may lead to threating of fetus life or cause malformations and teratogenicity etc.
Methodology:
A cross-sectional study of medication errors of 100 prescriptions dispensed to a pregnant women in a sample of Iraqi two cities (Al Sammawah & Al Diwania) during October, 2016.
A formal was used to collect data included the name of pregnant, age, trimester, doctor diagnosis, the drug dispensed and their dose, rout, duration, frequency, strength and notes section. The formal filled during visits of the research team to pharmacies that most of the prescriptions they dispense are for pregnant women prescribed by a nearby gynecology &obstruct doctors.
Then the data analyzed to identify the medication errors that includes; inappropriate and irrational, ineffective, over and under prescribing and drug interactions using available literature and drugs.com drug interaction checker.
Result:
Total number of prescriptions involved in the study is 100 prescriptions, they contain 487 medication dispensed to the patients. The total number of medication errors identified were 364(74.7%), included 110 irrational & inappropriate prescribing, 47 over prescribing. 19 under prescribing, and 8 ineffective prescribing. The drug interactions were classified to drug-drug interactions 126 interactions identified and drug food interactions 54 interactions were recorded. 0.8 % of all drug-drug interactions were major, 76 % moderate and 23% mild. Phenobarbital (luminal) is the drug that caused the most of medication error that identified as it dispensed 23 times but in all of these patient luminal was irrational and inappropriate and it caused the most of interactions recorded as 44 interactions were caused by luminal.
While Dydrogesterone was prescribed as a tocolytic 21 times, and this considered as irrational & inappropriate prescribing. Isoxsuprine prescribed irrationally 17 times. The parenteral iron administered without calculating the dose depending on the body weight and blood Hb. Most of antibiotics and antifungal prescribed for incorrect duration or dose. The other errors were related to other drugs duration, dose, and indication errors.
Conclusion:
Percentage of medication errors was high. Types of medication errors were mostly drug-drug interaction, irrational and inappropriate use. The impact of these medication errors may include teratogenic effect.
Recommendations:
Adherence to the treatment guidelines and further studies to assess the impact of medications errors on pregnant women and her fetus.
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
Scope on medicatio error in a sample of iraqi two cities samawa and diwania.Ali Al Samawy
Summery
Introduction:
The pregnancy is sensitive period and administration of drugs may lead to threating of fetus life or cause malformations and teratogenicity etc.
Methodology:
A cross-sectional study of medication errors of 100 prescriptions dispensed to a pregnant women in a sample of Iraqi two cities (Al Sammawah & Al Diwania) during October, 2016.
A formal was used to collect data included the name of pregnant, age, trimester, doctor diagnosis, the drug dispensed and their dose, rout, duration, frequency, strength and notes section. The formal filled during visits of the research team to pharmacies that most of the prescriptions they dispense are for pregnant women prescribed by a nearby gynecology &obstruct doctors.
Then the data analyzed to identify the medication errors that includes; inappropriate and irrational, ineffective, over and under prescribing and drug interactions using available literature and drugs.com drug interaction checker.
Result:
Total number of prescriptions involved in the study is 100 prescriptions, they contain 487 medication dispensed to the patients. The total number of medication errors identified were 364(74.7%), included 110 irrational & inappropriate prescribing, 47 over prescribing. 19 under prescribing, and 8 ineffective prescribing. The drug interactions were classified to drug-drug interactions 126 interactions identified and drug food interactions 54 interactions were recorded. 0.8 % of all drug-drug interactions were major, 76 % moderate and 23% mild. Phenobarbital (luminal) is the drug that caused the most of medication error that identified as it dispensed 23 times but in all of these patient luminal was irrational and inappropriate and it caused the most of interactions recorded as 44 interactions were caused by luminal.
While Dydrogesterone was prescribed as a tocolytic 21 times, and this considered as irrational & inappropriate prescribing. Isoxsuprine prescribed irrationally 17 times. The parenteral iron administered without calculating the dose depending on the body weight and blood Hb. Most of antibiotics and antifungal prescribed for incorrect duration or dose. The other errors were related to other drugs duration, dose, and indication errors.
Conclusion:
Percentage of medication errors was high. Types of medication errors were mostly drug-drug interaction, irrational and inappropriate use. The impact of these medication errors may include teratogenic effect.
