how to do a prescription auditing in a hospital setup, and various parameters that can be used

1. B Y : D R . S U M I T K U M A R M A H A T O
J U N I O R R E S I D E N T ( A C A D E M I C )
G U I D E : D R . U . S . P K E S H R I
A S S O C . P R O F .
D E P A R T M E N T O F P H A R M A C O L O G Y
R I M S , R A N C H I
Prescription Auditing

2.  The prescription order is an important link between
the doctor and the patient.
 The prescribing behavior of the doctor depends upon
the input from various sources like patients, academic
literatures, professional colleagues, commercial
publicity and government regulations.

3.  Various prescribing errors are result of ineffective
use of these inputs and are very common in clinical
practices.
 One of the most pressing problem encountered by
public health providers and administrators in
many countries is the rational use of drugs

4.  Rational use of drugs is based on use of right drug,
right dosage at right cost which is well reflected in the
world health organization (WHO) definition:
 "Rational use of drugs requires that patients receive
medications appropriate to their clinical needs, in
doses that meet their own individual requirements for
an adequate period of time, at the lowest cost to them
and their community”

5. The rationality of prescribing pattern is of utmost
importance because bad prescribing habits including
misuse, overuse and underuse of medicines can lead to
 unsafe treatment,
 exacerbation of the disease,
 health hazards,
 economic burden on the patients
 and wastage of resources.

6. Auditing
 Evaluation of data, documents and resources to
check performance of systems to meets specified
standards

7. Medical Audit
 “A quality improvement process that seeks to
improve patient care and outcomes through
systematic review of care against explicit criteria and
the implementation of change.”

8. Clinical Audit
can be defined as the systematic critical analysis of the
quality of medical care, including the procedures used
for diagnosis and treatment, the use of resources and
the resulting outcome and quality of life for the patient

9. STEPS
 Defining standards,
 Collecting data,
 Identifying areas for improvement,
 Making necessary changes
 Background for defining new standards.

10. BACKGROUND OF DEFINING NEW
STANDARD
 Observing current practice
 Comparing current practice to standards
and implementing change
 Setting standards of care

11. Objectives
 Ensuring that drug therapy meets current
standards of care
 Controlling drug cost
 Preventing problems related to medication
 Evaluating the effectiveness of drug therapy
 Identification of areas of practice that require
further education of practitioners

12. AUDIT CYCLE
Correct
the
problem

13. HOW TO IMPLEMENT

14. RANDOMLY SELECTED PRESCRIPTION
IN PRESCRIPTION CHECK ALL THE
PARAMETERS OF AUDIT AS PER CHECKLIST
FILL THE PRESCRIPTION AUDIT CHECK
LIST
REPORT SUBMITTED TO DEPARTMENT AND
QUALITY COMMITTEE
ANALYZE THE FILLED DATA
AFTER CHECKING THE PRESCRIPTION

15. Audit Parameters : Yes/ No/NA
 Name of patient
 Age
 OPD number
 Dose of drug
 Dosage of drug
 Route of drug
 Frequency / Time of administration
 Date
 Legible
 Known allergy documented
 Uniform location of treatment order
 Drug interaction, If Any
 Food drug interaction, If Any
 Signature of Doctor

16.  Average number of medicines per encounter
 % of medicines prescribed by generic name
 % of encounters with an antibiotic prescribed
 % of encounters with an injection prescribed
 % of medicines prescribed which are from the
essential medicines list or formulary list

17.  Average consultation time
 Average dispensing times
 % of medicines actually dispensed
 % of medicines that are adequately labeled
 % of patients who know how to take their medicines

18. Conclusion
 Annual reviews of drug utilization may be used to
provide background information for decisions on
formulation of National essential list of medicine
(NLEM).
 The observed patterns of drug use can be compared
with the current recommendations and guidelines
for the treatment of a certain disease
 Assessment of effective Implementation of the
generic prescription can be done
 Promote working with multidisciplinary teams

19.  Allocate resources (financial, human) to provide
better patient care
 Improve professional practice and quality standards
 Identify and eliminate wastage

20. THANK YOU