Abstract
BackgroundMedical prescription writing is legally and professionally regulated in order to prevent errors that can result in patients being harmed. This study assesses prescriber adherence to such regulations in primary care settings.MethodsA cross-sectional study of 412 prescriptions from four district hospital outpatient departments (OPDs) was conducted in March 2015. Primary outcome data were obtained by scoring prescriptions for accuracy across four categories: completion of essential elements, use of generic names of medications, use of recommended abbreviations and decimals and legibility. Secondary outcome data sought associations between accuracy scores and characteristics of the OPDs that might influence prescriber adherence.ResultsCompletion of the essential elements, including patient identifiers, prescriber identifiers, treatment regimen and date scored 44%, 77%, 99% and 99% respectively. Legibility, the use of generic names of medications and the use of recommended abbreviations and decimals scored 90%, 39% and 35%, respectively. Only 38% of prescriptions achieved a global accuracy score (GAS) of between 80% and 100%. A significant association was found between lower GAS and the number of prescriptions written per day (p = 0.001) as well as with the number of prescribers working on that day (p = 0.005), suggesting a negative impact on prescribers’ performance because of workload pressures.ConclusionLow GAS values indicate poor adherence to prescription-writing regulations. Elements requiring substantial improvement include completion of patient and prescriber identifiers, use of generic medication names and the use of recommended abbreviations and decimals. This study provides baseline data for future initiatives for improvement in prescription-writing quality.
Highlights
Medical prescriptions are often the last encounters patients have with healthcare practitioners
The purpose of this study was to assess the adherence of prescribers across Southern Gauteng district hospitals to prescription-writing regulations and examine potential barriers in order to raise awareness and provide baseline data for future prescription-writing quality improvement initiatives. This is a cross-sectional study dealing with the accuracy in prescription writing with regard to adherence to regulations amongst all levels of prescribers working in a primary care setting who were blinded to the study
Significant differences were found between the hospitals with regards to the average number of prescriptions per day, the number of prescribers on the day and the prescribers’ professional category mix
Summary
Medical prescriptions are often the last encounters patients have with healthcare practitioners Their writing is regulated by professional guidelines and the law.[1,2,3,4] Prescription-related inaccuracies may impact negatively the quality of care and compromise patient safety, and they may lead to medication errors that have significant social, financial and legal consequences.[5,6,7,8] Such errors can arise from errors related to medication prescribing, dispensing, administration or patient compliance;[9,10] the origin of majority of errors noted in the medical prescription can be traced to writing by healthcare professionals,[11] which can have knock-on effects such as delayed dispensing.[12] Prescription-writing errors account for up to 70% of medication errors that could potentially result in adverse effects.[13]. Medical prescription writing is legally and professionally regulated in order to prevent errors that can result in patients being harmed. This study assesses prescriber adherence to such regulations in primary care settings
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