Essential Drug List Research Articles

An Observational Study on Guideline Mediated Prescribing Pattern in Patients with Acute Decompensated Heart Failure

Introduction: Studies on prescribing patterns are useful investigative instruments for figuring out how drugs function in society. Examining the prescription pattern is a crucial part of gauging the ability of medical professionals to choose a medication that will benefit patients to the fullest. The current study goals were to evaluate, using accepted guidelines, the general medicine department's practice of prescribing in accordance with guidelines in a tertiary care hospital and to assess the inclusion of drugs from essential drug list patients with acute decompensated heart failure. Methodology: Hospital based prospective case observational study was conducted for a period of six months after obtaining the permission from institutional ethical committee. The data was collected and analysed according to the inclusion and exclusion criteria and necessary statistical testing like chi square test and pearson correlation were performed. Results and Discussion: Based on the study, the data of total 100 patients (n=100) were evaluated. Gender distribution of data shows high prevalence rate in males. The most commonly high susceptibility of disease age was found in 40-60 in males and females. The maximum number of patients were hospitalized for 6-7 days, hypertension was the most commonly found precipitating factor. Diuretics were prescribed maximum in the prescription. Out of 650 drugs the maximum number of drugs fall under the category of Anti-hypertensives. Most drugs are given through oral route. The American heart association (AHA) guidelines were assessed for drug prescription using IBM SPSS Statistics. It was depicted that most of the prescriptions were in compliance with the guidelines. Conclusion: The results of our study conclude that prescribing practices were satisfactory according to the American college of cardiology guidelines. Keywords: Prescribing pattern, Guidelines, Acute heart failure, Anti-hypertensives.

PERSPECTIVE OF THE DOCTORS IN A NEW MEDICAL COLLEGE OF NORTH-EAST INDIA REGARDING THE NATIONAL LIST OF ESSENTIAL MEDICINES

Objectives: To collate the perspectives of doctors regarding the national list of essential medicines (NLEM) and thus assess the factors affecting adaptation and implementation of NLEM at the state or institution level. Methods: This is a cross-sectional questionnaire-based study conducted among the doctors of Tomo Riba Institute of Health and Medical Sciences, which is a new medical college and a tertiary care hospital in Naharlagun, Arunachal Pradesh. The study was carried out for 6 months. The participants were explained the purpose of the study and requested to fill out the questionnaire and return it immediately. Data analysis was performed using simple statistical methods such as percentages and proportions. Results: Out of 73 participants, 63% were aware of NLEM, while 37% were unaware of the term NLEM. Only 17.8% of the doctors are satisfied that the drugs in the latest NLEM suffice for most of the medical conditions they come across in their daily practices. Only about 39.7% of the doctors frequently prescribed the drugs from the NLEM list in their routine practice. The majority (61.6%) of them agree that there should be a separate essential drug list supplementary to the World Health Organization list in every tertiary care medical college. Conclusion: The concept of NLEM offers the most cost-effective solution to healthcare needs. The selection of the medicines in the list or a separate state or institutional list according to the needs of the regional population can cater to most of the healthcare needs.

The Role of the Combination Paracetamol/Caffeine in Treatment of Acute Migraine Pain: A Narrative Review.

Thirty years ago, the first migraine-specific drugs (triptans) appeared. Todaytwo new categories (gepants and ditans) are marketed for acute migraine treatment. That said, is there still a role for conventional therapy? The aim of the present narrative review is to provide an expert overview examining the possible role of the combination paracetamol/caffeine in treatment of acute migraine pain. To understand possible settings for more appropriate use of paracetamol/caffeine (1000mg/130mg) in treatment of acute migraine, a structured literature search was performed using the PubMed database by a panel of experts from major Italian headache centers; articles not referring to migraine pain were excluded from this review; review articles were prioritized. Overall response, even to newer specific and selective trigeminal targeted drugs (TTTs), is not over 60%; thus, there is still room for conventional therapies in acute migraine treatment. The panel identified settings in which the use of paracetamol/caffeine combination to treat acute migraine attacks might offer benefit considering the consolidated use through years, despite the lack of studies directly addressing the efficacy of paracetamol/caffeine in the identified populations: subjects > 65years of age; presence of cardiovascular (CV) comorbidities; TTTs non-responders; pregnancy and breastfeeding; subjects < 18years of age; paracetamol/caffeine as add-on therapy. Paracetamol is included in the World Health Organization (WHO) essential drug list and has a high level of popularity among patients. Caffeine enhances the analgesic effect of other drugs including paracetamol. In early treatment of acute migraine pain, prescribing physicians might consider using the paracetamol/caffeine combination among other options.