Recommendations:
Adherence to the treatment guidelines and further studies to assess the impact of medications errors on pregnant women and her fetus.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
It is very important to incorporate clinically relevant practicals into the undergraduate pharmacology practical (UGPP) curriculum. Various medical colleges in the state of Gujarat have included clinical practicals in their UGPP curriculum. [2] Rai has recommended the inclusion of the 'P-drug' concept in the UGPP curriculum.
The conference of experts on the rational use of drugs, convened by the World Health Organization in Nairobi in 1985, stated that: "Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community." This goal can be achieved by acquiring knowledge of the principles of rational drug usage during undergraduate training. This correspondence emphasizes the importance of this concept.
» What is a P-drug?
The drugs you are going to prescribe regularly and with which you will become familiar are called P(ersonal)-drugs. The P-drug concept includes the name of a drug, dosage form, dosage schedule and duration of treatment for a specified condition. Due to varying availability and cost of drugs, different national formularies and essential drug lists, medical culture and individual interpretation of information, P-drugs differ from country to country and between doctors.
There are four reasons that indicate why a P-drug should never be the one that has been suggested or dictated by clinical teachers, senior colleagues or by sales representatives: a) the latest and the most expensive drug is not necessarily the best, the safest or the most cost-effective, b) by developing one's own set of P-drugs, one can learn to handle pharmacological concepts and drug-related data in an effective manner, c) by compiling one's own set of P-drugs, one can prescribe alternatives when the P-drug cannot be used and d) one has the final responsibility for his / her patient's well being, which he / she cannot pass on to others. While physicians can and should draw on expert opinion and consensus guidelines, they should always think for themselves.
» Example for selecting a P-drug for acute amoebic dysentery Top
Amoebiasis is one of the common infections encountered in clinical practice and it is relatively easy to understand the pathophysiology as well as the treatment of amoebiasis. Therefore, we have selected the example of acute amoebic dysentery and analyzed it in consultation with standard textbooks of pharmacology.
COMMON ERRORS IN DISPENSING by Mrs omorodion 3.pptxAnijuKenechukwu
a presentation on the common dispensing error encountered in a pharmacy and the role of pharmacy technicians in curbing or reducing the rate of these common errors
Assessment of drug utilization and rational drug use on WHO indicationZaibaFathima8
This is a study done in the outpatient department for a short period of time to recognize the drug utilized and use of rational drug use based on WHO indicators under the guidance of Dr. GOPINATH S, M Pharm., Ph.D.,
by Prabhavathi S co. B Pharmacy final year project.
REVIEWING THE CLINICIANS PRESCRIPTION AND TREATMENT PROGRESSION IS THE FUNDAMENTAL RESPONSIBILITY OF PHARMACIST. THIS PRESENTATION WILL DEAL WITH VARIOUS ASPECTS OF REVIEWING PATIENT DRUGTHERAPY PLAN
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
1. Malaysian Journal of Pharmacy 2002;1(2):45-50 Research Article
Noncompliance with Prescription Writing
Requirements and Prescribing Errors in an
Outpatient Department
Kuan Mun Ni1
, Chua Siew Siang1*
, Mohamed Noor bin Ramli2
1
Department of Pharmacy, Faculty of Medicine, University of Malaya, 50602 Kuala Lumpur
2
Outpatient Polyclinic Pharmacy Unit, Universiti Malaya Medical Centre, 59100 Kuala Lumpur,
Malaysia.
*Author for correspondence
ABSTRACT
New prescriptions received by an outpatient pharmacy department of a teaching
hospital were audited retrospectively for noncompliance with prescription writing
requirements as well as to identify the types of prescribing errors. Of the 397
prescriptions screened in a single day, 96.7% had one or more of the legal or
procedural requirements missing. These errors of omission, included prescriptions
without the patient’s age, date, clinic or department where the prescription was
issued, route of administration, dose and frequency of the drug to be used, strength,
dosage form and quantity of drug to be supplied. Additionally, there were errors of
commission involving 8.4% of the prescribed drugs. A total of 39 drug-drug
interactions were identified; 15 were classified as potentially hazardous but could be
overcome with careful monitoring of the patients. The results of the present study
show a low compliance rate to the legal and procedural requirements in prescription
writing. This indicates a need for pharmacy and medical educators to further
emphasize the importance of writing clear and complete prescriptions. It also calls
for the implementation of educational and monitoring programmes to bring more
awareness to all concerned so as to reduce the rate of noncompliance and hence
minimize the occurrence of prescribing errors.
