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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 114-117

Evaluation of the quality of prescription orders in a tertiary health-care facility in Southeastern Nigeria


Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka 410001, Nigeria

Date of Web Publication9-Apr-2018

Correspondence Address:
Nneka Uchenna Igboeli
Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka 410001
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_103_17

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  Abstract 


Background: Prescription orders serve as a source of communication linking the physician, patient, and pharmacist. However, inappropriate prescriptions may result in medication errors, thus may worsen clinical outcome and economic burden of the patient. Therefore, this study aimed at evaluating the quality of prescription orders in terms of completeness, appropriateness, and authenticity at a tertiary health-care facility in Nigeria. Methods: A retrospective, cross-sectional review of prescription orders from the Outpatient Pharmacy of the Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria. Data collection was done using a data collection form adopted from the World Health Organization (WHO) guideline for good prescription practice. This study was carried out between July and December 2012. Descriptive statistics were used for the purpose of analyzing extracted data. Results: Five hundred prescriptions were used in the study. Prescriptions containing the name of the prescribers and patients name and address were 0.8% and 97.8%, respectively. The age and body weight of the patients were documented in 17.6% and 38.8% of the prescriptions in that order. Thirty-five percent of the drugs were written in generic names, while most of the prescription orders had well-documented dosage form (95.6%), date of prescription (90.6%), and prescriber's initials or signature (83.0%). The direction for use by the physician was clearly written in <1½ (38.8%) of the prescriptions. Conclusion: Our findings suggest deviation from complete adherence to the basic principle of good prescription writing recommended by the WHO among medical practitioners in the study setting.

Keywords: Medication errors, outpatient pharmacy, prescription order, quality


How to cite this article:
Igboeli NU, Anosike C, Ukoha-Kalu OB, Ayogu EE. Evaluation of the quality of prescription orders in a tertiary health-care facility in Southeastern Nigeria. CHRISMED J Health Res 2018;5:114-7

How to cite this URL:
Igboeli NU, Anosike C, Ukoha-Kalu OB, Ayogu EE. Evaluation of the quality of prescription orders in a tertiary health-care facility in Southeastern Nigeria. CHRISMED J Health Res [serial online] 2018 [cited 2019 Sep 22];5:114-7. Available from: http://www.cjhr.org/text.asp?2018/5/2/114/229575




  Introduction Top


Prescription orders are essential documents in health-care delivery worldwide. It bridges the communication gap between the medical practitioners, patients, and the pharmacists.[1] Prescription orders should contain information such as date, patient's name, age, weight, name of drug(s), dose, route of administration, frequency of administration, duration of treatment, indication, and name and signature of prescriber.[2] A good prescription order should also contain sufficient information regarding medication use.[3]

Prescription errors as a result of inappropriately or incompletely written prescriptions can potentially affect the management of hospitalized or ambulatory care patients.[4],[5],[6] Previous studies indicate that issues with prescriptions still remain a significant problem in Africa, Europe, and America. For instance, in Nigeria, practice of polypharmacy and low rate of generic prescriptions are well documented.[7],[8],[9] Therefore, this study aimed to evaluate the quality of prescription orders at a teaching hospital in Enugu state, Nigeria.


  Methods Top


Study design and setting

The study was a descriptive, retrospective, cross-sectional assessment of randomly selected prescription orders from Outpatient Pharmacy Unit of the Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria. ESUTH is a tertiary hospital located in Enugu, the capital city of Enugu State, Southeastern Nigeria. This study was conducted for 6 months starting from July to December 2012.

Selection criteria

Prescription orders considered for selection in this study were those obtained from the outpatient pharmacy within the specified period of investigation (July 1–December 31, 2012). Worn out, damaged, and nonreadable prescriptions were excluded from the study. Of the 7860 prescription orders filled within the study period, 500 prescriptions were randomly selected for the study using systematic sampling technique. At least 80 prescriptions were selected per month.

Data collection

Data collection was done using a predesigned prescription review form adopted from the World Health Organization (WHO) checklist by a 3-member team of clinical pharmacists.[10] The review form consists of 14 items and 3 possible responses of “yes,” “no,” or “not applicable.” Extracted data include prescriber's information (name, address, and phone number), patient's information (name, address, age, and weight), date of prescription, inscription (drug name, strength, dosage form, and abbreviated names), subscription (quantity), doctor's instruction, and signature of the prescriber. The data were extracted by three investigators working together that screened the prescriptions based on the predetermined selection criteria.

Ethical consideration

The study protocol was approved by the Ethics Committee of ESUTH, Parklane, Enugu, Enugu State, Nigeria. We ensured confidentiality of information obtained from prescription orders during the course of the study.

Statistical analysis

The data collected were entered into Microsoft Excel Spreadsheet, and subsequently transferred to SPSS version 16 (SPSS for Windows, Chicago, SPSS Inc) for analysis. Descriptive statistics (frequencies and percentages) were used in analyzing the result.