Availability of essential, generic medicines before and during COVID-19 at selected public pharmaceutical supply agencies in Ethiopia: a comparative cross-sectional study

ObjectivesLockdowns and border closures impacted medicine availability during the COVID-19 pandemic. This study aimed to assess the availability of essential, generic medicines for chronic diseases at public pharmaceutical supply agencies...

Approval status of essential therapeutic drugs for systemic sclerosis versus that of drugs for rheumatoid arthritis

Objective: Systemic sclerosis, a rare disease characterized by chronic multisystem fibrosis, requires lifelong management, necessitating enough insurance coverage for the patient. Official drug approval is the first step to ensuring that the drug is covered by insurance. In this study, we investigated the approval status of essential therapeutic drugs for systemic sclerosis across eight countries and compared it with that of drugs for rheumatoid arthritis. Methods: The essential therapeutic drug lists for systemic sclerosis and rheumatoid arthritis were taken from the guidelines of the American College of Rheumatology and the European Alliance of Associations for Rheumatology. Official drug approval status for the selected drugs was confirmed by searching representative Internet databases from eight countries: the United States, the United Kingdom, Germany, France, Italy, Switzerland, Japan, and the Republic of Korea. Results: A total of 21 and 16 drugs were selected for systemic sclerosis and rheumatoid arthritis, respectively. The drug approval rates of the 21 drugs for systemic sclerosis varied among countries. Most drugs used to treat pulmonary arterial hypertension, which were developed recently and are expensive, are approved by most countries; however, most older drugs—which are still essential for management of Raynaud’s phenomenon, digital ulcers, interstitial lung disease, and skin fibrosis—are not approved by most countries. By contrast, almost all of the 16 drugs used to treat rheumatoid arthritis, whether old or new, are approved by most countries. Conclusion: Approval rates for drugs used to treat systemic sclerosis, a rare disease, are much lower than those for drugs used to treat rheumatoid arthritis. Thus, approval rates of essential therapeutic drugs for systemic sclerosis need to improve, which will benefit patients by increasing the number of drugs covered by insurance.

Prescription pattern study of the drugs used in emergency department in a teaching hospital

Background: The emergency department is a place where patients require immediate treatment and care. It is the specialty that cares for patients at risk. Doctors face challenges in rationalizing, choosing, and initiating appropriate drug therapy for patients admitted to emergency medicine. They also encounter problems with medication errors and adverse drug events. Hence, a prescription-based survey is one of the most effective methods for analyzing the prescribing patterns of drugs and the prescribing behavior of physicians. The core drug use indicators developed by the World Health Organization (WHO) are more informative and feasible. These include prescribing, patient care, and health facility indicators. Aims and Objectives: (i) The aim of this study was to study, assess, and evaluate the rationality of prescription pattern in emergency department in a particular region and (ii) to understand whether prescription pattern is in accordance with the WHO core prescribing indicators or not? Materials and Methods: Details regarding the age and gender of the patient, the reason for admission, diagnosis made, treatment given, the number of drugs per prescription, drugs prescribed by generic name, drugs prescribed from the essential drug list, dosage, refills, and dosage forms were collected. The rationality of the prescriptions was assessed and evaluated using these indicators. Results: In the present study, the average number of drugs per prescription was 4.6, injections were prescribed in 84.8%, antibiotics in 43.2%, and the generic name was mentioned in 50.8%. In addition, 72.8% of the drugs were prescribed from the essential drug list. Descriptive and inferential statistical analyses were used. The Student’s t-test was employed to compare inter-group variation for continuous variables. The Chi-square test was used to compare categorical variables. Conclusion: Among the study population, approximately three-fourths belonged to the age group of 20–60 years, and two-thirds were males. The majority of patients came due to injuries, including road traffic accidents, followed by respiratory illnesses (26.4%) and gastrointestinal ailments (15.6%). Among the prescriptions studied, all had the drug name legibly written, 93.3% had the dose mentioned, and 86.5% had the frequency mentioned. The most common route of administration was parenteral (76.6%), followed by oral (19.3%). In the present study, the average number of drugs per prescription was 4.6, injections were prescribed in 84.8%, antibiotics in 43.2%, and the generic name was mentioned in 50.8%.

