The document discusses prescription audits, which involve systematically reviewing prescriptions to evaluate quality and improve patient care. It outlines the objectives of prescription audits such as assessing irrational prescribing and identifying opportunities for improvement. Expected outcomes include providing feedback to improve prescription quality and promote rational drug use. The document also discusses indicators for evaluating the completeness, legibility, and rationality of prescriptions based on factors like inclusion of required details, legible handwriting, and adherence to treatment guidelines. It emphasizes the importance of legible and accurate prescriptions to prevent medication errors.

1. PH3.2 Perform and interpret a
critical appraisal (audit) of a given
prescription
Dr Pankaj Gupta, MD
Assistant Professor,
Department of Pharmacology,
Al Falah School of Medical Science & RC
Faridabad (HARYANA) INDIA

2. Objectives
• Definition
• Objectives of Prescription Audit
• Expected Outcomes
• Rational Use of drugs
• WHO Prescribing Indicators
• Indicators for Completeness of the Prescription
• Indicators for Legibility and Rationality of the Prescription
• Conclusion
• Exercise

5. Audit
• A systematic review and analysis of any
service delivered and its evaluation in terms of
quality within given resources.

6. Prescription Audit
• A prescription audit is a part of the holistic
clinical audit.
• It is process that seeks to improve patient care
and outcomes through a systematic review of
care against explicit criteria and the
implementation of change.

7. Objectives of Prescription Audit
• To assess the extent of irrational prescribing.
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Detection of prescribing errors with their reasons.
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To reduce the irrational usage of antibiotics, syrups,
injections, etc.
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To identify opportunities for the improvement and
developing benchmarks at the facility level, district,
state and national.
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To channelize the good practice of writing complete,
legible and rational prescriptions by the service
providers.

8. Expected Outcomes
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Assist public healthcare providers to analyze and interpret the
results of Prescription audits and provide feedback to the
service providers.
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Improve prescription quality at public health facilities.
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Promote the rational use of drugs.
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Reduce prescription errors and thus improves patient safety.
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Reduce the cost of treatment by reducing unnecessary
prescriptions (e.g. Antibiotics), efficient use of therapeutic
agents, encouraging generic medicines, and reducing
polypharmacy.
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Improving Quality of Care (QoC).

9. Rational Use of drugs
• Various prescribing errors are result of ineffective application
of best prescription practices.
• One of the most pressing problem encountered by public
health providers and administrators in many countries is the
rational use of drugs.
• Rational use of drugs is based on use of right drug, right
dosage at right cost which is well reflected in the world health
organization (WHO) definition:
"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”

10. WHO Prescribing Indicators
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Average number of drugs per prescription
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Percentage of drugs prescribed by generic name
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Percentage of prescriptions with an antibiotic
prescribed
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Percentage of prescriptions with an injection
prescribed
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Percentage of drugs prescribed from essential
medical list or formulary

11. Indicators for Completeness of the
Prescription
• Doctor details- (Name, Qualification, registration no., address, contact
details)
• Patient details- (Name, Age, Gender, Weight, Address, contact details)
• Date of Prescription-
• Clinical details- (Vitals, Chief complaints, Past history, Lab work suggestions)
• Diagnosis (provisional/definitive)
• Rx
• Prescribed drug details- (Drug Formulation + DRUG NAME + Dose +
Frequency + Food relation + Duration of therapy)
• Refill information- (SHOULD NOT BE REFILLED/ DO NOT DISPENSE MORE THAN
ONCE / How many times it will be refilled
• Direction to the patient/follow up details
• Signature of the prescriber with stamp

12. Indicators for Legibility and
Rationality of the Prescription
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Legible handwriting
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Medicines prescribed are in line with STG (Standard
Treatment Guidelines)
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Prescription with Vitamins, Tonics, or Enzymes. (must be in
line with STG)
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Antibiotics are prescribed as per Hospital Antibiotic Policy
• How many injections are prescribed
• Investigations advised (must be in line with STG)
• Number of medicines prescribed (Vary from 2-2.9 in general
OPD, may be higher for senior citizens [WHO])

13. Particulars of Doctors:-
Name-
Address- Mobile no:-
Qualification-
Registration No-
Date-
Particulars of patient:-
Name- Age:-
Gender- Weight-
Address- Mobile no-
Diagnosis – Stage 1 hypertension
RX-
Inscription: Tablet AMLODIPINE 5 mg
Subscription: send such 30 tablets
Transcription: one tablet once a day before breakfast, follow up after 1 month
Signature with stamp
Sample prescription
DISPENSED
Date:___________________ Pharmacist_________________________
Name of Pharmacy___________________________________________
City:_______________________________________________________

14. Inscription formula for writing any medicine
Drug Formulation + DRUG NAME (in capital letter with
generic name) + Strength + Frequency + Food relation +
Duration of therapy
Most critical for
minimizing
medication errors

15. Medication Error
• “… any preventable event that may cause or lead to
inappropriate medication use or patient harm while the
medication is in the control of the healthcare professional,
patient, or consumer. Such events may be related to
professional practice, health care products, procedures, and
systems, including prescribing; order communication; product
labeling, packaging, and nomenclature; compounding;
dispensing; distribution; administration; education;
monitoring; and use.”
https://www.ncbi.nlm.nih.gov/books/NBK519065/
Each year, in the United States alone, 7,000 to 9,000 people die due to a
medication error.