  Results Top


A total of 500 prescriptions were assessed. Prescriptions containing the name of the prescribers and patient's name and address were 0.8% and 97.8%, respectively. The age and weight of the patients were documented in 17.6% and 38.8% of the prescriptions in that order. Other details are shown in [Table 1].
Table 1: Prescriber and patient data in prescription order (n=500)


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[Table 2] shows that 35.0% of the drugs were written in generic names, while most of the prescription orders had well-documented dosage form (95.6%), date of prescription (90.6%), and prescriber's initials or signature (83.0%). The direction for use by the physician was clearly written in <1½ (38.8%) of the prescriptions.
Table 2: Quality assessment and authentication in prescription order (n=500)


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  Discussion Top


In the present study, we aimed to evaluate the quality of prescription orders in terms of completeness, appropriateness, and authenticity in a tertiary health-care facility in Enugu, Enugu State, Nigeria. Our findings showed that the most frequently completed parts of the prescriptions assessed include patients' name and address, dosage forms, date of prescriptions, and prescriber's signature, while generic names of medications, prescribers' names and signatures, patient's age and body weight, and direction for medication use were barely documented on the prescriptions.

The prescriber's name, signature, and date of prescription serve to authenticate or validate prescriptions.[10] We found wide variation regarding the use of prescriber's names and signatures on the prescriptions. The former was rarely documented when compared to the later. Our findings were similar to the result of the study conducted by Abdella and Wade in Ethiopia, in which prescriber's names and signature were written on 16.4% and 76.3% prescriptions, respectively.[11] However, prescriptions bearing prescriber's names as reported in Saudi Arabia (83.3%) and India (90.6%) were higher compared to the present study.[12],[13] On the other hand, prescriber's signature was completely omitted in a study conducted in Jimma University Specialist Hospital, Ethiopia.[14] In addition, we found that the number of dated prescriptions in our study was considerably higher in comparison to the findings reported by Calligaris et al. in their study conducted at Italian University Hospital.[15] Although all the prescriptions in an Indian study were affixed with date of issuance,[16] the usefulness of prescriptions as medicolegal document may be affected by the omission of important information pertaining to the prescriber and validity of the prescription such as name, signature, and date of prescription.[17]

It is generally recommended that medications be prescribed using the generic names, as they are less expensive.[18],[19] Our result revealed that about one-third of the prescribed medications was done by means of generic names. This proportion of generic prescribing is rather low considering that the WHO recommends 100% generic prescription of medications,[20] especially as the study setting was a tertiary hospital that equally serves as center for teaching and training of internees and undergraduate students. Similar low generic prescribing of medications has been reported in Nigeria,[7] India,[21] and Saudi Arabia.[12] However, studies in Ethiopia documented far higher use of generic names in prescriptions.[11],[14] Possibly, our finding may be as a result of neglect of the significance of writing prescriptions using generic names by the prescribers or probably because of prescriber's preference for and familiarity with brand names of medications. Nevertheless, it is expected that increasing use of generic names not only help save cost for both patients, private insurers, and health-care systems but also reduces the incidence of drug duplication.[19]

Furthermore, our findings showed that patients' age, body weight, and direction for the use of prescribed medications were scarcely written on the prescriptions. Unlike our finding, Abdella et al.[11], Patil et al.[13], Irshaid et al.[12] and Fadare et al.[9] in their studies found that 81.8%, 64%, 77.3%, and 69.9% of the prescriptions, respectively, had clearly written age of the patient. However, several studies found no inclusion of body weights on the prescriptions.[12],[14],[22] Regarding prescribers directives for medication use on prescriptions, our finding was appreciably lower relative to the 89.1% documented in a study conducted in Peshawar, Pakistan.[23] Documentation of patients' age, body weight, and instruction of medication use have a vital role in the delivery of high-quality health-care services. Inclusion of age, body weight, and prescribers directives in prescriptions will most likely assist the pharmacist in detecting potential drug therapy problems (DTPs), verifying the prescribed dose of the medication,[24] and in provision of adequate patient education and counseling.

The most frequently used means of identification of prescription as found in the present study was the use of patients' name as seen in almost all the prescription orders. Our finding was consistent with the previous studies [12],[14] but slightly higher than the proportion reported in a similar study in India (87.1%).[13] However, the WHO recommended that all prescriptions be properly identified with the name of the patient.[10] Our study result was short of the above recommendation probably because of excessive workload of the physicians in our study setting as patient-to-physician ratio is exceedingly high. Hence, there is a need to improve the working condition in the study facility and other hospitals with comparable working environment.

Remarkably, our study had few limitations that deserve consideration in understanding and interpretation of the implications of its findings. First, it is a single-center study; hence, its findings may not be entirely applicable to other hospitals in Nigeria with different working protocol. Second, the sample size used was small, thus may not reflect the overall quality of prescription orders in the study setting and elsewhere, though the study spanned over 6 months. In addition, only outpatients' prescriptions were assessed; therefore, further research including inpatients prescription orders would enhance understanding of prescribing practice in Nigeria.