Prescribing patterns of antidiabetic drugs in elderly patients attending a tertiary care hospital

Background: Type 2 diabetes mellitus is one of the most known chronic diseases in almost all countries and continues to rise in numbers and significance. Prescription pattern studies are drug utilization studies with the main focus on prescribing, dispensing, and administration of drugs and are mainly undertaken to promote rational use of medicines. Aims and Objectives: To study the prescribing patterns of antidiabetic drugs in elderly patients attending tertiary care hospitals. Materials and Methods: It was a cross-sectional study. After obtaining Institutional Ethics Committee clearance, written informed consent was obtained from all patients in the study. After consultation, prescriptions issued to the patients were copied into pro forma and case record forms. All participants with a disease duration &gt;1 year and an age above 65 years were included in the study. Details like the number of drugs, dosage forms, frequencies, and number of comorbidities were entered into the pro forma. Results: The total number of drugs prescribed was 654. The average number of drugs per prescription was 2.18. The most commonly prescribed class of drugs were biguanides (93.4%), followed by sulfonylureas (81%), and alpha-glucosidase inhibitors (42.3%). Generic drugs were seen in 97.4% of prescriptions, and insulins were seen in 22% of prescriptions. The percentage of prescriptions with drugs from the Essential Drug List (EDL) was 98%. Conclusion: Prescription pattern monitoring studies would thus help in the understanding of the extent of quality prescribing and rationality. In this study, the prescribing of injections, generic prescribing, and prescribing from EDL were adequate.

Evaluation of Drug Prescription using WHO Prescription Indicators at a Tertiary Care Teaching Hospital, Raipur Chhattisgarh, India: A Cross-sectional Study

Introduction: Prescription patterns significantly impact healthcare quality and patient outcomes. Evaluating these patterns using World Health Organisation (WHO) indicators helps identify areas for improvement and ensures rational drug use. The present study was conducted to evaluate prescription patterns via WHO indicators, aiming to uncover insights, identify discrepancies and enhance prescription quality within the institute for improved healthcare outcomes. Aim: To evaluate drug prescription patterns using WHO prescription indicators in the prescriptions of outdoor patients at a tertiary care teaching hospital in Chhattisgarh, India. Materials and Methods: A cross-sectional study was conducted in the Department of Pharmacology at Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, Chhattisgarh, India, from July 15, 2023, to October 15, 2023 (a duration of 3 months), involving 1,000 outpatient prescriptions at Dr. Bhimrao Ambedkar Memorial Hospital (BRAM), Raipur, Chhattisgarh. Ethical clearance was obtained from the Institutional Ethics Committee (IEC) (No./MCI/Ethics/2023/45 Raipur, dated 12/07/2023). Data were collected using a digital form and analysed statistically. Parameters evaluated included the average number of medicines per prescription, the percentage of drugs prescribed by generic name, the percentage of prescriptions containing antibiotics, the percentage of prescriptions containing injections, and the percentage of drugs prescribed from the Essential Drug List (EDL). Descriptive statistics were used to summarise the data, and analysis was performed using Microsoft (MS) Excel 2021. Results: The present study included 1,000 prescriptions. A total of 4,320 medicines were prescribed across these prescriptions, with 2,853 (66.04%) prescribed by their generic name. Injections accounted for 483 (11.18%) prescriptions, while antibiotics were included in 663 (15.34%) prescriptions. Additionally, 2,973 (68.81%) medicines were prescribed from the EDL. The average number of medicines prescribed per prescription was 4.3. Conclusion: The study revealed that while certain aspects of prescription practices aligned with WHO indicators, notable discrepancies persisted. The percentage of antibiotics prescribed per prescription was in accordance with WHO guidelines. Strategic measures are needed to enhance prescription practices and align them more closely with WHO guidelines.

