This study analyzed 900 outpatient prescriptions from three cities in Bangladesh to identify prescription errors. The highest error rate was found in the superscription part of prescriptions, with patients' gender omitted in 64.33% of cases. In the inscription part, directions for drug use were omitted 42% of the time. Illegible handwriting was the most common error in the subscription part, affecting 46% of prescriptions. On average, prescriptions contained three drugs, most commonly antibiotics, antacids, and NSAIDs. The study found unacceptably high rates of errors in outpatient prescriptions in Bangladesh that could negatively impact patient treatment outcomes and safety.
This study assessed the prescription pattern of injections at the outpatient pharmacy of Adama Hospital Medical College in Ethiopia. Some key findings include:
- 600 injections were prescribed over 500 prescriptions. The most commonly prescribed classes were injectable antibiotics, anti-pains, and diuretics.
- Prescriptions were generally well filled out, though some lacked information like the patient's address. Prescriber information like qualifications was missing from many.
- Injections were mostly prescribed appropriately in terms of dose, duration and frequency. However, a small percentage showed issues like incorrect antibiotic dosing.
- The study concludes rational injection use was generally found, though some problems need addressing like incomplete
This study evaluated drug use and patient care practices at a referral hospital in Nigeria using WHO indicators. Several prescribing indicators were assessed from 2450 prescriptions, including average number of drugs per encounter (3.4), percentage prescribed by generic name (62%), encounters with antibiotics (35.5%) and injections (22.4%). Patient care indicators like consultation time (11.5 minutes) and dispensing time (5 minutes) were also evaluated. The results showed high rates of polypharmacy and antibiotic prescription compared to standards. Patients' knowledge of their medications was inadequate. Overall, the indicators suggested room for improvement in rational drug use and care at this facility.
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.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
This study evaluated drug prescription patterns among medical specialties in West Azerbaijan, Iran between 2014-2015. A total of over 500,000 prescriptions were analyzed using prescription software. The results showed that antibiotics were most prescribed by ENT, gynecology, infectious disease, urology and general surgery specialists. Neurosurgeons, GPs and ENT specialists prescribed the most corticosteroids. Neurosurgeons, orthopedists and cardiologists prescribed most central nervous system drugs. Overall, antibiotics and corticosteroids were overprescribed compared to guidelines. The study concludes certain specialties prescribed drugs outside their expertise and some specialists overprescribed antibiotics and corticosteroids.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
This document discusses medication errors that can occur in hospitals. It defines medication errors as any error in prescribing, dispensing, or administering drugs, regardless of whether harm occurs. Medication errors are a major cause of preventable patient harm. The document classifies medication errors as mistakes, slips, or lapses, depending on where the error occurs in the medication use process. It also discusses different ways medication errors have been estimated to cause deaths in other countries to highlight the significant impact of these errors.
This study examined off-label drug use in hospitalized children at Gondar University Referral Hospital in Ethiopia. The researchers conducted a prospective observational study of 243 pediatric patients over 3 months. They found that 75.8% of the 800 drugs prescribed were off-label. Antimicrobials were the most commonly prescribed off-label drugs, accounting for 60.6% of off-label use. Inappropriate dosing and frequency was the leading reason for off-label use. Age group and undergoing surgery were significant predictors of off-label prescribing based on multivariate analysis. The study concludes that generating more evidence on safety and effectiveness of off-label drugs could help improve appropriate use in pediatric populations.
This study assessed the prescription pattern of injections at the outpatient pharmacy of Adama Hospital Medical College in Ethiopia. Some key findings include:
- 600 injections were prescribed over 500 prescriptions. The most commonly prescribed classes were injectable antibiotics, anti-pains, and diuretics.
- Prescriptions were generally well filled out, though some lacked information like the patient's address. Prescriber information like qualifications was missing from many.
- Injections were mostly prescribed appropriately in terms of dose, duration and frequency. However, a small percentage showed issues like incorrect antibiotic dosing.
- The study concludes rational injection use was generally found, though some problems need addressing like incomplete
This study evaluated drug use and patient care practices at a referral hospital in Nigeria using WHO indicators. Several prescribing indicators were assessed from 2450 prescriptions, including average number of drugs per encounter (3.4), percentage prescribed by generic name (62%), encounters with antibiotics (35.5%) and injections (22.4%). Patient care indicators like consultation time (11.5 minutes) and dispensing time (5 minutes) were also evaluated. The results showed high rates of polypharmacy and antibiotic prescription compared to standards. Patients' knowledge of their medications was inadequate. Overall, the indicators suggested room for improvement in rational drug use and care at this facility.
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.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
This study evaluated drug prescription patterns among medical specialties in West Azerbaijan, Iran between 2014-2015. A total of over 500,000 prescriptions were analyzed using prescription software. The results showed that antibiotics were most prescribed by ENT, gynecology, infectious disease, urology and general surgery specialists. Neurosurgeons, GPs and ENT specialists prescribed the most corticosteroids. Neurosurgeons, orthopedists and cardiologists prescribed most central nervous system drugs. Overall, antibiotics and corticosteroids were overprescribed compared to guidelines. The study concludes certain specialties prescribed drugs outside their expertise and some specialists overprescribed antibiotics and corticosteroids.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
This document discusses medication errors that can occur in hospitals. It defines medication errors as any error in prescribing, dispensing, or administering drugs, regardless of whether harm occurs. Medication errors are a major cause of preventable patient harm. The document classifies medication errors as mistakes, slips, or lapses, depending on where the error occurs in the medication use process. It also discusses different ways medication errors have been estimated to cause deaths in other countries to highlight the significant impact of these errors.
