prescription audit in a pharmacy of a tertiary care hospital balakrishnan s department of...
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Prescription audit in a pharmacy of a tertiary care hospital
Balakrishnan SDepartment of Pharmacology
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“Doctors who seek to exculpate themselves from serious, even
fatal, prescribing errors by appealing to undoubted difficulties
presented by the information explosion of modern times, allied
to pressures of work, are unlikely to get sympathy, and
increasingly are more likely to be told, ‘if you can’t stand the
heat, get out of the kitchen’ ( a dictum attributed to Harry S
Truman, US president 1948 – 52, though he assigns it to US
Army General Harry Vaughn).”
Pharmacists and nurses stand ready and willing to relieve Pharmacists and nurses stand ready and willing to relieve
doctors of the burden of prescribing. doctors of the burden of prescribing.
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A 62 – year old man requiring a metered dose inhaler ( for
the first time ) was told to “spray the medicine to the throat” .
He was found to have been conscientiously aiming & firing
the aerosol to his anterior neck around the thyroid cartilage ,
four times a day for two weeks.
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Accuracy includes legibility:A doctor wrote Intal ( sodium
cromoglycate ) for an asthmatic patient . The pharmacist
read it as Inderal ( propranolol). The patient DIED.
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Some facts :
Medical errors kill an estimated 44,000 – 98,000
Americans & injure 10,00,000:
1st surgical mishaps
2nd therapeutic mishaps & diagnostic errors.
20 – 25 % of litigations are following medication errors.
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??????
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Methodology:
WHO approved
Random prescription audit from 10 AM to 11 AM in OPD pharmacy -5 days a week –about 25 prescriptions / day
Duration: March 27 – April 26, 2009
Total number of prescriptions collected: 516
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Methodology:
Patient no. 1 2 3 4 5 6 7
Dept.
No. of drugs
Drugs by Generic
Drugs by brand name
No.drugs not dispensed
No.drugs not requested so not stocked
No. with doses not clear
No. with duration not written
No with name and designation not written
PROFORMA FOR PRESCRIPTION AUDIT MARCH 27-APRIL26 2009
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Results:
NONE OF THE PRESCRIPTIONS HAD DIAGNOSIS WRITTEN ON THEM!
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Results:
No. of prescriptions with department written 151 /516 (29%)
No. of prescriptions with department not written 365/ 516 (71%)
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Results:
Medicine - 20
ENT - 20
Neurology - 13
Neurosurgery - 13
OBG - 10
Dermatology - 10
Orthopedics - 10
TB Chest - 7
Nephrology - 7
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Results:
Psychiatry - 6
Surgery - 6
Pediatrics - 6
Dental - 5
Ortho PMR - 4
Physical medicine- 3
Ophthal - 3 . Pediatric Surgery - 2.Urology - 1.Plastic Surgery- 1
Cardiology - 1
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Results:
No. of drugs per prescription: 2.32
No. of drugs by generic: 0.69 (26.8%) 327 / 1220
Generic or brand?
Hospital generic preferred. Pharmacist will dispense whatever is held in stock
No. of drugs by brand name: 1.88 (73.2%) 893 / 1220
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Results:
No. of prescriptions with name and designation not written (80.6%) 415/ 516
No. of drugs with doses not clear (47.6%) 580 / 1220
No. of drugs with duration not written (53%) 647 / 1220
No. of drugs not dispensed (5.8%) 71 / 1220
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Model Prescription
1) Name: ABC 2) Date: 05.06.2009
3) Age: 70yrs. 4) Sex: male
5) Address: 20, III Cross, Eswaran koil st. Pondicherry 605 002
6) PIMS No: 0298298
7) Diagnosis: Idiopathic Parkinsonism
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Model Prescription
8) Rx
9) Tab Levodopa 100mg Tab Carbidopa 25mg10) Dispense 100 combination tablets11) Take 2 tablets by mouth3 times daily with breakfast, lunch and dinner. Take with food. 12) Dr. XYZ MD, DM 13) Assistant Prof. Neurology, 14) PIMS, Pondicherry 605 014 15) Ph: 0413-2207654 16) Reg. No. 34523 17) (TN medical council)
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Thanks!
Dr. Isabella Topno
Dr. Vanita Lal
Dr. S. Sandhiya
Dr. DJ Borah
Ms. Chennama
Mr. KC Arbind
Ms. Moncy ChackoMr. Jabez Raj
All staff of Pharmacy