An observational study of drug utilization pattern in patients with diabetes mellitus in tertiary care hospital

Background: Diabetes will be the 7th leading cause of death by 2030 as per the World Health Organization (WHO). Encouraging the populace to use drugs rationally is the main goal of research on drug usage. Aims and Objectives: The objective of this study is to determine drug utilization pattern among patients with diabetes mellitus using the WHO Core Indicators in a tertiary care hospital, Indore. Materials and Methods: A prospective and observational study was done in the Department of Pharmacology along with the Department of Medicine in MGM Medical College and Hospital, Indore. After taking informed consent from diabetic patients visiting the outpatient department, their demographic details and prescriptions were recorded in case record form and analyzed using WHO core indicators. Results: In our study, total prescription assessed was 123. The total drugs prescribed were 652, out of which a total of 278 were anti-diabetic drugs. The average number of drugs per encounter = 5.3. Percentage of drugs prescribed by generic name = 92.4%. Percentage of encounters with an antibiotic prescribed = 10.5%. Percentage of encounters with an injection prescribed = 34.9%. The percentage of drugs prescribed from the essential drugs list (2015) = 72.3%. Conclusion: Prescribing pattern of antidiabetic drugs vary a little from the WHO standards. Rational prescription should be encouraged and such studies should be done regularly for periodic auditing of prescription.

Morbidity pattern and drug utilization study in cancer patients in a tertiary care hospital

Background: Cancer is a set of diseases that include the unchecked proliferation and spread of abnormal body cell types. The primary treatment modalities are surgery, radiation, chemotherapy, immunotherapy, and hormones. As it describes the scope, nature, and causes of drug exposures, drug use research is a key and vital component of pharmacoepidemiology. Aim and Objectives: Utilization study seeks to encourage communities to use medications rationally. Materials and Methods: A prospective, cross-sectional, observational study was conducted in indoor patients of the radiotherapy department of a tertiary care teaching hospital. Six hundred patients of different types of cancers were involved in the study. At the end of data collection, the data were entered and analyzed with Microsoft Excel 2019. Descriptive statistics were used to analyze the results. Results: Buccal mucosa, tongue, and breast cancers had the highest admission rate with 24.17%, 13.33%, and 12.83%, respectively. The average number of drugs per encounter was 13.58 with a range of 5–17. The most frequently used anticancer drugs were cisplatin, carboplatin, paclitaxel, 5-fluorouracil, cyclophosphamide, and Adriamycin. Out of 32 drugs used, 30 drugs were prescribed from the World Health Organization Model List of Essential Medicines, 2021, and National List of Essential Medicines, 2022, and 8 drugs were by brand name. Conclusion: Compared to other systems such as the pulmonary, breast, genitourinary, and gastrointestinal tract, oral malignancies were more common. The most frequently used anticancer drugs were cisplatin, carboplatin, paclitaxel, 5-fluorouracil, cyclophosphamide, and Adriamycin. Prescribing drugs were mainly from Essential Drug List with generic names.

Evaluation of Drug Use in Three Secondary Health Facilities in Liberia Using the World Health Organization Indicators

Background: Effective and quality healthcare is achieved through rational drug use. The consequences of irrational drug use manifest as drug related problems like unnecessary drug prescription, ineffective therapy, inappropriate dose and adverse drug reactions. Objectives: To evaluate drug use and drug related problems in three secondary health facilities in Liberia. Methods: A retrospective analysis of 1200 prescriptions was conducted in the outpatient section of Liberia Government Hospital (LGH), Redemption Hospital (RH) and James Davis Junior Hospital (JDJH) to assess drug use with the WHO drug use indicators followed by assessment of drug-related problems (DRP) using the DRP-Registration Form 8.0. A prospective cross-sectional study was then conducted to evaluate consultation and dispensing time, and the availability of essential drugs list. Data were analysed by one-way analysis of variance using Statistical Package for Social Sciences (SPSS) version 20.0. Results were expressed as mean ± SD and values were considered significant at P &lt; 0.05. Results: The average numbers of medicines per prescription were 4.5 ±1.3, 3.6 ±1.1, and 3.7 ± 1.2 in LGH, RH and JDJH hospitals respectively (WHO value-1.6-1.8). The percentages of encounters with antibiotics were 77.5%, 74.3% and 82.5% respectively (WHO value - 20.0% - 26.8%). Observed DRPs were more in LGH for ‘no indication for drug use’ (6.50%) and ‘prescription of more drugs than clinically indicated’ (4.75%) while JDJH recorded more ‘inappropriate medication per established guidelines’ (4.00%) and ‘preventive/synergic drug not given for clinical indication’ (5.50%). Conclusion: Irrational use of drugs existed in all the three hospitals studied.