  Conclusion Top


Our findings suggest deviation from complete adherence to the basic principle of good prescription writing recommended by the WHO among medical practitioners in the study setting. Therefore, there is need for concerted effort of all stakeholders including the government and private organizations toward educational intervention involving training and retraining of medical practitioners aimed at improving prescription practice in Nigeria. In addition, policy aimed at implementing the use of electronic prescribing will not only improve the quality of prescribing but also reduce the incidence of medication errors in health-care system in Nigeria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shelat PR, Kumbar SK. Analysis of out door patients' prescriptions according to World Health Organization (WHO) prescribing indicators among private hospitals in Western India. J Clin Diagn Res 2015;9:FC01-4.  Back to cited text no. 1
    
2.
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Reddy B. Prescription writing standards: Why they are important. Nurse Prescr 2006;4:330-5.  Back to cited text no. 6
    
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Tamuno I, Fadare JO. Drug prescription pattern in a Nigerian tertiary hospital. Trop J Pharm Res 2012;11:146-52.  Back to cited text no. 7
    
8.
Erhun WO, Adekoya OA, Erhun MO, Bamgbade OO. Legal issues in prescription writing: a study of two health institutions in Nigeria. Int J Pharm Pract 2009;17:189-93.  Back to cited text no. 8
    
9.
Fadare JO, Agboola SM, Alabi RA. Quality of prescriptions in a tertiary care hospital in South-West Nigeria. J Appl Pharm Sci 2013;3:81-4.  Back to cited text no. 9
    
10.
De-Vries T, Henning R, Hogerzeil H, Fresle D. Guide to Good Prescribing: A practical manual. WHO. 2000. Available from: http://apps.who.int/medicinedocs/pdf/whozip23e/whozip23e.pdf [Last accessed on 2017 Sep 06].  Back to cited text no. 10
    
11.
Abdella S, Wade N. Prescribers adherence to the basic principles of prescrption orders writing in South West Ethiopia. Natl J Physiol Pharm Pharmacol 2012;2:1-5.  Back to cited text no. 11
    
12.
Irshaid YM, Al Homrany M, Hamdi AA, Adjepon-Yamoah KK, Mahfouz AA. Compliance with good practice in prescription writing at outpatient clinics in Saudi Arabia. East Mediterr Heal J 2005;11:922-8.  Back to cited text no. 12
    
13.
Patil KR, Dhangar BK, Bafna PS, Gagarani MB, Bari SB. Assessment of Prescribing Trends and Quality of Handwritten Prescriptions from Rural India. J Pharma Sci Tech 2015;5:54-60.  Back to cited text no. 13
    
14.
Tsegaye Melaku K, Gizat Molla K. Assessment of Prescribers' Adherence to the Basic Standards of Prescription Order writing in Jimma University Specialized Hospital. Southwest Ethiopia Exp 2014;19:1316-29.  Back to cited text no. 14
    
15.
Calligaris L, Panzera A, Arnoldo L, Londero C, Quattrin R, Troncon MG, et al. Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital. BMC Clin Pharmacol 2009;9:9.  Back to cited text no. 15
    
16.
Sudarsan M, Sitikantha B, Aparajita D, Sitikantha B. Audit and Quality Assessment of Prescriptions in an Urban Health Centre of Kolkata. International Journal of Medicine and Public Health 2016;6:136-9.  Back to cited text no. 16
    
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Panchbhai AS. Rationality of prescription writing. Indian J Pharm Educ Res 2013;47:7-15.  Back to cited text no. 17
    
18.
Kesselheim AS. Clinical Equivalence of Generic and Brand-Name Drugs Used in Cardiovascular Disease. JAMA 2008;300:2514.  Back to cited text no. 18
    
19.
Keenum AJ, DeVoe JE, Chisolm DJ, Wallace LS. Generic medications for you, but brand-name medications for me. Res Soc Adm Pharm 2012;8:574-8.  Back to cited text no. 19
    
20.
Isah A, Ross-Degnan D, Quick J, Laing R, Mabadeje A. The development of standard values for the WHO drug use prescribing indicators. Int Conf Improv Use Med 2004;1:1-6.  Back to cited text no. 20
    
21.
Kumari R, Idris MZ, Bhushan V, Khanna A, Agrawal M, Singh SK. Assessment of prescription pattern at the public health facilities of Lucknow district. Indian J Pharmacol 2008;40:243-7.  Back to cited text no. 21
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22.
Phalke VD, Phalke DB, Aarif SMM, Mishra A, Sikchi S, Kalakoti P. Prescription writing practices in a rural tertiary care hospital in Western Maharashtra, India. Australas Med J 2011;4:4-8.  Back to cited text no. 22
    
23.
Raza UA, Khursheed T, Irfan M, Abbas M, Irfan UM. Prescription patterns of general practitioners in peshawar, Pakistan. Pakistan J Med Sci 2014;30:462-5.  Back to cited text no. 23
    
24.
World Health Organisation. Medical Records Manual: A Guide for Developing Countries. Philippines: WHO Libr. Cat. Publ. Data, West. Pacific Reg 2006;1-126.  Back to cited text no. 24
    



 
 
    Tables

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