This study examined off-label drug use in hospitalized children at Gondar University Referral Hospital in Ethiopia. The researchers conducted a prospective observational study of 243 pediatric patients over 3 months. They found that 75.8% of the 800 drugs prescribed were off-label. Antimicrobials were the most commonly prescribed off-label drugs, accounting for 60.6% of off-label use. Inappropriate dosing and frequency was the leading reason for off-label use. Age group and undergoing surgery were significant predictors of off-label prescribing based on multivariate analysis. The study concludes that generating more evidence on safety and effectiveness of off-label drugs could help improve appropriate use in pediatric populations.
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.
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
This study aimed to determine the prevalence of inappropriate drug use in hospitalized elderly patients at a tertiary care hospital in Northeast India using the 2006 HEDIS criteria. The study reviewed prescriptions from 502 elderly patients admitted to the medicine and cardiology departments. It found that 12 patients (2.39%) received at least one inappropriate drug, with the most common being short-acting nifedipine. Increased number of concurrent medications (>11) and prolonged hospital stay (>5 days) were identified as predictors of inappropriate medication use. The study concluded that multiple medications and long hospital stays were risk factors for inappropriate drug prescribing in elderly patients based on the 2006 HEDIS criteria.
This document summarizes a study on barriers that rural physicians face in prescribing buprenorphine to treat opioid use disorder. The study surveyed rural physicians in the US with a Drug Enforcement Agency waiver to prescribe buprenorphine. It found that physicians not currently prescribing buprenorphine reported significantly more barriers than those who were, including time constraints, lack of specialty backup, and lack of confidence in managing opioid use disorder. The most commonly cited barriers across all physicians were concerns about diversion or misuse, time constraints, and lack of available mental health support services.
Medication errors that occur during hospital admission can lead to preventable adverse drug events. This study uses a model to assess the costs and health effects of interventions aimed at reducing medication errors during admission reconciliation. The model estimates that all five interventions identified by a literature review are highly cost-effective compared to current practice. A pharmacist-led reconciliation intervention has the highest expected cost-effectiveness. The study concludes that medication reconciliation interventions provide a cost-effective use of healthcare resources to improve patient safety.
Medication errors are preventable causes of patient harm and can occur at any stage of the medication process from prescribing to administration. There are many types of medication errors including omission errors, unauthorized drug errors, wrong dose errors, and wrong route errors. Factors that contribute to medication errors include illegible handwriting, confusion over drug names, lack of knowledge about drugs, and interruptions during medication administration. Some steps to prevent medication errors are following the rights of medication administration, double checking all calculations, avoiding distractions, and questioning any unclear or unusual orders.
Medication errors are preventable events that can harm patients. This presentation discussed medication errors, including classifications, types, causes, and strategies to prevent them. It summarized key points about prescribing errors, dispensing errors, administration errors, and monitoring errors. The presentation emphasized the importance of following proper procedures, such as double checking orders and medications, reconciling medications, and educating staff on policies to minimize errors. Overall, the presentation aimed to increase awareness of medication errors and promote safe practices to protect patients.
[Inf 295] week 6 parul seth patient-reported outcomes as a source of evidence...parulseth
Patient-reported outcomes from online communities can provide new evidence for off-label drug use. A study of two drugs on PatientsLikeMe found that less than 1% of users took modafinil and 9% took amitriptyline for their approved uses, while most reported the drugs helped for off-label conditions. Effectiveness was often comparable or better for off-label uses. Online data collection could identify new treatment targets at low cost compared to traditional trials, but has limitations like potential for bias and incomplete information.
A study was conducted at a community pharmacy in Madrid, Spain to evaluate dispensing errors over a 3-month period. Investigators observed over 12,000 prescriptions and identified 55 dispensing errors. The most common errors were dispensing the wrong drug strength (31.5% of errors) and dispensing the wrong quantity (25.9% of errors). Pharmacy technicians were found to make errors more frequently than pharmacists. The study aims to help identify ways to reduce dispensing errors and improve patient safety.
Nik Nuradlina N.A,Mohd Syamir M. S. ,Noor Nashreen M.S.,Rozita M.
Pharmacy Department, National Cancer Institute, Putrajaya.
1st Clinical Audit Pharmacy Department
Compendious Study On JNC- 7 In a Tertiary Hospitalpharmaindexing
This study analyzed 60 prescriptions for hypertension patients from a tertiary hospital in India to evaluate prescribing practices according to JNC7 guidelines. The study found that hypertension was more prevalent in males than females, with males receiving more mono therapy (68.33%) and females receiving more combination therapy (18.33%). The most commonly prescribed mono therapies were non-selective beta-blockers (36.6%) and potassium sparing diuretics (23.3%). The most common combination therapy was potassium sparing diuretics with high efficacy diuretics (28.3%). Most patients were from the cardiology department (66.6%) and the majority were in the geriatric age group above 60 years old (53
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
1) The study evaluated the potential severity of medication administration errors detected by a bar-code medication administration (BCMA) system in six hospitals.
2) The majority (91%) of errors reviewed were evaluated as having minor severity potential, while 9% were evaluated as moderate to severe.
3) "No order" errors, where there was no corresponding order entered, were significantly more likely to be evaluated as moderate or severe than other error types.
This document discusses medication errors, including definitions, types, causes, and ways to improve safety. Some key points:
- Medication errors are preventable events that may harm patients and are caused by failures in prescribing, dispensing, administration, or monitoring.
- Errors can occur at various stages of the medication use process and be due to factors like high workload, look-alike drug names, and poor communication.
- High-risk medications like anticoagulants require special precautions. Healthcare professionals should know drugs well, use memory aids, and develop checking habits to minimize errors.