Study on prescription pattern in acute myocardial infarction in a tertiary care teaching hospital

Background: Prescription pattern monitoring studies refer to drug utilization studies that primarily examine the prescribing, dispensing, and administration of medications to promote the rational use of drugs. Aims and Objectives: The present study aimed to examine the prescription patterns among patients with acute myocardial infarction (MI) who were admitted to intensive care unit of a tertiary care center. Materials and Methods: This was a prospective, cross-sectional study carried out in 201 acute MI patients. Patients’ demographics, clinical history, laboratory and imaging findings, the name of the drug (brand name or generic name), dosage form, and percentage of drugs prescribed from the WHO and National Essential Medicine List were noted. Results: In the present study, the majority of the study participants (73.14%) belonged to the age group of 41–65 years, with male predominance (60.20%). Most patients reported having a mixed diet (49.26%) and were from rural areas (63.68%). Aspirin, clopidogrel, and atorvastatin were prescribed to all the patients, followed by pentazocine (70.42%) and streptokinase. Percentage of drugs prescribed by generic name was 62%, while percentage of drugs prescribed from the WHO Model List of Essential Medicines (2021) and National Essential Drugs List (2022) was 70% and 68%, respectively. Conclusion: The present study findings revealed that the majority of patients belonged to the age group of 41–65 years, with male predominance. The present study revealed a low percentage of prescriptions with generic names, indicating a pressing need to revise the prescription standards in tertiary care hospitals.

Drug Utilization Pattern of Antimicrobial Agents in Medicine IPD of a Tertiary Care Teaching Hospital of Western Odisha

Background: Around the world, doctors frequently prescribe antimicrobial agents (AMAs). However, irrational and inappropriate use of AMAs results in several negative outcomes, including antimicrobial resistance, connected health issues, lengthened hospital stays, and increased treatment costs. Antimicrobial resistance (AMR) is becoming a more serious global challenge in hospitals and communities. Hence, Drug Utilization Evaluation (DUE) studies are created primarily to evaluate and improve prescribing procedures and enhance the rational use of pharmaceuticals to address this significant condition. Materials and methods: A prospective observational study was conducted in a tertiary care hospital’s in-patient department of medicine. Analyses were done on the antibacterial agent drug usage patterns. Using Defined Daily Doses (DDDs) and Anatomical Therapeutic Chemical (ATC) Classification. The cost of the AMA therapy was estimated using the government’s approval rate for generic drugs. Results: Sixty-seven of the 100 patients were women, and 33 were men. Throughout the research period, 432 medications were prescribed, of which 39.8% were antibiotics and 77 % of patients had their AMA prescriptions based on data from bacteriological culture and sensitivity tests. The National List of Essential Medicines (NLEM) of India and the state essential drug lists were followed for prescribing the antimicrobial drugs by their generic names, respectively. In 27% of prescriptions, there was evidence of polypharmacy, and 70% of the combinations were logical. The patient spent 3.47 days in the hospital on average throughout their stay. It was discovered that antibiotics cost an average of Rs 200.17 per patient every day. Conclusion: Hospital antibiotic policy according to the ASP (Antibacterial Stewardship Programme) is essential for the optimization of antimicrobial therapy in this institution to ensure rational use of AMAs and to fight antimicrobial resistance.

