When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4]. Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10] Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9]. All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20]. The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.

1. Saad Salman 1,
Muhammad Ismail1,
Naila Riaz Awan2,
Muhammad Anees3,
Jawaria IDrees4,
Fariha idrees5,
Zahid Nazar2
MASHAAL ARIFULLAH6
1Department
of Pharmacy, University of
Peshawar, Pakistan
2Lady Reading Hospital, Post Graduate Medical
Institute, Pakistan
3Khyber Medical College, Peshawar, Pakistan
4Department of Zoology, Islamia College
University Peshawar, Pakistan
5Department of Chemistry, Islamia College
Peshawar, Pakistan
Jinnah College for Women, University of
Peshawar.
Presenter
Mashaal Arifullah

2. Contents
 Introduction
 Aims
and Objectives
 Methodology
 Results and Discussion
 Conclusion
 References

3.  Prescribing
accounts for a large proportion of
errors [1]
 Errors include problems related to:






Strength of medication,
Frequency of medication,
Quantity per dose,
Instructions for use,
Total quantity to be dispensed,
Dosage form; and if absent, can cause great deal
of patients’ harm. [1-4].

4.  Irrational
prescribing is a global problem
and may also be regarded as
"pathological" prescribing [9].
 Irrational
drug therapy can cause
patient’s harm by exacerbation or
prolongation of illness, distress and higher
costs [8]

5.  All
prescriptions must include the name,
address, specialty and signature of the
prescriber as well as the name, sex, and age
of the patient and the strength, quantity, dose,
frequency, dosage form and instructions for
use of the medication [11–12].

6.  To
investigate prescriptions
of Psychiatry for the
essential elements of
prescriptions.
 To
study the prescribing
trends in psychiatric
practice in Peshawar area,
Pakistan.

7. We collected 602 prescriptions:
 written by private specialists, general practitioners
and physicians at private medical centers.

Prescriptions were collected from 1st of April to 4th
of September from the patients admitted in
Psychiatry ward.

Information present on the prescription was
transferred directly into the electronic form.

8.  The
prescriptions were carefully analyzed for
information about prescriber, patient and drug and
dose related information using a checklist for the
items mentioned above.
 Types
of drugs prescribed were analyzed to determine
the most commonly prescribed drug classes.

9. Information present
Number
Percentage
Physician related
Address
510
84.71
Specialization
411
68.27
Signature
333
55.32
Date
311
51.66
0
0
Licence Number
Patient related
Name
517
85.88
Age
501
83.22
Sex
227
37.71
Address
139
23.09
Weight
13
2.159

10. 600
500
Number
Percentage
400
300
200
100
0

11. Results and Discussion

12. Table 2: Variables related to drugs present on Prescriptions
Variable
Included for all
drugs in prescription
No
Included for some
drugs in
prescription
%
No
Not included for
any drug in
prescription
%
No
%
Frequency
499
82.89
93
15.45
27
4.49
Quantity per
dose
487
80.90
81
13.4551
31
5.15
50
79
13.1229
53
8.80
Instructions for 301
use
Total quantity
to be
dispensed
111
18.44
33
5.4817
0
0
Strength
409
67.94
317
52.6578
177
29.40

13. Variables related to drugs present on prescriptions.
90.00
80.00
Included for all
drugs in
prescription %
70.00
60.00
Included for
some drugs in
prescription %
50.00
40.00
30.00
Not included for
any drug in
prescription %
20.00
10.00
0.00
Frequency
Quantity per dose
Instructions for Total quantity to be dispensed Strength
use

14. Table 3: Prescribing trends of various drug classes
Drug Class
Number
Percentage
Central Nervous
System Drugs
1428
71.0094*
NSAIDs/analgesics
319
15.8627
Antimicrobials
125
6.2158
Vitamins
81
4.0278
Gastrointestinal
Medicines
37
1.8398
Cough syrups
12
0.5967
Others
9
0.4475

15. Prescribing trends of various drug classes.
1600
1400
1200
1000
800
600
400
200
0
Number
Percentage

16. Table 4: Patterns of CNS drugs prescribed.
Drug class
Number
Fluoxetine
121
Sodium valproate
113
Alprazolam
111
Carbamazepine
107
Escitalopram
97
Diazepam
94
Citalopram
87
Lithium
85
Olanzepine
56
Methyl phenidate
9
Others
1131
Percentage
8.4*
7.9*
7.7*
7.4
6.7
6.5
6.1
5.9
3.9
0.6
56.2

17. SSRI’s were the most frequently prescribed
medication in majority of prescriptions.
Inconsistency regarding different prescription
components was observed. Such as strength
of medication, frequency or instruction for
medication use etc.

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
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
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