- Encouraging patient involvement, thorough documentation, learning from past errors, and clear communication can also
- John Vane discovered in the 1960s that aspirin could disrupt platelet aggregation and prevent heart attacks and strokes, though the FDA did not approve it for these uses until 1998 due to a lack of clinical trials at the time.
- Off-label drug use, where physicians prescribe approved drugs for unapproved purposes, is common but raises informed consent issues given patients' assumptions that prescribed drugs have FDA approval for their usage.
- There are arguments both for and against requiring patient consent for off-label drug use, with some arguing it violates patient autonomy while others argue it could confuse patients or deter beneficial treatments not proven through clinical trials.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
This document discusses medical errors and medication errors. It defines medical errors as failures of planned actions or use of wrong plans that lead to unintended outcomes like adverse drug events. Medication errors are defined as preventable events involving medication use that may cause harm. The document notes that medical errors are the eighth leading cause of death in Pakistan, with around 7,000 deaths annually due to medication errors. Causes of medication errors discussed include omissions, commissions, communication failures, and environmental factors. The Swiss cheese model is presented as a way to understand how latent errors in the system can combine to cause patient harm when defenses are missed. Types of medication errors and steps to prevent errors are also outlined.
A voluntary, Internet-based reporting system for neonatal healthcare providers recently revealed that a broad range of medical errors occur in the NICU.[3] The most frequent error categories reported were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). Errors in patient misidentification, for example, were a common cause of feeding a mother's expressed breast milk to the wrong baby.[3]
According to WHO, Drug utilization research is defined as ‘the marketing, distribution, recommendation and utilize of drugs in a society, with particular focus on the resulting medical, social and economic results. In many developed countries, a number of studies about utilization of drug have been conducted, which indicates a wide proof of irrational drug use. The drug use indicators are considered as objective measures that can be extended to identify practices of medicines utilization in any health facility, country or an entire region. To check the drug utilize pattern in Primary Health Care (PHC) facilities of Bhakkar district Punjab Pakistan. Using WHO core drug use indicators, a prospective cross-sectional descriptive study was carried out in health facilities of Bhakkar district. A total of 40 prescriptions were analyzed. The average age of patients visiting HC centers was 33.11 years (female 35.79; male 30.40). 3.65 was the average number of prescribed drugs. 27% was the percentage of encounters with at least one prescribed antibiotic whereas 35% was the percentage of encounters with at least one prescribed injection prescribed, which was low. 25% is the total percentage of drugs given using generic names was noticed. The average consultation and dispensing time of 40 prescriptions was 2.02 minutes and 42.52 seconds. The study demonstrates that trend toward irrational practice mainly on use of antibiotics and non-generic prescribing in most of health facilities studied. Patient care given by health facilities studied was inadequate and thus for encouragement of rational drug use practice, an effective intervention program is recommended.
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.
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.
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
This study aimed to determine the prevalence of inappropriate drug use in hospitalized elderly patients at a tertiary care hospital in Northeast India using the 2006 HEDIS criteria. The study reviewed prescriptions from 502 elderly patients admitted to the medicine and cardiology departments. It found that 12 patients (2.39%) received at least one inappropriate drug, with the most common being short-acting nifedipine. Increased number of concurrent medications (>11) and prolonged hospital stay (>5 days) were identified as predictors of inappropriate medication use. The study concluded that multiple medications and long hospital stays were risk factors for inappropriate drug prescribing in elderly patients based on the 2006 HEDIS criteria.
This document summarizes a study on barriers that rural physicians face in prescribing buprenorphine to treat opioid use disorder. The study surveyed rural physicians in the US with a Drug Enforcement Agency waiver to prescribe buprenorphine. It found that physicians not currently prescribing buprenorphine reported significantly more barriers than those who were, including time constraints, lack of specialty backup, and lack of confidence in managing opioid use disorder. The most commonly cited barriers across all physicians were concerns about diversion or misuse, time constraints, and lack of available mental health support services.
Medication errors that occur during hospital admission can lead to preventable adverse drug events. This study uses a model to assess the costs and health effects of interventions aimed at reducing medication errors during admission reconciliation. The model estimates that all five interventions identified by a literature review are highly cost-effective compared to current practice. A pharmacist-led reconciliation intervention has the highest expected cost-effectiveness. The study concludes that medication reconciliation interventions provide a cost-effective use of healthcare resources to improve patient safety.
Medication errors are preventable causes of patient harm and can occur at any stage of the medication process from prescribing to administration. There are many types of medication errors including omission errors, unauthorized drug errors, wrong dose errors, and wrong route errors. Factors that contribute to medication errors include illegible handwriting, confusion over drug names, lack of knowledge about drugs, and interruptions during medication administration. Some steps to prevent medication errors are following the rights of medication administration, double checking all calculations, avoiding distractions, and questioning any unclear or unusual orders.
Medication errors are preventable events that can harm patients. This presentation discussed medication errors, including classifications, types, causes, and strategies to prevent them. It summarized key points about prescribing errors, dispensing errors, administration errors, and monitoring errors. The presentation emphasized the importance of following proper procedures, such as double checking orders and medications, reconciling medications, and educating staff on policies to minimize errors. Overall, the presentation aimed to increase awareness of medication errors and promote safe practices to protect patients.
[Inf 295] week 6 parul seth patient-reported outcomes as a source of evidence...parulseth
Patient-reported outcomes from online communities can provide new evidence for off-label drug use. A study of two drugs on PatientsLikeMe found that less than 1% of users took modafinil and 9% took amitriptyline for their approved uses, while most reported the drugs helped for off-label conditions. Effectiveness was often comparable or better for off-label uses. Online data collection could identify new treatment targets at low cost compared to traditional trials, but has limitations like potential for bias and incomplete information.
