Irrational Prescribing Research Articles

Assessing the Prescription Pattern of Antimicrobial Agents in Intensive Care Unit at Tertiary Care Hospital

Antibiotic resistance is the major concern in developing countries especially in India, and the prime reason behind it is the irrational prescription of antibiotics. Therefore, assessment of the prescribing pattern of antibiotics in the intensive care unit (ICU) would help to ascertain the rational use of antibiotics in ICU. In a prospective observational study, prescription pattern of patients on antimicrobial agents for any infectious diseases was reviewed and assessed in ICU at a tertiary care hospital for 6 months. All the patients receiving at least one antibiotic except paediatric, pregnant, and lactating patients were included in the study. The prescriptions were also analysed in accordance with the indicators provided by WHO AWARE list. A total of 227 patients were enrolled in the study after obtaining their informed consent form. The majority of patients were in the age group 51 to 65 (33.48%) and males (54.18%). The most common pathological conditions for which patients admitted to ICU were acute gastroenteritis (21.68%), urinary tract infection (13.98), and viral fever (11.19%). Amongst all antimicrobial agents prescribed, cefoperazone along with sulbactam (20.29%) and ceftriaxone (18.84%) was most frequently prescribed followed by metronidazole (9.90%) and levofloxacin (6.76%). Broad-spectrum antibiotics were prescribed in 66% of the total enrolled patients, whereas only 9% of patients underwent a culture sensitivity test. As per the WHO AWARE list, 50% of antimicrobial agents were from the watch category followed by 20% and 17% from the access and reserve category, respectively. The high use of broad-spectrum antibiotics suggests that there is a need for more awareness amongst the health care professionals and communities about the emerging antibiotic resistance problem which is mainly due to over and inappropriate use of antibiotics.

Prescribing Pattern of Antibiotics Using WHO Prescribing Indicators Among Inpatients in Ethiopia: A Need for Antibiotic Stewardship Program.

BackgroundIrrational prescribing of antibiotics is a universal public health problem, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is crucial to tackling irrational prescription. Yet, comprehensive studies regarding the prescribing pattern of antibiotics among inpatients and the need for an Antibiotic Stewardship Program (ASP) are lacking in Ethiopia. This study aimed to evaluate prescribing patterns of antibiotics and the need for an ASP.MethodsA hospital-based prospective observational study was carried out from February 2019 to December 2019. This study was conducted among patients admitted to Aksum University Comprehensive Specialized Hospital, Ethiopia. Data were collected using a data abstraction format generated by World Health Organization (WHO) prescribing indicators. Data analysis was carried out using SPSS version 25.0.ResultsA total of 1653 antibiotics were prescribed for 822 inpatients. Overall, 52.3% of patients had at least one oral and/or injectable antibiotic prescribed, for a mean duration of 4.2 (SD=2.3) days. The average number of prescribed antibiotics per patient was 2.01 (SD=1.9). The majority (97.6%) of antibiotics were prescribed by their generic name, and all prescribed antibiotics were from the national Essential Medicine List (EML). Frequently prescribed injectable and oral antibiotics were ceftriaxone (24.5%) and azithromycin (12.9%), respectively. Culture and sensitivity testing were not performed in any of the cases. During the study period, 65.2% of key antibiotics were available in stock.ConclusionIn this study, more than half of patients were on at least one antibiotic, and all antibiotics were prescribed from the national EML. However, all antibiotics were prescribed empirically. This result shows that the prescribing pattern of antibiotics in the hospital deviates from and is non-compliant with the standard endorsed by WHO. This study provides evidence for the necessity and a way forward for the establishment of an ASP in the hospital that may help to introduce the prescribing of antibiotics with the aid of culture and sensitivity tests, and to develop institutional guidelines.

