PRESCRIPTION AUDIT mbbs.pptxsystematic review and evaluation of medical prescriptions

PRESCRIPTION AUDIT
A prescription audit is a systematic review and evaluation of medical prescriptions to ensure they comply with established standards of care, safety, and regulatory guidelines.
The goal is to assess the appropriateness, accuracy, and rationality of the prescribed medications.
Improves the quality of healthcare, reduces medication errors, and promoting the rational use of drugs.

1. Duty of Care: Doctors are expected to follow standard guidelines and act responsibly while writing prescriptions. Errors or negligence in prescriptions can lead to legal consequences under the CPA, as patients have the right to safe and proper medical treatment.
2. Legibility and Completeness: Prescriptions must be clearly written and include all necessary details, such as the patient’s name, age, the correct dosage, drug form, duration of therapy, and proper instructions. Incomplete or illegible prescriptions can result in harm to the patient and may constitute a deficiency in service.
3. Rational Prescribing: Doctors are required to prescribe medications rationally, avoiding unnecessary or harmful drugs. Irrational prescribing practices can be challenged under the CPA.
4. Informed Consent:

1. PRESCRIPTION AUDIT DR T SAI PRANITHA PG 3 DEPT OF PHARMACOLOGY

2. Definition A prescription audit is a systematic review and evaluation of medical prescriptions to ensure they comply with established standards of care, safety, and regulatory guidelines. The goal is to assess the appropriateness, accuracy, and rationality of the prescribed medications. Improves the quality of healthcare, reduces medication errors, and promoting the rational use of drugs.

3. Under the Consumer Protection Act (CPA) in India, healthcare services, including prescription writing, are considered a part of the service offered by healthcare providers. As such, doctors and healthcare institutions are liable for any deficiencies in service, including errors or negligence in prescription writing. Key aspects related to prescription writing under the CPA: 1. Duty of Care: Doctors are expected to follow standard guidelines and act responsibly while writing prescriptions. Errors or negligence in prescriptions can lead to legal consequences under the CPA, as patients have the right to safe and proper medical treatment. 2. Legibility and Completeness: Prescriptions must be clearly written and include all necessary details, such as the patient’s name, age, the correct dosage, drug form, duration of therapy, and proper instructions. Incomplete or illegible prescriptions can result in harm to the patient and may constitute a deficiency in service. 3. Rational Prescribing: Doctors are required to prescribe medications rationally, avoiding unnecessary or harmful drugs. Irrational prescribing practices can be challenged under the CPA. 4. Informed Consent: Doctors must explain the treatment and potential side effects to the patient. Failure to do so may be considered a violation of the patient’s rights under the

4. Common errors in prescription writing Dosage form: (tab, cap, inj ) is missing from the prescription , hence difficult to dispense. Quantity: this is very common. Duration of therapy: missing. Most of the patients decide on their own when to stop or when to restart. Patient allergies Date: Signature Registration number Directions: eg - a lady took methotrexate daily which was to be taken weekly. She died because of severe bone marrow depression. An error in reading the prescription by the pharmacist: eg - Cotrimoxazole- Clotrimazole. Bad handwriting leading to confusion of drug names. eg - Acetazolamide and Acetohexamide. Use of expired/outdated drugs is common. Eg - Aspirin, Tetracycline.

5. Parameters of prescription audit: Format of the prescriptions: Superscription, Inscription, Subscription, Transcriptions-complete/ incomplete. Whether the diagnosis is recorded? Final or provisional. Number of drugs prescribed. Whether the drugs prescribed are by official/pharmacological or brand names. Choice of drugs for the given condition. Unnecessary/Irrational/Hazardous drugs. Dose regime: Dosage form, dose, frequency & duration of treatment. Prescription cost: using latest CIMS, MIMS or Drug index. Status of prescription. Date Signature of doctor, registration number. Patient's particulars are right.

6. Tips of writing a good prescription: Write or print the prescription legibly. Spell the name of the drug correctly. Write the prescription in proper English grammar. Latin abbreviations (od, bd tid ) are no longer recommended. Careful use of decimal points to avoid ambiguity. Avoid unnecessary decimal points (5.0ml instead of 5ml). always zero prefix decimals (0.5 instead of .5), never have trailing zeros on decimals (use 0.5 instead of .50) Directions should be written out in full in english . Total quantity of the drugs should be mentioned, calculated by frequency & duration. Where possible, usage directions should specify timings rather than simply frequency. Avoid the non-standardized units such as teaspoon or tablespoon.