A study was conducted at a community pharmacy in Madrid, Spain to evaluate dispensing errors over a 3-month period. Investigators observed over 12,000 prescriptions and identified 55 dispensing errors. The most common errors were dispensing the wrong drug strength (31.5% of errors) and dispensing the wrong quantity (25.9% of errors). Pharmacy technicians were found to make errors more frequently than pharmacists. The study aims to help identify ways to reduce dispensing errors and improve patient safety.
Nik Nuradlina N.A,Mohd Syamir M. S. ,Noor Nashreen M.S.,Rozita M.
Pharmacy Department, National Cancer Institute, Putrajaya.
1st Clinical Audit Pharmacy Department
Compendious Study On JNC- 7 In a Tertiary Hospitalpharmaindexing
This study analyzed 60 prescriptions for hypertension patients from a tertiary hospital in India to evaluate prescribing practices according to JNC7 guidelines. The study found that hypertension was more prevalent in males than females, with males receiving more mono therapy (68.33%) and females receiving more combination therapy (18.33%). The most commonly prescribed mono therapies were non-selective beta-blockers (36.6%) and potassium sparing diuretics (23.3%). The most common combination therapy was potassium sparing diuretics with high efficacy diuretics (28.3%). Most patients were from the cardiology department (66.6%) and the majority were in the geriatric age group above 60 years old (53
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
1) The study evaluated the potential severity of medication administration errors detected by a bar-code medication administration (BCMA) system in six hospitals.
2) The majority (91%) of errors reviewed were evaluated as having minor severity potential, while 9% were evaluated as moderate to severe.
3) "No order" errors, where there was no corresponding order entered, were significantly more likely to be evaluated as moderate or severe than other error types.
This document discusses medication errors, including definitions, types, causes, and ways to improve safety. Some key points:
- Medication errors are preventable events that may harm patients and are caused by failures in prescribing, dispensing, administration, or monitoring.
- Errors can occur at various stages of the medication use process and be due to factors like high workload, look-alike drug names, and poor communication.
- High-risk medications like anticoagulants require special precautions. Healthcare professionals should know drugs well, use memory aids, and develop checking habits to minimize errors.
- Encouraging patient involvement, thorough documentation, learning from past errors, and clear communication can also
- John Vane discovered in the 1960s that aspirin could disrupt platelet aggregation and prevent heart attacks and strokes, though the FDA did not approve it for these uses until 1998 due to a lack of clinical trials at the time.
- Off-label drug use, where physicians prescribe approved drugs for unapproved purposes, is common but raises informed consent issues given patients' assumptions that prescribed drugs have FDA approval for their usage.
- There are arguments both for and against requiring patient consent for off-label drug use, with some arguing it violates patient autonomy while others argue it could confuse patients or deter beneficial treatments not proven through clinical trials.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
This document discusses medical errors and medication errors. It defines medical errors as failures of planned actions or use of wrong plans that lead to unintended outcomes like adverse drug events. Medication errors are defined as preventable events involving medication use that may cause harm. The document notes that medical errors are the eighth leading cause of death in Pakistan, with around 7,000 deaths annually due to medication errors. Causes of medication errors discussed include omissions, commissions, communication failures, and environmental factors. The Swiss cheese model is presented as a way to understand how latent errors in the system can combine to cause patient harm when defenses are missed. Types of medication errors and steps to prevent errors are also outlined.
A voluntary, Internet-based reporting system for neonatal healthcare providers recently revealed that a broad range of medical errors occur in the NICU.[3] The most frequent error categories reported were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). Errors in patient misidentification, for example, were a common cause of feeding a mother's expressed breast milk to the wrong baby.[3]
According to WHO, Drug utilization research is defined as ‘the marketing, distribution, recommendation and utilize of drugs in a society, with particular focus on the resulting medical, social and economic results. In many developed countries, a number of studies about utilization of drug have been conducted, which indicates a wide proof of irrational drug use. The drug use indicators are considered as objective measures that can be extended to identify practices of medicines utilization in any health facility, country or an entire region. To check the drug utilize pattern in Primary Health Care (PHC) facilities of Bhakkar district Punjab Pakistan. Using WHO core drug use indicators, a prospective cross-sectional descriptive study was carried out in health facilities of Bhakkar district. A total of 40 prescriptions were analyzed. The average age of patients visiting HC centers was 33.11 years (female 35.79; male 30.40). 3.65 was the average number of prescribed drugs. 27% was the percentage of encounters with at least one prescribed antibiotic whereas 35% was the percentage of encounters with at least one prescribed injection prescribed, which was low. 25% is the total percentage of drugs given using generic names was noticed. The average consultation and dispensing time of 40 prescriptions was 2.02 minutes and 42.52 seconds. The study demonstrates that trend toward irrational practice mainly on use of antibiotics and non-generic prescribing in most of health facilities studied. Patient care given by health facilities studied was inadequate and thus for encouragement of rational drug use practice, an effective intervention program is recommended.
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.
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.
Patterns of Prescription Writing in Psychiatric ClinicsHafiz Saad Salman
This study analyzed 602 psychiatric prescriptions from private clinics in Peshawar, Pakistan to evaluate prescription writing practices and prescribing trends. The key findings were:
1) On average, 3.34 drugs were prescribed per prescription. Central nervous system drugs accounted for 71% of all drugs prescribed.
2) Important prescription elements like drug strength, quantity, and dosage instructions were missing in about 30% of prescriptions evaluated.
3) The most commonly prescribed medications were fluoxetine (8.4%), sodium valproate (7.9%), and alprazolam (7.7%). Non-steroidal anti-inflammatory drugs and vitamins were also regularly prescribed.