Modern approaches to diagnosis and treatment of early-onset neonatal sepsis

Early-onset neonatal sepsis (EOS) remains the leading cause of morbidity and mortality, especially among premature babies. Therefore, accurate diagnosis, prompt monitoring of the course of the disease and an effective therapeutic strategy are a guarantee of improving the quality of medical care for newborns, as well as an important reserve for reducing perinatal losses. The aim of the work to summarize modern views on the diagnosis and treatment of early-onset neonatal sepsis in newborns with perinatal pathology. Results and their discussion. An analytical review of modern literature data on problematic issues of EOS diagnostics is carried out. The approaches are stated and the main directions of EOS management at the present stage are formulated. It was revealed that the lack of a consensus definition of neonatal sepsis, the nonspecificity of clinical data is a limiting factor in the timely accurate identification of the septic process. Insufficient diagnostic value of existing laboratory tests leads to defects in the registry and monitoring of this disease, the inability to conduct an objective assessment of the existing epidemiological and microbiological situation in the health care system and the subsequent effective implementation of preventive measures. Conclusions. In the conditions of modern scientific realities, none of the existing laboratory tests can sufficiently reliably confirm or deny the presence of EOS in a newborn child, which determines the search for new promising laboratory tests with high diagnostic and prognostic potential. The optimal treatment strategy for newborns with EOS is broad-spectrum antibiotics. However, today the global problem of excessive irrational prescribing of antibacterial drugs is associated with the formation of multidrug-resistant strains of bacteria, as well as the development of long-term adverse effects, which requires improved diagnostic and treatment algorithms for children who are in the risk group of the development of neonatal sepsis by implementing a comprehensive approach using modern accurate tests in the dynamics of the disease

Parental knowledge, attitude and practice regarding antibiotic use in children at a municipal corporation in Northeast India

Background: Parental beliefs and expectations often lead to abuse and irrational prescriptions of antibiotics in pediatric population. The goal of this study was to examine parental knowledge, attitudes, and practices (KAP) about antibiotic use in children at the Agartala Municipal Corporation (AMC) area in northeast India.Methods: This cross- sectional study was undertaken after ethics committee approval. A questionnaire was given to parents participating in the study. The questionnaire had questions on socio-demographic profile and questions from knowledge, attitude and practice domains regarding use of antibiotics. Data was collected by house to house visit. Descriptive statistics was used to assess the knowledge and practice level and to explore the attitude about antibiotics use. Chi-square test was used to find out the determinants associated with knowledge level.Results: A total of 254 participants responded to the study. Their mean age was 31.3 (S.D; 7.8) years. Adequate knowledge about antibiotic use was found in 59.1% (150) participants. Parental age, sex, educational level, and number of children was found to be associated with the knowledge and practice of antibiotics use. 33.5% (85) respondents felt that antibiotics should be prescribed for their child whenever they suffer from cold, ear ache, throat pain. 70.9% (180) of the respondents do not give antibiotics without consulting a doctor.Conclusions: There is a trusted relationship between parents and their child's doctors. But many parents have insufficient knowledge related to antibiotic use in children. This results in inappropriate attitudes and practices. Educational interventions will reduce inappropriate use of antibiotics.

Medical Knowledge Graph to Enhance Fraud, Waste, and Abuse Detection on Claim Data: Model Development and Performance Evaluation

BackgroundFraud, Waste, and Abuse (FWA) detection is a significant yet challenging problem in the health insurance industry. An essential step in FWA detection is to check whether the medication is clinically reasonable with respect to the diagnosis. Currently, human experts with sufficient medical knowledge are required to perform this task. To reduce the cost, insurance inspectors tend to build an intelligent system to detect suspicious claims with inappropriate diagnoses/medications automatically.ObjectiveThe aim of this study was to develop an automated method for making use of a medical knowledge graph to identify clinically suspected claims for FWA detection.MethodsFirst, we identified the medical knowledge that is required to assess the clinical rationality of the claims. We then searched for data sources that contain information to build such knowledge. In this study, we focused on Chinese medical knowledge. Second, we constructed a medical knowledge graph using unstructured knowledge. We used a deep learning–based method to extract the entities and relationships from the knowledge sources and developed a multilevel similarity matching approach to conduct the entity linking. To guarantee the quality of the medical knowledge graph, we involved human experts to review the entity and relationships with lower confidence. These reviewed results could be used to further improve the machine-learning models. Finally, we developed the rules to identify the suspected claims by reasoning according to the medical knowledge graph.ResultsWe collected 185,796 drug labels from the China Food and Drug Administration, 3390 types of disease information from medical textbooks (eg, symptoms, diagnosis, treatment, and prognosis), and information from 5272 examinations as the knowledge sources. The final medical knowledge graph includes 1,616,549 nodes and 5,963,444 edges. We designed three knowledge graph reasoning rules to identify three kinds of inappropriate diagnosis/medications. The experimental results showed that the medical knowledge graph helps to detect 70% of the suspected claims.ConclusionsThe medical knowledge graph–based method successfully identified suspected cases of FWA (such as fraud diagnosis, excess prescription, and irrational prescription) from the claim documents, which helped to improve the efficiency of claim processing.