16. Points of error
• Ordering/prescribing
• Documenting
• Transcribing
• Dispensing
• Administering
• Monitoring
•Errors are most common at this
place
•Errors include
•Writing the wrong
medication
•Wrong route, dose, frequency
•Illegible handwriting
•Confusion over similarly
named drugs
•These ordering errors account for
almost 50% of medication errors
https://www.ncbi.nlm.nih.gov/books/NBK519065/

17. Correct and legible hand-writing

18. Correct and legible hand-writing
• Doctors, notorious for bad handwriting, may
choose the right drug, but the pharmacist may
read it incorrectly.
• Sometimes, the prescription gets transferred
by phone from the doctor's office to the
pharmacy, but the people making or receiving
the phone calls make mistakes while writing or
filling the prescription and one of the reason is
similarly named drug or brand.

19. Similarly Named Drugs
Inderal (Propranolol used for HT) Adderall (Amphetamine mixture used for
ADHD & Narcolepsy)
Zyrtec (Cetirizine used for allergy) Zantac (Ranitidine used for relief and
prevention of heartburn)
Celebrex (Celecoxib used for pain &
inflammation)
Cerebyx (Fosphenytoin, an anti-epileptic
drug)
Aciphex (Rabeprazole for stomach reflux) Aricept (Donepezil for memory in AD)
Allegra (Fexofenadine for allergies) Viagra (Sildenafil for erectile dysfunction)
Fosomax (Alendronic acid for bone in
osteoporosis)
Flomax (Tamsulosin for BPH & kidney
stones).
https://dailymed.nlm.nih.gov/dailymed/index.cfm

20. Conclusion
Good Prescription means-
– Rational prescription
– Correct prescription
– Legible prescription
– Generic prescription
– In line with standard treatment guidelines

21. Exercise

23. Check list for Completeness of the Prescription
• Doctor details- (Name, Qualification, registration no., address, contact
details)
• Patient details- (Name, Age, Gender, Weight, Address, contact details)
• Date of Prescription-
• Clinical details- (Vitals, Chief complaints, Past history, Lab work suggestions)
• Diagnosis (provisional/definitive)
• Rx
• Prescribed drug details- (Drug Formulation + DRUG NAME + Dose +
Frequency + Food relation + Duration of therapy)
• Refill information- (SHOULD NOT BE REFILLED/ DO NOT DISPENSE MORE
THAN ONCE / How many times it will be refilled
• Direction to the patient/follow up details
• Signature of the prescriber with stamp

24. Check list for Legibility and Rationality of the Prescription
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Legible handwriting
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Medicines prescribed are in line with STG (Standard
Treatment Guidelines) (as per inscription formula)
• ™
™
™
™
Prescription with Vitamins, Tonics, or Enzymes. (must be in
line with STG)
• ™
™
Antibiotics are prescribed as per Hospital Antibiotic Policy
• How many injections are prescribed
• Investigations advised (must be in line with STG)
• Number of medicines prescribed (Vary from 2-2.9 in general
OPD, may be higher for senior citizens [WHO])
STG-Standard Treatment Guidelines

25. SN Parameters Standard achieved
1 Doctor details
2 Patient details
3 Date of Prescription
4 Clinical details
5 Diagnosis (provisional/definitive)
6 Prescribed drug details as per inscription formula
7 Refill information
8 Direction to the patient/follow up details
9 Signature of the prescriber with stamp
10 Legible handwriting
11 Medicines prescribed are in line with STG
12 Prescription with Vitamins, Tonics or Enzymes are in line with STG
13 Antibiotics are prescribed as per Hospital Antibiotic Policy
14 No. of injections prescribed (in line with STG)
15 Investigations advised are in line with STG
16 No. of medicines exceeding WHO standard (2-2.9)
STG-Standard Treatment Guidelines

26. SN Parameters Standard achieved
1 Doctor details YES
2 Patient details NO
3 Date of Prescription YES
4 Clinical details NO
5 Diagnosis (provisional/definitive) YES
6 Prescribed drug details as per inscription formula NO
7 Refill information NO
8 Direction to the patient/follow up details NO
9 Signature of the prescriber with stamp NO
10 Legible handwriting NO
11 Medicines prescribed are in line with STG NO
12 Prescription with Vitamins, Tonics or Enzymes are in line with STG NO
13 Antibiotics are prescribed as per Hospital Antibiotic Policy NO
14 No. of injections prescribed (in line with STG) NO
15 Investigations advised are in line with STG NA
16 No. of medicines exceeding WHO standard (2-2.9) YES
STG-Standard Treatment Guidelines

27. References
• Srivastava SK, Srivastava Rohan. Manual of practical pharmacology for
MBBS, First Edition 2021. Avichal Publishing Company.
• https://nhsrcindia.org/sites/default/files/2021-
07/1534_Prescription%20Audit%20Guidelines16042021.pdf

29. Thanks