4
Medication therapy is becoming increasingly more complex as new drugs are developed and more therapeutic targets are elucidated. In addition, polypharmacy (≥5 scheduled medications) has become exceedingly common in geriatric patients and in patients with chronic disease states. As the complexity of drug therapy and the number of medications increase, patients are at a high risk for medication errors and adverse drug events (ADEs), or injuries resulting from medication. The type of adverse events may be associated with professional practices, healthcare products, procedures, and systems including prescription, communication through instructions, drug labeling, packaging and nomenclature, reformulation, dissolution, distribution, administration, education, monitoring, and use. Classification and evaluation of medication errors according to their importance may constitute an important factor for process improvement in order to render the administration of medicines as safe as possible. In hospitals, medication errors occur at a rate of about one per patient per day. A dispensing error is one made by pharmacy staff when distributing medications to nursing units or directly to patients in an ambulatory-care pharmacy; the error rates for doses dispensed via the cart-filling process range from 0.87% to 2.9%. Technology has grown to be a constituent part of medicine these days. A few advantages that technology can supply are categorized as follows: the assisting of communication between clinicians; enhancing medication safety; decreasing potential medical errors and adverse events; rising access to medical information and encouraging patient-centered healthcare. The aim of this article is to provide a compendious literature review regarding Medication errors
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
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United Arab Emirates Pharmacists’ Practices and Views on Adverse Drug Reactio...iosrjce
Adverse drug reactions (ADRs) constitute a huge burden on health systems, and medication errors
(MEs) are the most common preventable cause of adverse drug events. In developed countries pharmacists
contribute to a great extent in ADR monitoring and reporting, improving patient quality of care and safety. This
review aims to explore pharmacists’ practices and views on ADR reporting, extent and causes of MEs and other
health professionals expectations of pharmacists in this regards. An extensive literature search was conducted
using pertinent electronic health databases (ProQuest, PubMed, Embase, and International Pharmaceutical
Abstracts, and the Cumulative Index to Nursing & Allied Health Literature). Hand-searching of the references
retrieved was also performed. Very few studies were found, none report the prevalence or severity of MEs.
Under-reporting of ADRs is common place among community pharmacists in the UAE. Overall physicians
expressed positive views about clinical pharmacists’ role in medication reviews to identify and prevent drug
interactions and improve patients’ clinical outcomes. More research is required to enhance ADR reporting and
reduce MEs in the UAE. Training about the process of ADR monitoring and reporting at undergraduate level
across health science disciplines and continued education and development led by pharmacists is vital to
improve patient safety.
Patients' Perceptions of Community Pharmacy Practice in UAE: An Overviewiosrphr_editor
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).
This document discusses prescription auditing as a way to promote rational drug use and improve patient care. It defines rational drug use as using the right drug, at the right dosage and cost to meet a patient's clinical needs. Prescription auditing involves collecting data on current prescribing practices and comparing it to standards to identify areas for improvement. The audit cycle involves defining standards, collecting data, identifying issues, implementing changes, and defining new standards. Prescription audits can help ensure appropriate drug therapy, control costs, prevent medication problems, evaluate effectiveness, and identify needs for practitioner education.
This study analyzed 4,607 medical prescriptions from 63 health centers in Belo Horizonte, Brazil. The prescriptions were grouped as either internal (from municipal health centers) or external (from other facilities). The following were found:
1) On average, there were 2.4 drugs prescribed per consultation for both internal and external prescriptions.
2) 84.3% of internal prescriptions and 85.5% of external prescriptions provided no instructions for medication use. Information on dosage regimen was present in over 50% of prescriptions but varied between groups.
3) Generic drug names were specified for 51.9% of internal prescriptions but only 28.
- The document discusses a study that assessed the attitudes and behaviors of pharmacy professionals towards patient counseling in Awi Zone, North West Ethiopia.
- The study found that over half of respondents believed counseling is a shared responsibility between pharmacists and physicians. The main reason respondents cited for counseling was improved patient compliance.
- Lack of knowledge and confidence was the primary barrier preventing respondents from counseling patients more. Most respondents felt counseling promotes rational drug use.
This study analyzed 2,000 antibiotic prescription records from Bangladesh to evaluate rational antibiotic prescribing practices. It found that the majority (63%) of patients visited unlicensed village healthcare workers due to their widespread availability. The most commonly prescribed antibiotic classes were cephalosporins (36%), macrolides (25.5%), and quinolones (21%). However, 81% of prescriptions lacked clinical tests to justify antibiotic use. Only 66.5% of patients completed their full antibiotic course. The study concludes that irrational antibiotic prescribing in Bangladesh contributes to growing antibiotic resistance and calls for national treatment guidelines and public education programs.
The role and scope of pharmacists in community settings a review of developin...pharmaindexing
This document discusses the role and scope of pharmacists in community settings in developing countries. It outlines that community pharmacists play important roles beyond dispensing medications, such as counseling patients, managing medication records, identifying drug interactions, and providing health promotion services. The document argues that community pharmacists are well-positioned to help improve patient adherence and health outcomes. An expanded role for community pharmacists includes services like counseling, health screenings, and smoking cessation programs that can benefit public health.
The role and scope of pharmacists in community settings: a review of developi...pharmaindexing
A pharmacist is a person who is involved in designing, creating or manufacturing of a drug product, dispensing of a drug, managing and planning of a pharmaceutical care plan. They are experts on the action and uses of drugs, including their chemistry, pharmacology, the formulation of medicines. There are number of ways where pharmacist can serve the society. In a community pharmacy setting a pharmacist is tailored as the one who is knowledgeable enough to render such services. The role of pharmacist in community settings continues to be the objective of this article.