Assessment of Rational Antibiotic Prescribing in Public Hospitals in Nasarawa State, Nigeria

Antibiotics are the most commonly used medicines in healthcare facilities globally; and they are often misused, especially in developing countries. Periodic assessment of antibiotic prescribing practices is essential to improve prescribing standards and ensure rational use. A cross-sectional, retrospective evaluation of antibiotic prescribing in public secondary and tertiary hospitals in Nasarawa State, Nigeria was carried out. A total of 2800 case sheets of patients who accessed the hospitals under review during the period 2008-2018 were randomly sampled and evaluated. Prescribing indicators of World Health Organization (WHO) and Strengthening Pharmaceutical System/United States Agency for International Development (SPS/USAID) were evaluated and compared with published standards for each of the indicators to identify irrational antibiotic use. Percentage of hospitalization with one or more antimicrobials prescribed was 75.6%. Average number of antimicrobials prescribed per hospitalization in which antibiotics were used was 1.75±0.66. Percentage of antibiotic prescribed consistent with hospital formulary was 100.0%. Average duration of prescribed antimicrobial treatment was 5.57±2.42 days. Percentage of antimicrobials prescribed by generic name was 45.8%. Percentage of injectable antibiotic used was 36.4%. Percentage of antimicrobials prescribed from the national essential medicine list was 85.7%. Average encounter with antibiotic was 0.82±0.2. Many of the prescribing indicators deviated from the WHO or SPS/USAID optimal values; and thus, were predictors of irrational antibiotic prescribing. Continuous education and re-training of prescribers in public hospitals in Nasarawa State to comply with approved standards of prescribing should be emphasized in to ensure rational antibiotic use.

Critical Evaluation of Drug Advertisements in a Medical College in Lalitpur, Nepal.

PurposeThe information provided in drug advertisements (DAs) often do not follow the recommended criteria and may promote irrational prescribing behaviors. Recently Health Action International (HAI) formulated detailed criteria to evaluate DAs which further develop and expand on the World Health Organization (WHO) criteria. This study was done to evaluate DAs using both criteria.MethodsThe study was carried out from October 2019 to January 2020 in the Department of Pharmacology of KIST Medical College, Lalitpur, Nepal. A structured proforma was used to collect data.ResultsAltogether 100 DAs were analyzed. Maximum (85%) were having pictorial presentations. Majority (89%) were found to have authentic information and 3% were found to have exaggerated information. All DAs mentioned generic name, brand name, active drug per dosage form and approved therapeutic uses. Only 4% of DAs mentioned about the adverse effects that can be caused by the use of these medicines. The DAs evaluated as per the HAI criteria for pictures and images showed that people portrayed did not seem to be Nepalese. Females and males were portrayed differently with females being laypersons and males being healthcare professionals. Nineteen DAs contained 33 references to scientific literature. Thirty references contained adequate citation information to be identified and were retrievable. Retrieved references were of high methodological quality and from peer-reviewed journals. There was only one graph in the DAs and it contained the number needed to treat (NNT) information. The graph was not having statistical calculations and was not obscured by other visual material.ConclusionUsing both HAI and WHO criteria for assessing the DAs was the strength of this study. None of the DAs fulfilled all the criteria. Additionally, lack of any information on harm in the large majority of DAs, and very limited backing of claims with references was also seen.

Antibiotics Prescription Pattern and their Financial Burden before and after Intervention in Traumatic Injuries

