A prescription audit for medication safety in a tertiary care centre of Tamilnadu, India

Chanthini devi

Assistant medical administrator, Kauvery Hospital, Cantonment, Trichy

Background

Objective

To systematically evaluate the quality, accuracy, and appropriateness of prescriptions to enhance patient safety, ensure compliance with guidelines, and improve overall healthcare delivery.

To discuss the strategies to reduce prescription error.

  • Place of Audit: KMC Speciality Hospital, Cantonment, Trichy
  • Duration of Audit: January 2024 to October 2024
  • Source of Audit: Out Patient Department of KMC Speciality Hospital, Cantonment
  • Done By: Clinical team

Methodology

This audit employed a retrospective analysis of prescription records over ten months (From Jan 2024 to Oct 2024). We evaluated the legibility of the prescription to meet NABH standards.

NABH standard for writing prescription

  • Legibility: The prescription should be written in capital letters and be legible.
  • Completeness: The prescription should include the name of the drug, strength, dose, and dosage form, route of administration, frequency, and duration.
  • Signature: The doctor should sign the prescription, along with their name and registration number.
  • Abbreviations: Abbreviations should not be used for prescribing medications.
  • Decimals: When using decimals, leading zeros should be used, such as 0.5 mg.

Results and Discussion

1. Prescription Written in Small Letter

  • No. of prescription audit 1703
  • No. of prescription written in small letter 876
  • No. of prescription written in capital letter 827

Approximately, 49% written in capital letter and 51% written in small letter.

Prescription – Small Handwriting- Difficult to Interpret

Example 1

Example 2

? Ceftazidime/cefuroxime, if written in capital letters can be readable

2. Dosage form written in prescription

Dosage forms: Tablets, Capsules, Syrup, Powders, Injectable solution.

  • No .of prescription audit 1703
  • No. of prescription dosage form entered 1430
  • No. of prescription dosage form not entered 223

87% of prescription dosage forms has been entered and 13% were not entered.

Dosage Form Not Legible in Prescription

Example

Dose unit entry in prescription

Dose unit entry: Milligrams (mg), Millilitres (mL), International Units (IU)

  • No. of prescription audit 1692
  • No. of prescription dose unit entered 1472
  • No. of prescription dose unit not entered 220

87% of prescription dose unit has been entered 13% were not entered.

Example 1

Dose unit mg is not legible. Dose of Tramadol 50mg can be read as 5 mg.

Example 2

The dose of the drug can be read as 150mg but it is 100mcg

Registration number in prescription

  • No. of prescription audit total 1695
  • No. of prescription registration number written 456
  • No. of prescription registration number not written 1239

27% of prescription were written registration number and 73% not written.

Route of Administration

Route of administration: Intravenous (IV), Intramuscular (IM), Topical, Inhalation

  • No. of prescription audit 1703
  • No. of prescription route of administration entered 120
  • No. of prescription route of administration not entered 1583

7% of prescription route of administration has been entered and 93% were not entered.

Route of administration written in prescription is not clear legible

Example 1

Usage of approved abbreviation

Abbreviations: qd – once a day, bid – twice a day, syr – syrup, tab – Tablet, cap – Capsule, inj – Injection.

  • No. of prescription audit 1695
  • No. of prescription usage of approved abbreviation 236
  • No. of prescription not using the approved abbreviation 1459

14% of prescription usage of approved abbreviations and 86% were not entered.

Example 1

Approved abbreviation Injection (inj), written in the order, is not legible.

Example 2

Abbreviations should not be used for prescribing medications.

Abbreviation of Drug name, which should not be, used (example KCL, NACL, MGSO4.) Need to be written as Potassium chloride, sodium chloride and is accepted.

Example 3

When using decimals, leading zeros should be used as per NABH standards

.25mg can read as 25mg, so need to be written as 0.25mg which is clear .

Findings

Overall assessment of prescription audit reveals

S. NoAssessmentResults
1Legibility of prescription49%
2Completeness of prescription75%
3Route of administration in prescription7%
4Registration number of doctor entered27%
5Approved abbreviation in prescription14%

Strategies to Overcome Manual Prescription Errors

  • Manual prescription errors are a significant concern in healthcare, as they can compromise patient safety.
  • Prescription errors often arise due to illegible handwriting, incomplete information, incorrect dosages, or misinterpretation of instructions.
  • Addressing this issue requires a multifaceted approach involving standardization, technology adoption, education, and system optimization.

E-Prescribing (EMRs) is indeed solution in modern healthcare.

AspectEMR PrescriptionManual Prescription
AccuracyHigher (automated checks for errors)Prone to errors due to illegible handwriting
LegibilityClear and standardizedOften illegible or inconsistent
EfficiencyFaster, integrated with pharmacy systemsSlower, requires physical transfer
Patient SafetyAlerts for drug interactions and allergiesHigher risk of mistakes and missed interactions
Prescription SharingInstant sharing with pharmacies and providersPhysically transferred, prone to delay/loss
Environmental ImpactReduced paper waste, electronic storageGenerates paper waste and requires physical storage
Audit and ComplianceEasy tracking, integrated with regulationsDifficult to track and audit
AdaptabilityCan quickly adapt to new guidelines or regulationsSlow adaptation to changes

EMR usage in OPD KMC cantonment

Conclusion

The transition from handwritten prescriptions to EMRs is driven by the need for efficiency, accuracy, and patient safety in healthcare. Both have their advantages and limitations, but EMR systems are increasingly becoming the standard in healthcare due to their efficiency and potential to improve patient safety and care quality. While the transition may involve challenges, but the long-term benefits of EMRs—such as better compliance, reduced errors, and improved patient outcomes.

 

Dr. Chanthini devi
Assistant Medical Administrator

Kauvery Hospital