7. 1. A person with systemic hypertension and bronchial asthma was given the following prescription. Tab. Propranolol 40 mg BD Tab. Salbutamol 4mg TDS CCR (criticise, correct & rewrite) the above prescription. CCR (CRITICISE, CORRECT & REWRITE) Critique: 1. Propranolol: non-selective beta-blocker that blocks both β1 (heart) and β2 (lungs) receptors. In a patient with bronchial asthma, non-selective beta-blockers like propranolol can worsen asthma by causing bronchoconstriction due to β2 receptor blockade. Hence, propranolol is contraindicated in patients with asthma. 2. Salbutamol: This is a beta-2 agonist used to relieve bronchospasm in asthma. However, its effectiveness might be reduced when given with a non-selective beta-blocker like propranolol, as they counteract each other’s effects.

8. Corrected Prescription: • Replace Propranolol with a cardioselective beta-blocker (one that selectively blocks β1 receptors) to avoid bronchoconstriction. A better option would be CCB (Muscle relaxant property ), Diuretics , Atenolol or Metoprolol, as they have minimal effects on the lungs. • Continue Salbutamol for asthma management, but ensure there’s no contraindication due to the new medication. Rewritten Prescription: 1. Tab. Amlodipine 5mg Once a Day (or Tab. Metoprolol 25 mg Once a day for hypertension) 2. MDI Salbutamol 200 mcg 2-3 times a day (for asthma management) This approach manages both systemic hypertension and bronchial asthma without causing drug interactions or exacerbating the asthma condition.

9. 2. A transport driver suffering from allergic rhinitis was prescribed: Tab. Diphenhydramine 25mg TDS CCR (criticise, correct & rewrite) the above prescription.

10. Critique: Diphenhydramine: This is a first-generation antihistamine that can be effective for allergic rhinitis. However, it causes significant sedation and drowsiness due to its ability to cross the blood-brain barrier. This is particularly problematic for a transport driver, as it can impair reaction times and increase the risk of accidents. Corrected Prescription: For a transport driver, a non-sedating second-generation antihistamine would be a safer and more appropriate option, as it effectively treats allergic rhinitis without causing drowsiness. Rewritten Prescription: 1. Tab. Loratadine 10 mg Once a Day (or Tab. Cetirizine 10 mg Once a Day ) These are second-generation antihistamines that are less likely to cause sedation and are effective for allergic rhinitis. This correction ensures the driver can manage allergic rhinitis symptoms without compromising alertness or safety while driving.

11. 3.A pregnant lady suffering from hyperthyroidism was prescribed: Tab. Carbimazole 10mg bd CCR (criticise, correct & rewrite) the above prescription. DRUGS FOR HYPOTHYROIDISM AND HYPERTHYROIDISM IN PREGNANCY HYPOTHYROIDISM T. Levothyroxine HYPERTHYROIDISM T.Propylthiouracil T.Methimazole

12. Critique: 1. Carbimazole: While carbimazole is an antithyroid medication used to treat hyperthyroidism, it is not the first choice during pregnancy, especially in the first trimester. There are concerns about its potential teratogenic effects and the risk of causing fetal hypothyroidism. In pregnant women, propylthiouracil (PTU) is usually preferred during the first trimester due to its safety profile. 2. Dosage: While the dosage of 10 mg BD (twice daily) may be appropriate for carbimazole in some contexts, it is essential to ensure that the treatment plan minimizes risks to both the mother and the fetus. Corrected Prescription: Replace carbimazole with propylthiouracil and adjust the dosage as necessary based on the patient’s thyroid function tests and clinical status. Rewritten Prescription: 1. Tab. Propylthiouracil 50 mg Thrice a day Additionally, regular monitoring of thyroid function tests is essential to adjust the medication dose and ensure the safety of both the mother and the fetus.

13. 4.A 60 yr old patient with chronic renal failure was diagnosed of gram negative septicemia. He was treated with the following drug. Inj. Amikacin 500mg OD CCR (criticize, correct & rewrite) the above prescription.

14. Critique: 1. Amikacin: While amikacin is an aminoglycoside antibiotic effective against gram-negative bacteria, it is crucial to consider the patient’s chronic renal failure. Aminoglycosides are primarily eliminated by the kidneys, and their dosing needs to be adjusted in patients with renal impairment to prevent toxicity, including nephrotoxicity and ototoxicity. 2. Dosing Frequency: The prescription indicates 500 mg OD (once daily). In patients with chronic renal failure, once-daily dosing may not be appropriate, as the patient’s renal function will affect drug clearance. Dosing adjustments based on renal function should be made. Corrected Prescription: • Inj. Amikacin: The dose and frequency should be adjusted based on the patient’s creatinine clearance ( CrCl ) or glomerular filtration rate (GFR) or given a drug which is less nephrotoxic and effective on gram negative bacteria . For a patient with chronic renal failure, a typical approach might be to administer 5 to 7.5 mg/kg once daily, but the exact dose would depend on the patient’s renal function.

15. Rewritten Prescription: 1. Inj. Ceftriaxone 1gm/ IV 12 th hourly (adjust based on renal function) every 24-48 hours, depending on the patient’s creatinine clearance. Additionally, it’s important to monitor drug levels and renal function closely while the patient is on amikacin to adjust dosing as needed.