Background: Antibiotics contribute to a lot of patients’ treatment. However, improper prescription and wasteful use of antibiotics may lead to various side effects or complications such as medicinal resistance and lack of treatment, resulting in an excessive financial burden. Objectives: The present study aimed to compare antibiotics prescription pattern and their financial burden before and after intervention based on prophylactic antibiotics guidelines in traumatic surgical sections. Methods: This analytical and cross-sectional study was conducted in 2018 on patients undergoing surgery in 4 general, urology, neurosurgery, and orthopedics surgery sections. The sample consisted of 464 patients with traumatic injuries. A researcher-made questionnaire was used as a principal instrument for gathering data. The data was analysed using SPSS (version 21). Results: The accordance of dose, method and kind of prescribed antibiotics with the instructions and guidelines after intervention increased to 29, 5.1 and 28.8%, respectively. There was a significant relationship between dose, method, and kind of prescribed antibiotic before and after the intervention (p <0.05). The financial burden of prescribed antibiotics before and after the intervention was 56400480 and 52789290 IRR, respectively. Conclusion: Based on the results, the intervention was effective in accordance with dose, method and kind of prescribed antibiotics. Also, financial burden reduced by 6.4% after the intervention. Continuous monitoring of antibiotic prescription based on instructions, training instructions of prophylaxis antibiotics to physicians, and infectious monitoring committee meetings can prevent irrational prescriptions and reduce the excessive financial burden on society, government and insurance organizations.

Assessment of Drug Prescription Pattern in Mekelle General Hospital, Mekelle, Ethiopia, Using World Health Organization Prescribing Indicators.

Introduction Irrational prescribing is a major cause for irrational drug use. Bad prescribing habits lead to ineffective and unsafe treatment, exacerbation or prolongation of illness, distress and harm to the patient, and higher costs. Incidence of irrational prescribing practice cannot be reduced without a critical intervention by assessing the causes. Objectives The objective of this study was to assess drug prescription pattern, using WHO prescribing indicators, in OPD at Mekelle General Hospital (MGH) Methodology. The study was conducted at Mekelle General Hospital (MGH), Mekelle, Northern Ethiopia, from December 2016 to April 2017. A descriptive cross-sectional, retrospective hospital-based study design was used to assess prescriptions at OPD in MGH from 01 January to 31 December 2016. A systematic random sampling technique was used to select prescriptions at the time of data collection. Result 384 prescriptions were analyzed. 751 medications were prescribed from which 679 (90.4%) were with their generic name, 225 (58.6%) prescriptions contained antibiotics, 162 (42.2%) prescriptions were encountered with injection, and 648 (86.3%) encountered from the hospital list of medicine. Conclusion In general, average number of drugs per encounter, generic prescribing, and the use of EDL/formulary of the hospital to prescribe drugs reviewed in this study were totally out of the recommended values and hence inappropriate. The study also revealed overprescribing of both antibiotics and injections.

Pattern of skin diseases and common drugs prescribed in dermatology outpatient department of Kathmandu Medical College-Teaching Hospital, Duwakot

Background: There is a wide variation in the pattern of skin diseases in different countries and the pattern even varies across different parts within the same country. For the treatment purpose different classes of drugs and combinational products are widely used in dermatology. Periodic prescription analysis in the form of drug utilization study can improve the quality of prescription and decrease irrational prescribing.&#x0D; Objectives: The objective of the study was to find the pattern of skin diseases and the common group of drugs prescribed in Kathmandu Medical College Teaching Hospital at Duwakot.&#x0D; Methodology: A prospective, observational, single center study was conducted at Dermatology outpatient department of Kathmandu Medical College Teaching Hospital at Duwakot, from December 2018 to June 2019 and a total of 300 prescriptions were collected during the study period. The data were collected from patient card and details were filled in the predesigned proforma.&#x0D; Results: A total of 300 prescriptions were collected and analyzed for demographic profile, disease incidence and drug prescription. Most common condition observed were dermatitis 50 (16.7%), tinea 43 (14.3%), urticaria 31 (10.3%). Antihistaminics (28.7%), corticosteroids (16.9%) antibiotics (14.8%), antifungals (14.8%) were the most common class of drugs prescribed. Drugs prescribed were mainly given by topical route (50.6%) followed by oral route.&#x0D; Conclusion: The current study revealed that the mean number of drugs/prescriptions was slightly higher than the recommended limit of two approved by world health organization and the practice of poly-pharmacy was occasionally seen.

