Drug Prescribing and Dispensing Practices in Tertiary Care Hospital of Eastern Ethiopia: Evaluation with World Health Organization Core Prescribing and Patient Care Indicators

Abstract

Background: Rational prescribing, dispensing and patient use are the major components of rational drug use; however, the actual drug use pattern is not in line with World Health Organization (WHO) guidelines and is often irrational in many healthcare settings, particularly in developing countries. Therefore, this study aimed to highlight general prescribing and dispensing practices at Hiwot Fana Specialized University Hospital (HFSUH) outpatient settings. Method: Across-sectional study design was employed to determine the medication prescribing and dispensing practices at HFSUH. As per the WHO guideline for prescribing encounters, about 600 prescriptions were included in the study. Systematic random sampling was applied to obtain samples from encounters prescribed and dispensed from Jan 1-June 30, 2016. Moreover, as per the minimum requirement of the WHO guideline, 100 patient encounters were also included in the study with convenient sampling method. The data were evaluated against WHO standards for core drug use indicators. Results: From the total of 600 outpatient prescribing encounters, the prevalence of getting recorded diagnosis was almost negligible (4.67%). Only two thirds (67.60%) of prescription contain the patient name to whom the drug was prescribed. Coming to the drug related information, the prevalence of getting written dosage forms (18.5%), and the total quantity (35.34%) were found suboptimal. Duration of treatment had been documented in less than threefourth of encounters (73.00%). Regarding the WHO core prescribing indicators, the average number of drugs prescribed per encounter was found to be 1.89. The percentage of encounters that contain at least one antibiotic and injection was 304 (50.67%) and 315 (59.16%), respectively. Besides, the percentage of drugs prescribed by generic name and from an Essential Drug List (EDL) of the country was 1055 (93.04%) and 1134 (100.00%), respectively. The most commonly prescribed antibacterial agents were ceftriaxone 110 (36.20%), metronidazole 52 (17.11%), and cloxacillin 27 (8.89%). Besides, the top four prescribed injections were tramadol 214 (34.79%) ceftriaxone 110 (17.89%), furosemide 95 (15.45) and metronidazole 52 (8.46%). Looking at the patient care indicators, the percentage of drugs actually dispensed and labeled were 86% and 11%, respectively. The average dispensing time was 59.9 s and the percentage of patients knowing the entire regimen was 61.88%. Conclusion: As a tertiary care hospital, the overall completeness and rationality of prescription was found suboptimal since some of the key components were missed. The degree of polypharmacy fell within the window of WHO criteria. However, inappropriate use of antibiotics and injections was highly noticeable (significant deviation from the upper limit of the WHO standard). These are two critical but commonly misused classes of drugs given greater emphasis by WHO. Prescribing practice with generic name and from EDL is highly appreciable in this setting. However, labelling practice has been significantly poor in this setting.