Volume 8, Issue 12, December – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Assessment of Appropriateness of Medical

Prescriptions in Community Pharmacies and
Adoption of WHO Prescribing Indicators
M Kumaraswamy1, Harshitha V*1, Anvil Preem Rebello1, Rithesh Patel1, Sanjay Gowda AV1, Chandrakala D1
1
Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B G Nagara, Karnataka (571448) India

Corresponding Author:- Harshitha V*

Department of Pharmacy practice
Sri Adichunchanagiri college of pharmacy,
B G Nagara, Karnataka (571448) India

Abstract:- Prescription auditing is critical because auditing is critical because poor prescribing practices, such as
improper prescribing practices, such as medication medication misuse, overuse, and underuse, can result in risky
abuse, overuse, and underuse, can result in patient treatment, a worsening of the illness, health risks, financial
financial hardship, dangerous treatment, and resource hardship for the patients, and resource waste. One can
waste, particularly in community pharmacies. This study distinguish between the technical and conceptual components
was aimed to determine the appropriateness of medical of a prescription. The cognitive component involves making
prescriptions dispensed in community pharmacy. 1,010 decisions, which involves comprehending the diagnosis,
prescriptions filled in the three community pharmacies medication interactions, and prescription contraindications.
during a six-month period were gathered for a The technical portion is providing the pharmacists with
prospective observational study. The World Health essential information, like the drug's name and dosage [2,3].
Organization's basic drug prescribing indicators were
used to analyze each prescription, and an additional 16 By raising the bar for medical care at every stage of the
essentials were evaluated. The findings demonstrated that health care delivery system, people's quality of life can be
the proportion of medications prescribed under generic enhanced. The compliance with these guidelines is monitored
names was significantly lower than the WHO- by a medical audit [4,5]. Prescription auditing requires us to
recommended ideal value. It is recommended that analyze the following parameters: department, clinical
prescribers get ongoing education regarding appropriate diagnosis, prescribing criteria, patient demographics, doctor
prescription practices and incentives for writing name and signature [5,6]. Inappropriate use of drugs is
prescriptions for generic medications. To meet the WHO believed to be more of an issue in the Global South. Given
core criteria of medication prescribing, we advise that between 25% and 70% of global health care spending is
prescribers to be aware of the importance of safe and allocated to pharmaceuticals, this could have an impact on
rational prescribing practices, and to receive frequent health care expenditures [7,8].
training, evaluation, and monitoring.
Research conducted throughout India has revealed that
Keywords:- Prescription Auditing; World Health nearly all handwritten prescriptions lacked patient
Organization; Rational Prescribing; Community Pharmacy; information when audited. The World Health Organization
Generic Name. (WHO) promoted improved patient management and
pharmaceutical use by developing prescribing indicators to
I. INTRODUCTION analyze prescriptions. The number of medications prescribed
each contact, the proportion of medications provided by
Prescription auditing is an ongoing cycle that includes generic name, the proportion of encounters involving
practice observation, standard-setting, practice comparison injections and prescriptions for antibiotics, and the proportion
with standards, change implementation, and practice of medications recommended from the Essential Medicine
observation of new practices. It is a thorough, critical List (EML) were among the prescribing indicators [8,9].
examination of the standard of medical care, covering the
methods utilized for diagnosis and treatment, the utilization Upon analysis, it was discovered that the prescriptions
of resources, the final result, and the patients' quality of life. lacked information regarding the patient's history, physical
It is based on documented data to back up the diagnosis, examination, diagnosis, and investigations. The reasons may
course of care, and sensible application of hospital resources. include a high volume of cases in the outpatient department,
For the public, patients, health care management, and vague concerns, or doctors communicating verbally rather
medical practitioners, effective prescription auditing is than in writing. In addition, prescribing errors involving
essential. It helps medical practitioners ensure that their dosage calculations and treatment duration omissions were
patients get the finest care possible [1,2]. Prescription pattern prevalent in 26.7% and 27.5% of cases, respectively.

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Volume 8, Issue 12, December – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Recurring dose, duration, and omission errors were the most A. Assessment part 1
common forms of prescribing errors seen in multiple The following details were evaluated for each
international studies [3,8,10,11]. Prescription auditing aids in prescription: Patient information included: Name, gender,
evaluating the volume of patient-related data included on address, and age of the patient, Prescription is Legible, Drug
prescriptions, professional prescribing practices, the name correctly mentioned Block capitals are used, Dosage
appropriateness of drug availability and usage, drug Form clearly written, Dose with clear Units, Route of
dispensing procedures, and dispensary workload [12]. Administration stated, Frequency of Dose mentioned,
Presence of Therapeutic Duplication, Drug-Drug
II. METHODOLOGY Interactions, Date, Signature Name & address of prescriber.
Item was scored depending on whether the pertinent piece of
A Prospective and Observational study is conducted in information was missing (0) or present (1).
selected community pharmacies namely, Mahaveera
Medicals, Cheluva Store & Fathima Medicals in and around B. Assessment part 2
Bellur, B.G Nagara. In order to compile a representative The primary prescribing metrics evaluated were:
sample of the community pharmacy population, a total of  Quantity of prescribed drugs
1,010 prescriptions filled over the course of six months were  Number of prescription items for generic drugs
dispensed at three different community pharmacies. Each  Quantity of prescribed antibiotics
participating pharmacist collected information on patients'  Quantity of prescribed injections
age, gender, diagnosis, specialty of the prescribing physician,  Quantity of prescription medications from the essential
name of the medications in each prescription, dosage, and drug list (EDL).
quantity of medications dispensed, all while maintaining the
confidentiality of all personal data from each prescription, III. STATISTICAL ANALYSIS:
including the patient's name and address. This was done with
the patient's oral and written consent. Data were entered into Microsoft Excel spread sheets
and cross checked for its accuracy. The statistical analysis
was performed using Microsoft Excel for windows.