Strengths and Barriers in Achieving “Green Status” of Breastfeeding; The Story of Frontline Health Care Workers in Sri Lanka

Abstract Objectives The achievements in breastfeeding in Sri Lanka are due to multiple factors and the work of frontline health care workers: public health midwives (PHMs) was crucial. Objective of this study is to explore the strengths and constraints of PHMs in optimizing breastfeeding practices in the Sri Lankan community. Methods We conducted a series of focus group discussions with PHMs in three different areas in Anuradhapura district Sri Lanka. Transcribed data were analyzed thematically to identify the types of strengths and constraints. Results Thirty six PHMs participated in the focus groups conducted. The well-established public health system that introduces and reinforce knowledge and skills on breastfeeding assured that mothers will adhere to the current recommendations on EBF. PHMs agreed on the support given by the hospital labor room, theatres and Lactation Management Center on early initiation and EBF. However, emphasis on attachment to breast rather than discharging a newborn on cup feeding was mentioned. PHMs devotion on establishing proper breastfeeding during the early postpartum home visits, the respect and acceptance of PHM by the mother and the community and the knowledge and skills they possess on breastfeeding counseling were highlighted. Irrational prescription of formula by medical practitioners, negative verbal comments by in-laws and unfavorable attitudes of mothers of high social class were seen as social obstacles to promote EBF. The PHMs seem to work with many barriers which could compromise care provision for mothers and children. Inability to attend for the home visit early due to scheduled work, the increased time needed to spent to counsel mothers and subsequent restriction of the daily duties, high population density and having to cover the vacant areas through out, excessive documentation work were problems needed to be addressed with regard to service enhancement. Conclusions The PHMs role is inevitable and Sri Lanka needs to enhance and facilitate service provision of grass root level health workers to optimize promotion, protection and support for EBF. Funding Sources No funding source.

A prospective study on antibiotic prescribing pattern among in-patients of medicine department of a tertiary care hospital

Background: Irrational prescription is a major contributor to the antimicrobial resistance. Tertiary care centres in a state are the centres of excellence where policies are framed. So, they have an important role in promoting rational antibiotic prescription.Methods: The study was conducted on in-patients of medicine ward in government medical college, Calicut, for a period of 2 months (January to February 2018), The data was collected from IP case records of patients. The parameters checked includes appropriateness of the antibiotic as, to whether it is according to our hospital antibiotic policy, whether de-escalation and change to oral drug was done, whether it is prescribed by generic name, is it given as fixed drug combination (FDC), is it from national list of essential medicine.Results: Among the 135-prescription analyzed, total 225 antibiotics were used. Cephalosporins (32%) were the most commonly used. Of this only 40% was given by generic prescription. 27% was FDCs. 55% was from national list of essential medicines and 69% of them were ‘WATCH’ drug according to WHO Antibiotic Policy. Regarding appropriateness of prescriptions around 56% included right drug, 93% had right dose and frequency, and 70% had right duration and 100% were given through right route.Conclusions: Strict adherence to hospital antibiotic policy and plan for effective teaching programs regarding antibiotic resistance and importance of rational prescription of antibiotics can improve the quality of antibiotic prescription and minimize antibiotic resistance.

Cross-sectional study of drug utilisation in a Chinese neonatal unit.

ObjectiveThis study aimed to describe drug utilisation in a large Chinese neonatal unit and to compare the findings with those from other countries.MethodsData were collected from electronic medical records. Prescription drugs were defined as the number of unique medication names for each patient. Medicine doses were defined as the total number of doses of all medicines administered. Information was collected regarding drugs prescribed to inpatients between March 1 and April 1 2018 in the neonatal intensive care unit and the general neonatal ward of West China Second University Hospital.ResultsThe 319 neonates received 1276 prescription drugs and 11,410 medicine doses involving 81 drugs. Vitamin K1, hepatitis B vaccine, and cefoperazone-sulbactam were the three most frequently prescribed drugs. Antimicrobials were the most frequently used group of medicines, with cefoperazone-sulbactam and piperacillin-tazobactam the most frequently used in an off-label manner. Domperidone and simethicone were both widely used.ConclusionsThe most commonly prescribed antimicrobials differed greatly from those reported for other countries. The evidence base for the use of some medicines is poor, and is indicative of irrational prescribing.