Keywords: prescription screening, pharmacist, compliance, errors of omission, errors
of commission
INTRODUCTION
The screening of prescriptions and intervention
process commences with the pharmacist’s initial
assessment for completeness and legality of the
prescriptions. Prescription deficiencies formed a
large proportion of errors identified in prescription
screening (1). This is mainly due to the attitude of
some prescribers who are always in a hurry and
hence unwilling to spend a little more time in
writing clear and complete prescriptions. However,
the extra time spent on the prescription will help to
ensure that the patient receives the treatment that is
intended by the prescriber. Additionally, the
prescriber will be well compensated for the extra
time taken by not having to answer enquiries from
the pharmacist (2).
Errors in prescribing may be classified into two
main types, errors of omission and errors of
2. Research article: Noncompliance with prescription writing requirements
commission. Errors of omission are defined as
prescriptions with essential information missing
while errors of commission involve wrongly
written information in the prescriptions (3). Errors
of omission include absence or incomplete
specification of dosage form or strength, dose or
dosage regimen, quantity or duration of drug to be
supplied as well as prescriptions that are illegible
and prescriptions that violate legal requirements.
Whereas, errors of commission include wrong
dose or dosage regimen, wrong drug or its
indication, wrong quantity or duration of therapy,
incorrect patient’s name on the prescription,
duplicate therapy and drug-drug interactions.
Noncompliance with prescription writing
requirements involves mainly errors of omission.
A study by Ingrim and colleagues (4) in an
outpatient pharmacy department found that the
overall rate of prescription noncompliance was
14.4%. In this study, the pharmacists spent 16.3
hours each day correcting prescription errors. Most
of the other studies in the literature focused more
on the prescribing errors that involved mainly
errors of commission as well as pharmacist
intervention. This includes an audit on community
pharmacies that identified 153 prescriptions with
errors from a total of 5874 new prescriptions
(2.6%) [1]. Other studies found the rate of
prescribing errors between 2.6% to 15.4% or
estimated as 2.87 to 4.9 per 1000 medication
orders (1, 5-11).
Studies on the types of prescribing errors in
Malaysia appeared scarce in the literature.
Therefore, the present study was conducted to
evaluate the extent of noncompliance with
prescription writing requirements as well as to
identify the types of prescribing errors.
METHOD
This study was conducted in the Outpatient
Pharmacy Department (OPPD) of a major teaching
hospital in Malaysia in 1998. This OPPD received
an average of 1057 prescriptions per day during
the study period and was operated by one
registered pharmacist, 3 trainee pharmacists and 8
pharmacy assistants.
The study involved retrospective screening of new
prescriptions received by the mentioned OPPD in a
day. A researcher with pharmacy training but not a
staff of the OPPD, collected the prescriptions for a
single day and screened them retrospectively. Any
prescription that did not comply with one or more
of the legal or the hospital procedural requirements
(12-13) would be considered as noncompliance
and this was recorded in a standard form. These
were mainly errors of omission, including illegible
prescriptions. A prescription would be considered
as illegible in this part of the study if the researcher
could not read it. Errors of commission that were
related to the drugs prescribed were also recorded.
Any drug-drug interaction was confirmed with
standard references (14-16).
RESULTS
Errors of omission
Of the 1057 prescriptions received on the day of
the study, only 397 new prescriptions were
included in the study. Repeat prescriptions were
excluded as the prescriptions had to be returned to
the patients and hence were not available for
evaluation. Of these prescriptions, 96.7% did not
follow at least one of the legal or procedural
requirements and these are classified as errors of
omission (Table 1 and 2).
Table 1: Errors of omission that were related to the patient or prescriber or place of issue of the
prescription ( n = 397).
Errors of Omission Frequency %
Patient’s name 0 0
Age 130 32.7
Registration number 2 0.5
Date 68 17.1
Prescriber’s name 7 1.8
Prescriber’s signature 1 0.3
Clinic or department 65 16.4
Illegible 28 7.1
3. Research article: Noncompliance with prescription writing requirements
A total of 862 drugs were prescribed in these 397
prescriptions giving an average of 2.2 drugs per
prescription.