A PROSPECTIVE STUDY OF DRUG UTILIZATION PATTERN AND EVALUATION USING WHO GUI...M.Arumuga Vignesh
This document describes a prospective study conducted to evaluate drug utilization patterns and prescribing practices in a government hospital in India using WHO prescribing indicators. Data was collected from 282 patient records over 6 months across various wards. The study aimed to promote rational drug use, avoid polypharmacy, prevent antibiotic resistance, and estimate disease prevalence. Key metrics analyzed included the average number of drugs per prescription, percentage of generics prescribed, consultation times, and drug availability. The findings could provide insights into prescribing quality and opportunities for improvement.
THE IMPACT OF CLINICAL PHARMACIST IN DETECTION OFIslam Shallal
This study analyzed medical records from 80 patients at an internal medicine department in Zagazig, Egypt to identify drug-related problems. The study found that 66.2% of patients experienced drug-drug interactions, with the most common being moderate in severity and fair reliability. Errors included high doses, inappropriate frequencies, and wrong or duplicate drugs. The study recommends including clinical pharmacists in prescribing and monitoring to reduce errors and establish treatment guidelines.
NURS 438 Trends And Issues In Nursing And Health Systems.docxstirlingvwriters
This document discusses trends and issues related to medical errors in nursing and health systems. It outlines several common causes of medical errors, including communication problems, inadequate information flow, and technical errors. Communication issues between nurses and patients can lead to medication errors, while inadequate discharge instructions and a lack of information for patients post-hospitalization can also result in errors. Technical failures of medical equipment during procedures have caused patient injuries and deaths. Reducing these types of errors will help improve safety and outcomes in healthcare.
This study used electronic health records data to evaluate health care resource utilization in 64,038 patients diagnosed with fibromyalgia. The highest utilization was for medication orders and physician office visits, with patients receiving an average of 21 medication orders and 15 office visits in the year following diagnosis. Opioids were the most commonly prescribed medications, used by 44.3% of patients. Factors associated with increased resource use included being female, specific comorbid conditions, and use of opioids not recommended by fibromyalgia guidelines. The study aims to identify drivers of health care costs in fibromyalgia to help improve patient management and reduce utilization.
2. Haque et al. / Journal of Applied Pharmaceutical Science 6 (06); 2016: 042-046 043
Community pharmacists have an important role in
checking prescriptions to ensure that they are appropriate to
dispense (Shah et al., 2001). Prescription errors have been
identified and documented worldwide by many researchers but
very little coverage on Bangladesh is available.
One study shows that 15–21% prescriptions bear at least
one prescribing error (Jeetu and Girish, 2010). About 7.1%
prescribing errors were detected in another survey
carried out at a teaching hospital in Saudi Arabia out of 1580
prescriptions (Al-Dhawailie, 2011). A similar and separate study
carried out at a hospital in India reported that out of 304
prescriptions 34% had at least one error and 5% were incorrect
(Pote et al., 2007).
At a primary healthcare center in Riyadh city 18.7%
prescriptions were found to be erroneous (Khoja et al., 2011) and
at a government hospital in Indonesia out of 229 outpatient
prescriptions 98.69% were with medication errors (Perwitasari et
al., 2010). A survey report on prescription errors drew the
conclusion that the increased rate of prescription errors was
evolved from the handwritten prescriptions and pharmacists need
to clarify 1–5% of prescriptions (Dean et al., 2005). A review
article states that patient’s outcomes can be improved by the
intervention of pharmacists (Lewis et al., 2009). Friedman et al
showed that not only the pharmacist's role in dispensing process
but also the policies and procedures should be implemented to
.
prevent errors (Friedman et al., 2007). Moreover, the pharmacist’s
intervention can considerably reduce the cost of therapy, the
adverse reactions of drugs and improve total health system of a
certain region. In several reports it has been emphasized that the
interdisciplinary communication and cooperation is necessary in
identifying and resolving prescription errors to achieve optimal
therapeutic outcomes for the patients (Alam et al., 2006; Aronson,
2009a; Aronson, 2009b). The literature review has shown that
there are no enough reports about the epidemiology of prescription
errors of omission for outpatients in Bangladesh. Therefore, the
present study was undertaken to investigate the prevalence,
frequency and nature of outpatient prescription errors in three
cities of Bangladesh and to provide valuable suggestions to avoid
these errors for the benefit and safety of patients.
METHODS
Study site and period of survey
Three cities viz. Rajshahi, Naogaon and Bogra of
Bangladesh pointed in the country map (Figure 1) were selected
for collecting data over six month period of January to December,
2014 (http://en.wikipedia.org/wiki/Rajshahi,
http://en.wikipedia.org/wiki/Naogaon,
http://en.wikipedia.org/wiki/Bogra).
Fig. 1: Survey sites on country map.
Three cities, Rajshahi, Naogaon and Bogra, are marked with red color filled circles.
3. 044 Haque et al. / Journal of Applied Pharmaceutical Science 6 (06); 2016: 042-046
Data collection
This survey was carried out with a self-designed standard
questionnaire by directly interviewing patients of Rajshahi,
Naogaon and Bogra cities, 300 outpatients were taken from each
city. Volunteer students of the Department of Pharmacy, Varendra
University were assigned and given instruction to do the survey.
The written consent was taken from each patient during study.
Data were collected at the pharmacies by randomized manner
when patients were purchasing drugs and the prescribing doctors
were not informed about the study due to avoid the interference of
the data collection process. The prescriptions were analyzed
following WHO standard treatment guidelines and British
National Formulary using Microsoft Office Excel 2010 software.