EVALUATION OF ANTIBIOTIC USE IN 2018 AT THE KEBAYORAN BARU PRIMARY HEALTH CARE, INDONESIA, USING THE ANATOMICAL THERAPEUTIC CHEMICAL/DEFINED DAILY DOSE METHOD

Objective: The abnormally high use of antibiotics can indicate irrational prescribing. One of the ways by which to support rationally prescribingantibiotics is by evaluating their frequency of use. This study aimed to evaluate the use of antibiotics in 2018 by outpatients at the Kebayoran BaruPrimary Health Care of Indonesia.Methods: The study was a cross-sectional and descriptive design. Data were collected retrospectively from sampling outpatient records. The data wereon oral antibiotics prescribed in 2018 at Kebayoran Baru Primary Health Care. There were 10,553 prescriptions for oral antibiotics used as the studysamples. Both quantitative and qualitative evaluations were conducted. The quantitative evaluations were conducted using the method recommendedby the World Health Organization, namely, the anatomical therapeutic chemical/defined daily dose (DDD), and the qualitative evaluations wereconducted using the 90% drug utilization (DU 90%) method and the suitability of antibiotic use with the list of drugs in the Indonesian nationalformulary for the first-level health facilities (FKTP).Results: Three of the antibiotics used most often were amoxicillin at 0.9358 DDD/1000 inhabitants/d, ciprofloxacin at 0.4940 DDD/1000inhabitants/d, and cefadroxil at 0.1983 DDD/1000 inhabitants/d. The drugs within the DU 90% segment were amoxicillin, ciprofloxacin, cefadroxil,and thiamphenicol. There was 70% compatibility of antibiotic use with Indonesian national formulary for the FKTP.Conclusion: We suggest that the use of antibiotics at Kebayoran Baru Primary Health Care tended to be on the high side and not in accordance withnational guidelines.

Study on rationality of different fixed dose drug combinations in tertiary care hospital: an evaluation study

Background: The fixed dose drug combinations (FDCs) of drugs is defined as product of two or more active ingredients in a defined composition. There is a need to study the pattern of prescription from time to time to evaluate their rationality. In this context we undertook this study to know the prescription pattern of FDC in our setting. To study the rationality of different prescribed FDCs.Methods: This is a prospective study which is carried out in NIMRA Institute of medical sciences which is a tertiary care teaching private hospital. For this study we have collected one thousand prescriptions of patients for 3 months that is from 10th March 2017 to 25th of June 2017 including both in-patients as well as outpatients. Selection criteria of patients mainly basing on their willingness to give prescriptions. Institutional ethical committee permission was taken for the study. The prescribed FDCs were compared with the essential drug list of FDCs approved by Drugs Controller General of India, July 2018. we have used descriptive statistics to analyze data. The percentage of FDCs used in each class and their contribution to overall FDCs were calculated.Results: In a total of 2952 drugs were prescribed, of this 747 were FDCs and 2205 were non FDCs. In the prescribed FDCs 89.2% drugs were rational and 10.8% drugs were irrational.Conclusions: From this study, we can conclude that 10.8% of irrational prescription of fixed dose drug combinations are prescribed in Nimra Institute of Medical Sciences which is a tertiary care teaching private hospital.

Analysis of rational prescribing in “X” Hospital, Jakarta

Background: The irrational prescribing is one of the problems in health care in Indonesia. The irrational prescribing can cause medication errors, increase costs, the possibility of adverse drug side effects or drug interactions that may inhibit the quality of care. The purpose of this study is to know the rationality of drug prescribing in March 2016 in Hospital X, Jakarta.Methods: This study assessed a prescribing which admitted in March at X hospital with descriptive analysis design and samples taken by multistage sampling.Results: 384 prescription were used and the results of this study : 23,96 % (92) rational prescribing, 5,47 % (21) incomplete administrative prescription, 15.88% (61) overprescribing, 11.20% (43) underprescribing, 15,36 % (59) multiple prescribing, 4.95 % (19) extravagant prescribing and 23.18% (89) polypharmacy.Conclusion: Rational presription 23.96% and the most irrational prescription form is polypharmacy 23.18% .

Study of Drug Utilisation and Prescribing Pattern in the Department of Dermatology

Skin diseases seriously impact the quality of life of an individual. It affects all age groups and its chronic nature disturbs the financial status of the sufferer and family. Periodic audit of prescription in the form of drug utilisation study is a way to improve the quality of prescription and reduces the irrational prescribing and use of drugs. The present study was done to assess the drug prescribing patterns in dermatology outpatient department.

Knowledge, attitude and antibiotic prescribing patterns of medical doctors providing free healthcare in the outpatient departments of public hospitals in Sierra Leone: a national cross-sectional study.