Prescription Pattern of Antiepileptic Drugs in Different Types of Seizure Disorder in Children

Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. The incidence of epilepsy is highest during childhood, especially for children aged 0 - 14 years. The goal of the study is find out the prescribing pattern of antiepileptic drugs in different types of seizure disorder in children. An educational observational study was carried out among 55 samples in the In-patient Department of Pediatrics, in a tertiary care teaching hospital, Bangalore. The data was collected by using self-designed data collection form. All information’s were processed and analyzed by using Microsoft excel. In the present study, breakthrough seizures was the most commonly observed type of seizure followed by simple febrile seizure. The most commonly prescribed antiepileptic drug was levetiracetam, followed by clobazam in monotherapy. Majority of the patients were prescribed with monotherapy followed by dual therapy. Levetiracetam + Clobazam, Levetiracetam + Sodium valproate and Levetiracetam + Phenytoin was the most preferred combination. Drug use pattern of Antiepileptic Drugs was described based on WHO prescription indicators, which shows out of 55 sample size, average number of drugs per encounter was 0.5, 44% of injections were encountered, antibiotics prescribed were 0%, drug prescribed based on generic name were 54% and 93% of drug was encountered based on essential drug list. Antiepileptic prescribing in this study population was only 56% in accordance to the ILAE treatment guidelines for epilepsy.

Drug Utilization Research and Predictors of Outcomes in the Intensive Care Unit of a Tertiary Care Hospital: A Prospective Observational Study.

Multiple drugs are commonly prescribed to intensive care unit (ICU) patients owing to the disease profile, multiple organ dysfunction, prophylaxis, management of stress ulcers, nosocomial infections, etc. This study aimed to evaluate the drug utilization patterns and factors influencing mortality and duration of stay in ICU patients. Methodology: A prospective observational study was conducted in the ICUof our tertiary care hospital, Postgraduate Institute of Medical Sciences, Rohtak. Data was collected from treatment charts of patients using a structured pretested proforma. World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose (WHO ATC/DDD) methodology and core prescribing indicators were used to assess drug utilization data. The effect of different variables on mortality and duration of stay in the ICU was evaluated using regression analysis. An average of 8.78 drugs were prescribed per patient. Among the 922 prescriptions, anti-infectives, anti-inflammatory drugs, and drugs acting on the gastrointestinal tract were the most frequent medication classes prescribed. Polypharmacy and trade name prescribing were common. For most of the drugs, the prescribed daily dose corresponded to the WHO-DDD except ceftriaxone and levofloxacin. Age, presence of cardiac disorders, and Glasgow Coma Scale (GCS) score at admission directly correlated with mortality while the use of diuretics had a negative correlation with the duration of ICU stay. Conclusions: There is a need to rationalize drug therapy in the ICUwith regard to limiting polypharmacyand emphasizing generic drug name prescribing and adherence to the essential drug list. Antibiotic prescription patterns, in particular, deserve a special focus keeping in mind the multitude of factors demanding aggressive antibiotic use in critically ill intensive care patients.

Prescription Pattern of Antibiotics at Outpatients Department of Gynaecology and Obstetrics in a Teaching Hospital in Bangladesh

Background: Antibiotics are usually prescribed based on the clinical features of infections. Objective: The purpose of the present study was to assess the prescription pattern of antibiotics at outpatients Department of Gynaecology and Obstetrics in a teaching hospital in Bangladesh. Methodology: This cross-sectional study was carried out among patients attending the outpatients’ department (OPD) of Obstetrics and Gynaecology from October 2014 to April 2015 in Rajshahi Medical College and Hospital, Rajshahi, Bangladesh. The demographic details, average number of drugs per prescriptions, percentage of drugs prescribed by generic names, percentage of encounters with an antibiotic and an injection prescribed, percentage of drugs prescribed from Essential Drug List (EDL) of Bangladesh, percentage of encounters with prescription of antiulcerant, NSAID, multivitamin and multimineral, iron preparation and a calcium preparation were noted. Results: A total number of 384 women were recruited for this study. The age group of 20 to 29 years accounted for the highest number 180 (46.8%) and from the age group of 70 to 79 years accounted for the lowest number 2 (0.5%) patients. Groups of drug which commonly prescribed were anti-ulcerant 247. The other commonly prescribed group of drugs were iron preparations 235, calcium preparations 182, antimicrobials 160, multivitamins and multi-minerals 147, antispasmodics 120. The most commonly prescribed antibiotic was cefuroxime 56(36.36%) followed by cefixime, azithromycin, fluconazole, ciprofloxacin, nitazoxanide, roxithromycin, metronidazole, clindamycin and flucloxacillin were 28(18.18%), 21(13.63%), 12(7.79%), 11(7.14%), 9(5.84%), 8(5.19 %), 6(3.89 %), 5(3.24%), 4(2.59%) respectively. Conclusion: In conclusion antibiotics are frequently using in the OPD of Obstetrics and Gynaecology department among the women. Bangladesh Journal of Medical Microbiology, July 2023;17 (2):77-81