The omission errors include superscription, inscription and
subscription errors and identified according to the method
described by Al-Shahaibi et al (Al-Shahaibi et al., 2012). The
superscription errors of omission are classified based on the
information omitted on patients’ age, name and gender. The
inscription errors include absence of dose, dosage form and dosage
regimen of the drugs and incomplete directions for drug use. The
subscription errors include illegible hand writing, prescriber's
signature, and date of prescription (Al-Shahaibi et al., 2012). The
percentage of all the errors were calculated for individual cities
and finally expressed as mean ± SD. The frequencies of different
class of drugs prescribed in prescriptions were analyzed such as
antibiotics, antacids, multivitamins and minerals, non-steroidal
anti-inflammatory drugs (NSAIDs), antihistamines, antipyretics,
cardiovascular drugs, oral contraceptives, antiemetic drugs, skin
drugs, cough expectorants, bronchodilators, anti-diabetics, etc.
(Calligaris et al., 2009).
Ethical considerations
The survey was conducted following the section 12 of
WMA declaration of Helsinki and this study was also logistically
supported by the Department of Pharmacy, Varendra University
and Rajshahi University, Bangladesh. As the human subjects did
not use any hazardous agents during the study and only
participated in the interview of the patient so this survey based
research did not require any further permission from institutional
ethics committee.
Statistical analysis
Descriptive statistics were applied to the collected data using
Microsoft Excel Software 2010. Results were expressed
graphically in percentages, means and standard deviations (SD).
RESULTS
Epidemiology
This survey based study conducted in three cities of
Bangladesh viz. Rajshahi, Naogaon, and Bogra, revealed that
about 55% of outpatients were males and 45% were females.
Almost the same statistics of patients’ gender were seen in all test
cities (Table 1). Among the patients (n=900) under survey,
averagely 73% visited MBBS doctors and 8% visited BDS
doctors. It is noticeable that a large number of patients (19%)
visited quack doctors although the survey sites were metropolitan
city and district city areas. However, no doubt, this number will be
larger in village or city side area. Among three test cities, the
average number of patients visiting MBBS doctors in Rajshahi
was higher (79%) than that of Naogaon (69%) and Bogra (71%)
since Rajshahi is a metropolitan city with more available hospital
and clinic facilities than two other cities.
Table 1: Gender variability and health care professionals of collected
outpatient prescriptions
Variables
Rajshahi Naogaon Bogra Mean ± SD
Frequency of variables (%)
Gender Male 56 55 54 55 ± 0.67
Female 44 45 46 45 ± 0.67
Doctors MBBS 79 69 71 73 ± 4.00
BDS 8 6 10 8 ± 1.33
MBBS: Bachelor of Medicine and Bachelor of Surgery, BDS: Bachelor of
Dental Surgery
Errors and omissions in prescription
The prescriptions were analyzed for superscription,
inscription and subscription errors by following WHO standard
treatment guidelines and British National Formulary with the help
of Microsoft Office Excel 2010 software and the error of
omissions was expressed as means. The highest error of omissions
was found in the part of superscription in which the absence of
patients’ gender (64.33%) was most frequently occurred (Table 2).
The second highest superscription error was the omission of
patients’ age (17.67%) and the third highest error under this
category was the absence of patients’ name (5%). In inscription
errors, the dose of drug was found to be omitted in about 26% of
prescriptions, the dosage form of medication was omitted in
12.67% of prescriptions, the dosage regimen of drug was omitted
in 28% of prescriptions and the complete direction for drug use
was omitted in 42% of prescriptions. In subscription errors, the
prescribers’ signature was omitted in 10.67% of prescription,
while the date of prescription was omitted in 4% of prescription
and illegible handwriting was found in 46% of prescription.
Among three cities the prescription error of omissions was less
frequent in Rajshahi than Naogaon and Bogra.
General medication pattern
A total of 2619 drugs were prescribed in 900 outpatient
prescriptions where averagely 3 drugs were given to a patient. A
variety of drugs were prescribed and in a single prescription
maximally eight drugs were found to be prescribed. However, only
the drugs with frequencies higher than 1% of total prescribed
drugs were depicted in figure 2. The type of drugs with highest
frequency of occurrence in prescriptions was antibiotics (18.25%),
the second highest type of drugs was antacids (17.45%) and the
third highest type was NSAIDS (13.60%). This result indicated
that infections and/or gastroenteritis accompanying with
pain/inflammation were the most common health complications of
patients in these cities. Multivitamins and minerals, cardiovascular
4. Haque et al. / Journal of Applied Pharmaceutical Science 6 (06); 2016: 042-046 045
drugs, antipyretic drugs, antihistamines and antidiabetic drugs
were also common in prescriptions that were 12.50%, 10.85%,
6.4%, 5.04% and 3.92%, respectively (Figure 2). The therapeutic
application of multivitamins and minerals is generally wide in the
treatment of diseases which was found to be 12.50% but
cardiovascular drugs which were quite disease-specific were found
to be 10.85%. Thus, the obtained result implicated that the
prevalence of cardiac patients were significantly higher in study
areas. Furthermore, bronchodilators, antiemetics, skin drugs,
cough expectorants, oral contraceptives and corticosteroids were
drugs with low frequencies that were 2.7%, 1.9%, 0.99%, 0.9%,
0.9% and 0.6%, respectively.
Fig. 2: Various categories of medication in prescriptions
AB: Antibiotics, NS: NSAIDs, MV: Multivitamins, AN: Antacids, AH:
Antihistamines, AP: Antipyretics, CD: Cardiovascular drugs, AD:
Antidiabetics, AE: Antiemetics, BD: Bronchodilators, OD: Other drugs.
DISCUSSION
In this study the average number of male outpatients was
found to be higher than that of female outpatients which cannot be
fully explained although we think medical decisions are being
biased by the male because of their dominance character in
Bangladesh. A large number of patients (73%) visited MBBS
doctors in the study areas since two large public medical college
and hospitals were present there in Rajshahi and Bogra districts,
and also a public general hospital in Naogaon, where patients
could easily see the MBBS doctors.