Antibiotic resistance is a global health crisis and irrational prescribing behaviour has been identified as a contributing factor. The current study aimed to assess the knowledge of, attitudes towards and practices regarding antibiotic prescribing of medical doctors providing free healthcare services in the outpatient departments of public hospitals in Sierra Leone. In addition, we evaluated prescribing patterns of antibiotics. The study has two parts. First, we conducted a cross-sectional survey using a self-administered questionnaire to assess doctor's knowledge of, attitudes towards and practices regarding prescribing antibiotics. Second, using patient medical records, we used the World Health Organization methodology on how to assess drug use in health facilities to evaluate prescribing patterns of antibiotics in four selected public hospitals in Sierra Leone. Of 130 administered questionnaires, 119 were returned, for a response rate of 91.5%. The majority of doctors (n=83 [69.7%]) agreed that amoxicillin is safe in the first 3weeks of pregnancy and considered antibiotic resistance a global (n=108 [90.7%]) and national (n=97 [81.5%]) public health crisis. Less than a quarter of medical doctors agreed that antibiotics may speed up the recovery when added to malaria (n=25 [21%]) or cold and cough (n=81 [68%]) therapies. Prescribing pattern results show that children <5y of age (adjusted odds ratio 5.199 [confidence interval 2.743 to 9.855], p<0.0001) were more likely to be prescribed an antibiotic than pregnant women/lactating mothers. Penicillins were the most commonly prescribed pharmacological class of antibiotics, with amoxicillin being the most commonly prescribed penicillin. Doctors demonstrated a sound knowledge of antibiotics and antibiotics resistance, with a positive attitude towards prescribing antibiotics. However, the prescribing pattern of antibiotics was irrational, necessitating the need for the establishment of audit and feedback programmes such as antimicrobial stewardship programmes.

Tragedy of Errors- An Analysis of Human Factor in Medical Errors

William Shakespeare wrote a play “Comedy of error”, but this is about medical error which may often result in tragic outcome. We often read about medical errors and sometimes realise in our clinical practice that an error has been committed by us or our team leading to an adverse event. Sometimes, these errors are due to lack of knowledge and sometimes due to improper communication and misinterpretations. The aim of this manuscript is to analyse the causes of medical errors, which may vary from irrational prescription, attitudes of arrogance in seniors and juniors leading to communication gaps, bad hand writings or wrong patient selection for surgical intervention for economic benefits. Use of Artificial intelligence, Data mining and Medical informatics can rectify errors of improper assessment and irrational prescription. Self-introspection and spirituality can prevent errors arising from attitudes of arrogance, fear, greed and pride in medical professional.

Outpatient prescribing and antibiotic use for children in a tertiary hospital

Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance, and treatment failure. Assessment of prescribing practices helps monitor the utilization of medicines. Objectives: The aim of this study was to evaluate the prescribing pattern and utilization of antibiotics for children attending outpatient units. Materials and Methods: This was a descriptive, retrospective study of outpatient pediatric prescriptions received at the pharmacy of a Nigerian teaching hospital, using the World Health Organization (WHO) core prescribing indicators and Index of Rational Drug Prescribing (IRDP). Prescription information for a 2-year period was collected on a standardized prescribing form. Computer data entry was made into Microsoft Excel 2010 spreadsheet. Data analysis was done using SPSS Version 20(IBM, Corp., Armonk, NY, USA). Results were compared with the WHO core prescribing indicators and presented as means, frequencies, proportions, contingency tables, and charts comparing with published standards. Results: There were 3445 eligible prescriptions, with mean child age of 3.2 (±2.9) years. An average of 2.4 (±1.6) drugs were prescribed per encounter, with 48.2% written in generic names. Prescriptions containing oral antibiotics and antibiotic injections constituted 50.2% and 41.2%, respectively. Medicines prescribed were available in the essential medicines list in 95.5% of cases. The IRDP was 2.98 against the ideal of 5. Majority (71.3%) of antibiotic-containing prescriptions had one antibiotic prescribed while β-lactam penicillins and cephalosporins were the most prescribed, with ampicillin/cloxacillin being the most common combination. Conclusion: Irrational prescribing and inappropriate antibiotic use were prevalent in this tertiary hospital. Similar studies are needed to describe the trends in all Nigerian tertiary hospitals, along with retraining on rational prescribing.