Of the 321 prescriptions with the gender of the
patient indicated, about half (50.8%) were for
females and the other half (49.2%) for males.
From the prescriptions with the clinic or
department indicated, a majority of the
prescriptions was from the outpatient polyclinic
(79.2%), another 16.6% were from the wards and
4.2% from units such as the Accident and
Emergency Unit, Rehabilitation Unit, Radiology
Department and Operation Theatre. The
researcher who screened the prescriptions was
unable to read 28 prescriptions (7%) but the
pharmacist-in-charge of the OPPD could not read
only three of these prescriptions (0.76%).
Two of the prescriptions did not contain the name
of the drug required but were merely written as
“syrup mixture expectorant” and “antacid”. Only
20% of the drugs prescribed had the route of
administration written and these involved mainly
topical or external preparations (73%). Of the 485
drugs prescribed without strength specifications,
2.5% involved drugs with more than one strength
available.
A total of 314 drugs prescribed (36.4%) did not
have the dosage forms written on the prescription
and 33.4% of these drugs have more than one
dosage form available. These included salbutamol,
paracetamol, cloxacillin, amoxycillin, bisacodyl,
and betamethasone. Of the 75 preparations with
no dose indicated, six were oral rehydration salts,
two were glyceryl trinitrate and two were GelusilR
.
The others involved eye products, mouth and
throat
preparations, topical decongestants and nasal
preparations, and ear products. Topical
preparations such as creams or ointments where
dose specification is not relevant were not
included.
Additionally, the quantity to be supplied was not
indicated for 50 drugs. These include
dermatologicals (n=10), analgesics and
antipyretics (n=9), eye, ear, mouth and throat
preparations (n=8), antacids and antiulcerants
(n=6), and nasal preparations (n=4).
Errors of commission
Table 3 shows the errors of commission detected
in this study. The 27 drugs with wrongly written
dosage form included Benadryl syrup instead of
expectorant for adult patients from 15
prescriptions. Others were nystatin and co-
trimoxazole being prescribed as syrups instead of
suspensions, cloxacillin, doxycyclin, phenytoin
and ketoprofen being prescribed as tablets instead
of capsules or sustained-release capsules.
A total of 39 drug-drug interactions were detected
in 20 of the prescriptions (5%). The groups of
drugs most commonly indicated were the beta-
adrenergic blockers (n=13), antidiabetic agents
(n=12), diuretics (n=10), calcium channel blockers
(all 9 cases involved nifedipine), angiotensin-
converting enzyme (ACE) inhibitors (n=7),
corticosteroids (all six cases involved
prednisolone) and cardiac glycosides (all five cases
involved digoxin). Fifteen of these interactions
could be classified as potentially hazardous and
should be avoided if possible or appropriate
monitoring and precautions should be taken (14).
Table 2: Errors of omission that were related to the drug ( n = 862).
Errors of Omission Frequency %
Drug name 2 0.2
Route of administration 690 80
Dosage
• Dose* 75 8.7
• Frequency 46 5.3
• Strength 485 56.3
• Dosage form 314 36.4
• Duration or number of doses 76 8.8
Quantity to supply 50 5.8
*
cases not mandatory such as creams and ointment had been excluded.
4. Research article: Noncompliance with prescription writing requirements
DISCUSSION
Errors of omission
Only 13 out of the 397 prescriptions screened
complied with all the legal requirements in the
Poisons Act 1952 and also the procedural
requirements of the hospital surveyed. This
indicates a need for the hospital to further
emphasize the necessity of writing clear and
complete prescriptions. Some useful pointers for
prescription writing have been suggested (2, 17).
These included writing the patient’s full name,
printing the name of drugs especially those newly
marketed medications and those infrequently
prescribed agents, as well as indicating the strength
and dosage form of all drugs prescribed even if
only single strength or dosage form is available.
The rate of noncompliance to the legal or
procedural requirements varied from 80% of drugs
prescribed with no indication of the route of
administration to 0.3% of prescriptions without the
prescriber’s signature. The seriousness of such
noncompliance depends on the types of errors of
omission.
The absence of the patient’s age would not
normally prevent the dispensing of the
prescription. It could be easily resolved with the
patient or the holder of the prescription if required.
Whereas, the absence of the prescriber’s signature
would invalidate the prescription and cause
inconvenience to the patient and staff involved.