Evaluation of Medication Errors by Prescription Audit at a Tertiary Care Teaching Hospital

Objectives The prescription errors and prescribing fault analysis was assessed, the rationality of the prescriptions was checked, and the medication error was categorized according to the NCC MERP Index. Materials and Methods A cross-sectional, observational study was designed as per STROBE guidelines and conducted for 2 months in the pharmacy stores after approval of the Institutional Review Board. Patients’ written informed consent was taken before getting their prescriptions, and each of the prescriptions procured in this way was photographed for record. The completeness of 320 prescriptions of outpatients of all age groups regarding the details about the doctor and the patient and clinical diagnosis/indication was analyzed. The rationality of prescription was based on WHO core drug use indicators. Descriptive analysis was done by using Microsoft Excel. Results A total of 320 prescriptions were analyzed from eight departments. Information about patients and prescribers was mentioned in 100% of prescriptions. The diagnosis (40%), an indication was written in 195 prescriptions. Instructions for dispensing drugs (89%), instructions to patients (90%), duration of treatment (100%), follow-up visits (19%), and non-pharmacological instructions (13%) were mentioned. In total, 82% of prescriptions were legible. In a total of 1004 drugs, 92% of drugs were prescribed with a generic name, 100% from the essential drug list. The route and frequency of drug administration were mentioned for all drugs. According to NCCMERP, the category of medication errors falls under category B. Conclusion To reduce medication errors, we can implement an electronic system, involve clinical pharmacologists, utilize prescription charts, and organize nationwide workshops on rational prescription writing. We should encourage regular prescription audits and reporting to improve the healthcare system in the country.

Distribution of Diseases and their Prescription Pattern at Outpatients Department of Gynecology and Obstetrics in a Tertiary Care Hospital in Bangladesh

Background: Different gynaecological and obstetrics conditions are commonly encountered by the physicians in the outdoor patient. Objective: The purpose of the present study was to observe the distribution of diseases and their prescription pattern at outpatients Department of Gynaecology and Obstetrics in a tertiary care hospital in Bangladesh. Methodology: This cross-sectional study was carried out among patients attending the outpatient’s department (OPD) of Obstetrics and Gynaecology from October 2014 to April 2015 in Rajshahi Medical College and Hospital, Rajshahi, Bangladesh. The demographic details, average number of drugs per prescriptions, percentage of drugs prescribed by generic names, percentage of encounters with an antibiotic and an injection prescribed, percentage of drugs prescribed from essential drug list (EDL) of Bangladesh, percentage of encounters with prescription of antiulcerant, NSAID, multivitamin and multimineral, iron preparation and a calcium preparation were noted. Results: A total number of 384 prescriptions were collected from Out Patient Department of Obstetrics and Gynaecology of Rajshahi Medical College and Hospital, Rajshahi, Bangladesh. Among 384 prescriptions date, name and age of the patient was written in 384 prescriptions which was 100.0% cases. Weight was written in 190(49.5%) and absent in 194(50.5%) prescriptions. Strength of drugs were written in 11(2.9%) prescriptions and not written in 373(97.1%) prescriptions. Duration of treatment was written in 100.0% prescriptions. Subscription is absent in 100.0% prescriptions. Direction to the patient was present in all prescriptions, but follow up advice were written only in 9(2.3%) prescriptions. Sign present in all prescriptions. There were about 169(44.0%) prescriptions have written the diagnosis and 215(56.0%) prescriptions did not have any diagnosis written. Conclusion: In conclusion the date, name and age of the patient are written in all prescriptions and strength of drugs are absent in almost all prescriptions. Journal of Current and Advance Medical Research, January 2023;10(1):13-18