The research report suggests that the frequency of error
increases with an increasing number of drugs (Calligaris et al.,
2009). The reasons of this diversity may be due to the huge
number of patients against the available number of doctors,
patients having multiple complications, doctors’ trend to achieve a
target forced by the pharmaceutical marketing policy, and the
different geographical region of the study
The highest superscription error of omission was the
gender of patients (64.33%) which has a great impact on the
medication. For example, some medications react faster/better in
female patients than males. So, missing gender in a prescription
can interrupt the proper treatment of patient. The second highest
superscription error of omission was patient’s age (17.67%) which
is very important in terms of dose and dosage form. This error of
omission falls in line with the study carried out in Nepal (Alam et
al., 2006) and lowers than other study (52.4%) carried out in
Indonesia (Perwitasari et al., 2010). In inscription, the highest
number of omissions was observed on the direction for drug use
(42%) which was written obscurely that may lead to dispensing
errors. The dosage regimen of the drug, which would help to reach
the therapeutic target and prevent adverse effects, were missed in
28% of prescriptions that were almost equal to other studies in
India and Indonesia (Perwitasari et al., 2010; Inamdar et al.,
2014). However, the missing of dose and dosage form in
prescriptions were 26% and 12.67%, respectively which were
relatively high to other study conducted in Bangladesh (Biswas et
al., 2014).
As shown in table 2, the highest frequency of
subscription error of omissions was obscure handwriting of the
physician which was 46%. In practice it may create serious
problems to the retail pharmacist who sometimes misinterprets or
even dispenses wrong medicine to the patients. The prescriber's
signature is imperative, without it the drug cannot be dispensed to
the patient. Here the frequency of occurrence of this error was 2
fold higher (10.67%) than that of other similar studies (5%) (Shah
et al., 2001; Marwaha et al., 2010). However, another type of error
occurring considerably in lower extent is the date of prescription
(4%). The date of prescription is essential part of record. In case a
patient suffers from an adverse reaction or the therapy is not being
effective, the date could indicate when the patient started the
therapy. The frequency of occurrence of this error (4%) was higher
than a study carried out in India (1.02%) and lower than a study
carried out in Indonesia (7.42%) (Shah et al., 2001; Perwitasari et
al., 2010).
Table 2: Omission errors in outpatient prescriptions.
Variables
Rajshahi
Naogaon
Bogra
Mean ± SD
Superscription errors Frequency of variables (%)
Patients’ name missing 4 6 5 5.00 ± 0.67
Patients’ age missing 15 20 18 17.67 ± 1.78
Patients’ gender missing 61 65 67 64.33 ± 2.22
Inscription errors
Dose missing 20 31 27 26.00 ± 4.00
Dosage form missing 10 16 12 12.67 ± 2.22
Incomplete dosage regimen 26 30 28 28.00 ± 1.33
Incomplete direction for drug use 37 50 39 42.00 ± 5.33
Subscription errors
Prescriber signature missing 8 11 13 10.67 ± 1.78
Date of prescription missing 3 5 4 4.00 ± 0.67
Illegible hand writing 42 46 50 46.00 ± 2.67
The implications of our findings are significant. First, it
is clear that handwritten outpatient prescription errors of omission
are abundant in Bangladesh as found in different countries of the
world (Shah et al., 2001; Perwitasari et al., 2010; Bates et al.,
2001; Meyer, 2000). Second, the handwritten prescription errors
could be avoided by using computerized prescriptions and
supportive software. Third, retail pharmacist has a significant role
5. 046 Haque et al. / Journal of Applied Pharmaceutical Science 6 (06); 2016: 042-046
to play in avoiding prescription errors and to improve the patient
care services by working together with all health professionals.
CONCLUSIONS
The antibiotics were the most frequently prescribed drugs
followed by antacids and NSAIDs. Serious prescription errors
were dose, dosage form, dosage regimen of drugs which can be the
causes of treatment failure in Bangladesh specifically for the
infections. The prescribers need to be more professional in writing
prescriptions and pharmacists intervention in hospital can only
reduce the errors.
LIMITATIONS OF STUDY
The study was carried out in three cities of the northern
part of Bangladesh which cannot reflect the generalized
prescribing practices of the whole country.
LIST OF ABBREVIATIONS
MBBS: Bachelor of medicine and bachelor of surgery;
BDS: Bachelor of dental surgery; NSAIDs: Non-steroidal anti-
inflammatory drugs; WMA: World medical association; BNF:
British National Formulary.
CONFLICT OF INTERESTS
The authors declare that they have no competing
interests.
AUTHORS’ CONTRIBUTIONS
All authors have substantially contributed to the research.
Specifically MUH and NK coordinated in the survey part; SMAB,
SB, RI, SB, AK and AHD contributed in data collection; AUC
analyzed the data and drafted the manuscript.
ACKNOWLEDGEMENTS
Authors wish to thank the students of Department of
Pharmacy, Varendra University and Rajshahi University,
Bangladesh for their support in data collection from outpatient
prescriptions.
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Alam K, Mishra P, Prabhu M, Shankar PR, Palaian S, Bhandari
RB, Bista D. A study on rational drug prescribing and dispensing in
outpatients in a tertiary care teaching hospital of Western Nepal.
Kathmandu Univ Med J, 2006; 4:436–443.
Al-Dhawailie AA. Inpatient prescribing errors and pharmacist
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How to cite this article:
Haque MU, Barik SMA, Bashar S, Islam R, Bashar S, Kumar A,
Dipon AH, Kona N, Chouduri AU. Errors, omissions and
medication patterns of handwritten outpatient prescriptions in
Bangladesh: a cross-sectional health survey. J App Pharm Sci,
2016; 6 (06): 042-046.