This is especially crucial if the prescription was for
psychotropic or dangerous drugs (controlled
drugs).
The omission of the strength or dosage form
required may not pose any problem if the drug
prescribed is available in single strength or dosage
form. However, with the rapid advances in drug
development, many drugs are increasingly
available in various strengths and dosage forms
and hence this type of error of omission may pose
some problems. For example, salbutamol is
available in the form of 2 or 4 mg tablets, 4 mg
sustained-release tablets, syrups, inhalers,
easyhaler inhalation powder, turbohaler, respirator
solutions, rotacaps, nebules and injections.
Most of the preparations prescribed with no
indication of the dose to be used were external
preparations such as eye or ear drops, except for
the prescriptions with oral rehydration salts,
glyceryl trinitrate and GelusilR
. The prescribers
had probably assumed that the pharmacy staff
would give the appropriate standard instructions.
However, it should be emphasized that all oral
preparations should be prescribed with specific
doses as the prescription has limited information
for the pharmacy staff to judge the prescriber’s
intention.
It appeared that the oral route of administration
was not usually specified in the prescription and
this was acceptable, although in some instances the
route specification may help to identify the
unspecified dosage form. Drugs prescribed without
indication of total quantity to be supplied involved
analgesics and antipyretics as well as antacids and
ulcer-healing agents. Although many of these
drugs may be given on “as required” basis, the
prescriber is still the best judge on the total
quantity to be supplied based on the patient’s
medical requirement. Even for dermatological,
eye, ear, mouth or nasal preparations, an indication
of the amount to be supplied is still necessary.
Legibility assessment is quite subjective and thus
may be biased in the study. Whether a prescription
is legible or not depends on the assessor’s
familiarity with the handwriting of the prescriber
as well as information provided in the prescription.
This has been demonstrated in the present study
where the researcher could not read 28
prescriptions as compared to the pharmacist of the
hospital who was unable to read only three
prescriptions. However, it should be emphasized
that prescriptions should be easily read by anyone
Table 3: Errors of commission ( n = 862)
Errors of Commission Frequency %
Wrong strength 6 0.7
Wrong dosage form 27 3.1
Drug-drug interactions 39 4.5
Total errors of commission 72 8.4
5. Research article: Noncompliance with prescription writing requirements
involved in the dispensing activities since the
prescriptions could be filled by any pharmacy
outside the hospital. This is especially important
since many drugs tend to have similar names such
as LosecR
and LasixR
or DaonilR
and AmoxilR
(18). This type of error may be reduced if the
indication of the drug prescribed or the medical
problem of the patient is also written in the
prescription as suggested by Robinson (17).
Therefore, all prescriptions should be clearly and
adequately written and if possible printed to
prevent such medication errors. The
implementation of electronic prescribing will
probably eliminate some of these problems.
Errors of commission
Errors of commission represent a greater threat to
the patient’s health than errors of omission, if it is
not identified and corrected. If the strength of a
drug required is written wrongly, it may lead to
more serious consequences than if the strength is
not written at all. If the drug is available as a fixed
amount in a certain dosage form only, then this
type of error could be easily identified and
rectified. For example, if amoxycillin 400 mg is
prescribed but amoxycillin is only available as 500
mg capsules, then most likely it is amoxycillin 500
mg that is required.
Generally, a wrongly written dosage form does not
lead to serious consequences unless the strength or
the frequency of use of that dosage form is also
different. For example, the strength of paracetamol
syrup is 120 mg per 5 ml while paracetamol
suspension is 250 mg per 5 ml. Therefore, if the
prescription for a one-year old child was written as
“Paracetamol Suspension 5 ml 6 hourly”, the child
would be given 250 mg of paracetamol per dose
instead of 120 mg. The pharmacy staff may be
aware of such error if the child’s age is stated on
the prescription. However, if both tablet and
capsule contained 500mg paracetamol and were
given the same frequency, it would not cause any
major problem if either dosage form were
dispensed.
Another common error in dosage form is related to
sustained-release (SR) tablets as also mentioned by
other authors (19). Standard-release dosage forms
are usually given as 6 hourly, whereas, the SR
tablets are given as 12 hourly. For example, if
ketoprofen is prescribed to be taken two times a
day without the “SR”, the standard-release tablets
of 50mg may be dispensed instead of the intended
200mg SR tablets, causing the patient to take an
under dose.