IV. RESULTS

Table 1: Percentage of prescriptions with different criteria mentioned in it.

Criteria Frequency Percent
Name of patient mentioned 1010 100%
Gender 842 83.36%
Address of patient mentioned 168 16.63%
Age of patient mentioned 926 91.68%
Prescription is legible 169 16.73%
Drug name correctly mentioned 169 16.73%
Block capitals are used 84 8.31%
Dosage form clearly written 842 83.3%
Dose with clear units 926 91.68%
Route of administration stated 589 58.31%
Frequency of dose mentioned 785 77.72%
Presence of therapeutic duplication 112 11.08%
Drug interactions 120 11.88%
Date 898 88.91%
Signature 692 68.5%
Name and address of prescriber 1010 100%

Table 2: WHO criteria of prescribing indicators

Average number % of drugs prescribed % of prescriptions % of injections % of drugs prescribed
of drugs in generic name containing antibiotics from EDL
2.96% 16% 17% 13.33% 40.49%

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Volume 8, Issue 12, December – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

2.96% V. DISCUSSION

16% Prescription clarity is the most crucial prerequisite for

40.49%
prescription writing. It should be easy to read and specify
exactly what needs to be provided [13]. In this study, the
17% 1010 prescriptions were collected from community
pharmacies and analyzed. In our analysis, 50.39% of
prescriptions were from females and 49.60% from males. In
13.33% comparable research by Kaur and Walia, the population was
dominated by men (54.2%) and women (44.8%) [14]. There
were 46.73% females and 53.27% males in a research by
Darji et al. [15]. In a different study by Kumar and
Average number of drugs Rajasekhar, 52% of participants were women and 58% were
% of drugs prescribed in generic name men. When analyzing WHO core prescribing indicators,
average number of medicines per prescription was 3 as per
% of prescriptions containing antibiotics this study. The WHO proposes less than 2 to be an optimal
value [Table 3].
% of injections

% of drugs prescribed from EDL

Fig 1 WHO Criteria of Prescribing Indicators

Table 3: Comparison of WHO core drug use prescribing indicators

Prescribing indicators Optimal values Values obtained in the audit
Average number of medicines per prescription <2 3
Percentage of medicines prescribed by generic name 100% 16%
Percentage of antibiotics per prescription <30% 17%
Percentage of injections per prescription <20% 13.33%
Percentage of medicines prescribed from the essential drug list 100% 40.49%

In the study of Kaur and Walia, the average number of prescribing patterns and indicators as well as how they relate
medications per prescription was 8.8 [14]. The average to the WHO core prescribing indicators. This aids in
number of medications per prescription was 6.49 out of 302 understanding the areas of patient care that require
prescriptions with 1986 medications in a study by Darji et al. improvement in our environment as well as the present
[15] and 1.8 out of 1440 prescriptions with 2610 medications prescribing practices. This study's limitation is that it was
assessed in a study by Bekele and Tadesse [18]. A high value conducted for a set amount of time only. Prescription
could result from monetary rewards, ongoing marketing auditing should, however, be a continuous procedure carried
campaigns by suppliers, or prescribers' lack of therapeutic out on a regular basis. It will support the monitoring of
training [16]. In contrast to research by Kaur and Walia [14], prescribing procedures and identify areas in need of
our analysis found that 16% of medications were prescribed improvement. The appropriate authorities can make
under their generic names. According to the WHO, 100 was adjustments if they are aware of the necessary corrections to
the ideal figure. Prescription rules are adhered to when provide high-quality patient care [13].
medications are prescribed from the essential medicine list or
in generic form. The low value could be the result of a lack VI. CONCLUSION
of trust in generic medications, a preference for branded
medications, or the unavailability of generic drugs [13]. The primary objectives of the research were to assess
the suitability of medical prescriptions filled in community
In our investigation, 16 percent of the prescriptions pharmacies and to identify any possible drug-drug
were readable. interactions by looking at the kind, quantity, and occurrence
of such interactions. Certain prescribing indicators in our
97.01% of legitimate prescriptions were recorded by study, such as the percentage of medications prescribed from
Bekele and Tadesse, and 86.8% by Kaur and Walia [14]. the essential drug list, the percentage of medications
Compared to Bekele and Tadesse, where it was 93.54%, the prescribed by generic name, and the average number of
doctor's signature was found on 68% of prescriptions [13]. medications per prescription, deviated from WHO guidelines,
Clarity in the prescription is the most crucial prerequisite for while other indicators, such as the percentage of prescriptions
prescription writing [17]. It should be easy to read and clearly for antibiotics and injections, were within optimal ranges.
outline the requirements for submission. Writing clearly is Merely 16% of the prescriptions were readable, which could
required by law. Our study's conclusions suggest that several be attributed to inadequate time and ignorance of the most
prescribing practices should be improved. This study's recent WHO criteria. The percentage of medications
strength is that it provides information on our setting's prescribed under generic names was much lower than the

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Volume 8, Issue 12, December – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
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