ASSESSMENT OF WHO/INRUD CORE DRUG USE INDICATORS AT PUBLIC AND PRIVATE HEALTHCARE CENTRES IN LAHORE, PAKISTAN: A MULTICENTRE CROSS-SECTIONAL STUDY

Background: A key element of the pharmaceutical care plan is the appropriate use of medications. Objectives: Using the WHO/INRUD core drug use indicators, this study sought to evaluate medication usage trends at both public and private healthcare centres in the Lahore district of the Punjab province of Pakistan. Methodology: A cross-sectional and descriptive study design was adopted. For data collection, 399 prescriptions (199 prescriptions from public and 200 prescriptions from private healthcare facilities) were systematically sampled written from February to July 2022. To evaluate the prescription indicator, patient-care and facility-specific indicators, patients randomly selected from both public and private hospitals were examined and interviewed. For each of the WHO/INRUD indicators, we considered ideal criteria that have been published. Results: The average number of medicines prescribed each encounter was reported to be 6.26% in public hospitals and 4.14% in private hospitals among the prescribing indicators, generic medication, antibiotics, and the number of times patients received injections were prescribed, respectively, in 54%, 84%, and 89% of public hospitals and 19%, 61.7%, and 78% of private hospitals. In the public and private sectors, respectively, 71% and 97% of prescription drugs were from the list of essential drugs. The average consultation time was found to be 2.1 minutes in public hospitals and 3.2 minutes in private hospitals, while the average dispensing time was reported to be 37 seconds in public hospitals and 39 seconds in private hospitals. Of the total prescribed medicines, 84% and 97 % were dispensed in public and private hospitals respectively and the percent medicine adequately labelled was 100% in both healthcare facilities. Regarding patient awareness, 69% of patients in private hospitals and 42.5% of patients in public hospitals were aware of the proper dosage, frequency, and duration of the medications that were prescribed. In terms of facility-specific data, both public and private hospitals had 100% availability of the EDL copy and 82% stock of the important medications, respectively. Conclusion: Irrational use of drugs was observed in both public and private healthcare facilities. WHO/INRUD proposed 12 key initiatives to encourage rational use of medications must be put into practice as a result of present study.

Antibiotic Prescribing Practice in a Paediatric Outpatient Clinic in Owerri, Imo State, Nigeria

Background: Antibiotics are amongst the most frequently prescribed drugs for children in outpatient clinics but irrational prescribing can cause medication errors, antibiotic resistance and treatment failure. Examples of irrational prescribing includes poly-pharmacy, over use of injections, inappropriate use of antimicrobials and failure to prescribe in accordance with treatment guidelines.&#x0D; This study sought to assess antibiotic prescribing practice in the children’s outpatient clinic of the Federal university teaching hospital Owerri, Imo state.&#x0D; Materials and Methods: This was a descriptive prospective study carried out in the Children’s Outpatient Clinic (CHOP) of the Federal university teaching hospital Owerri, Imo state Nigeria between April and June 2021. During the study period, medical record of patients who attended the CHOP and who had antibiotic(s) prescribed were collated. Prescribing practice was assessed using the World Health Organization prescribing indicators.&#x0D; Results: A total of 495 antibiotic prescriptions were made for 478 patients. This gave 1.04 as the average number of medicines prescribed per patient encounter. 1.6% of the antibiotics were prescribed as injections and 79.2% of the prescriptions were in generic names. While only 96.8% of the prescriptions were from the Nigerian essential drug list, the three most prescribed antibiotics Amoxicillin/Clavulanic acid, Cefuroxime and Amoxicillin are all listed in it.&#x0D; Conclusion: The antibiotic prescribing practice in the children’s outpatient clinic was rational with regards to average number of medications per patient encounter and percentage of encounters with injection prescribed. It was irrational in terms of percentage of antibiotics prescribed in generic names and percentage of antibiotics prescribed from the Nigerian essential drug list.