The frequency of wrongly written dosage form
could be under-reported as the error may not be
detected even if the prescriber has written tablet
instead of capsule or suspension instead of syrup if
both the dosage forms are available. Information
such as the unit strength of the drug required may
help to identify this type of error. This further
emphasizes the importance of writing a
prescription with complete details.
Of the 39 drug-drug interactions identified in the
present study, 15 could be classified as potentially
hazardous but most of the consequences of
interactions could be overcome with careful
monitoring of the patients. However, the aim of
reporting such drug-drug interactions is to bring
awareness to the health care professionals so that
appropriate precautions would be observed to
minimize any adverse consequences.
CONCLUSION
The results of the present study show a low
compliance rate to the legal and procedural
requirements in prescription writing. This
indicates a need for pharmacy and medical
educators to further emphasize the importance of
writing clear and complete prescriptions. It also
calls for the imple mentation of educational and
monitoring programmes to bring more awareness
to all concerned so as to reduce the rate of
noncompliance and hence minimize the occurrence
of prescribing errors.
ACKNOWLEDGMENTS
The authors wish to thank the staff of the
Outpatient Polyclinic Pharmacy Unit, Universiti
Malaya Medical Centre for their assistance and
cooperation.
*****
6. Research article: Noncompliance with prescription writing requirements
REFERENCES
1. Rupp MT, Schondelmeyer SW, Wilson GT,
Krause JE. Documenting prescribing errors and
pharmacist interventions in community pharmacy
practice. Am Pharm 1988; NS28 (9): 30-37.
2. Cohen MR, Davis NM. Complete prescription
orders reduce medication errors. Am Pharm 1992;
NS32: 24-25.
3. Rupp MT. Screening for prescribing errors. Am
Pharm 1991; NS31: 71-78.
4. Ingrim NB, Hokanson JA, Guernsey BG, Doutre
WH, Blair CW Jr, Verrett TJ. Physician
noncompliance with prescription writing
requirements. Am J Hosp Pharm 1983; 40: 414-
417.
5. Christensen DB, Campbell WH, Madsen S,
Hartzema AG, Nudelman PM. Documenting
outpatient problem intervention activities of
pharmacists in an HMO. Med Care 1981; 19: 105-
117.
6. Folli HL, Poole RL, Benitz WE, Russo JC.
Medication error prevention by clinical
pharmacists in two children’s hospital. Pediatrics
1987; 79: 718-722.
7. Morrill GB, Barreuther C. Screening discharged
prescriptions. Am J Hosp Pharm 1988; 45: 1904-
1905.
8. Hawkey CJ, Hodgson S, Norman A, Daneshmend
TK, Garner ST. Effect of reactive pharmacy
intervention on quality of hospital prescribing.
BMJ 1990; 300: 986-990.
9. Bates DW, Boyle DL, Vander Vliet MB,
Schneider J, Leape LL. Relationship between
medication errors and adverse drug events. J Gen
Intern Med 1995; 10: 199-205.
10. Lesar TS, Briceland L, Stein DS. Factors related to
errors in medication prescribing. JAMA 1997; 277:
312-317.
11. Lesar TS, Lomaestro BM, Pohl H. Medication
prescribing errors in a teaching hospital. A 9-year
experience. Arch Intern Med 1997; 157: 1569-76.
12. Senarai ubat-ubatan. Kuala Lumpur: Pusat
Perubatan Universiti Malaya; 1996.
13. Poisons Act 1952 (Act 366). Kuala Lumpur:
International Law Book Services; 1997.
14. British National Formulary. 40th
ed. London:
British Medical Association and the Royal
Pharmaceutical Society; September 1998.
15. Reynolds JEF, editor. Martindale, The Extra
Pharmacopoeia. 31st
ed. London: Royal
Pharmaceutical Society; 1996.
16. Stockley IH. Drug Interactions. 3rd
ed. London:
Blackwell Scientific Publications; 1994.
17. Robinson A. An ounce of prevention could
eliminate most prescription-writing errors. Can
Med Assoc J 1994; 151: 659-661.
18. Aronson JK. Confusion over similar drug names:
Problems and solutions. Drug Safety 1995; 12(3):
155-160.
19. Lesar TS. Common prescribing errors. Ann Intern
Med 1992; 117(6): 537-538.