PRESCRIPTION AUDIT IN OUTPATIENT DEPARTMENTS OF A SUPERSPECIALITY HOSPITAL IN NORTH-EASTERN INDIA
DOI:
https://doi.org/10.22159/ijcpr.2025v17i5.7071Keywords:
Prescription audit, Drug utilization, Superspeciality OPDs, Irrational prescriptionsAbstract
Objective: The study was conducted to evaluate prescribing patterns, assess adherence to standard treatment guidelines, and identify areas for improvement in prescription practices across superspeciality OPDs of a tertiary care hospital in Northeast India.
Methods: A cross-sectional prescription audit study was conducted over a 3-month period in the superspeciality OPDs of a tertiary care hospital in Northeast India. A total of 600 prescriptions were systematically sampled and analysed using WHO/INRUD prescribing indicators. Statistical analysis was performed using descriptive statistics and appropriate analytical tests.
Results: The present study demonstrates that the OPD registration number, date of consultation, and patient gender were consistently recorded in all prescriptions (100%), but complete patient names missing in 1.2% of prescriptions. The handwritings on 11% of prescriptions were not legible. 78.9% of prescriptions included a record of the salient features of the clinical examination, and just 75.1% mentioned a presumptive or definitive diagnosis. The average number of drugs per prescription was 5.39, indicating a trend towards polypharmacy. 88% of drugs were prescribed by their generic names. Antibiotics were prescribed in 12% of encounters. Drugs used by parenteral route were approximately 5% and percentage of drugs prescribed from EDL (Essential Drug List) is 82%. A notable finding was that only 72% of the prescribed medicines were available in the hospital dispensary.
Conclusion: The study shows excellent documentation of basic prescription elements and the generic prescribing rates are also commendable. But the trend of polypharmacy and inadequate drug availability require urgent attention.
Downloads
References
1. Sunny D, Roy K, Benny SS, Mathew DC, Gangadhar Naik JG, Gauthaman K. Prescription audit in an outpatient pharmacy of a tertiary care teaching hospital a prospective study. J Young Pharm. 2019;11(4):417-20. doi: 10.5530/jyp.2019.11.85.
2. World Health Organization. How to investigate drug use in health facilities: selected drug use indicators. Geneva: World Health Organization; 1993.
3. Meena DK, Mathaiyan J, Thulasingam M, Ramasamy K. Assessment of medicine use based on WHO drug-use indicators in public health facilities of the South Indian Union Territory. Br J Clin Pharmacol. 2022 May;88(5):2315-26. doi: 10.1111/bcp.15165, PMID 34859476.
4. Aravamuthan A, Arputhavanan M, Subramaniam K, Udaya Chander J SJ. Assessment of current prescribing practices using World Health Organization core drug use and complementary indicators in selected rural community pharmacies in Southern India. J Pharm Policy Pract. 2017;10:1. doi: 10.1186/s40545-016-0074-6, PMID 27446591.
5. Ofori Asenso R, Agyeman AA. Irrational use of medicines a summary of key concepts. Pharmacy (Basel). 2016 Oct 28;4(4):35. doi: 10.3390/pharmacy4040035, PMID 28970408, PMCID PMC5419375.
6. Saha A, Bhattacharjya H, Sengupta B, Debbarma R. Prescription audit in outpatient Department of a Teaching Hospital of North East, India. Int J Res Med Sci. 2018;6(4):1241-7. doi: 10.18203/2320-6012.ijrms20181275.
7. Marupaka J, Kodam L, Tamma NK, Karedla S. Prescription audit of patients in a Teritiary Care Hospital. Int J Basic Clin Pharmacol. 2020 Oct 21;9(11):1583-91. doi: 10.18203/2319-2003.ijbcp20204435.
8. Ariaga A, Balzan D, Falzon S, Sultana J. A scoping review of legibility of hand-written prescriptions and drug orders: the writing on the wall. Expert Rev Clin Pharmacol. 2023 Jul-Dec;16(7):617-21. doi: 10.1080/17512433.2023.2223972, PMID 37308401.
9. Ciapponi A, Fernandez Nievas SE, Seijo M, Rodriguez MB, Vietto V, Garcia Perdomo HA. Reducing medication errors for adults in hospital settings. Cochrane Database Syst Rev. 2021;11(11):CD009985. doi: 10.1002/14651858.CD009985.pub2, PMID 34822165.
10. Navadia KP, Patel CR, Patel JM, Pandya SK. Evaluation of medication errors by prescription audit at a Tertiary Care Teaching Hospital. J Pharmacol Pharmacother. 2023;14(4):275-84. doi: 10.1177/0976500X231222689.
11. Afrah ALM, Abdulla LM, Saleem N, Baktharatchagan A, Vishwanath U. Refining patient care: evaluating prescription practices of medical residents and interns in a teaching hospital through an audit. Sage Open Med. 2024 Nov 20;12:20503121241300902. doi: 10.1177/20503121241300902, PMID 39575311, PMCID PMC11580091.
12. Smith JD, Lemay K, Lee S, Nuth J, Ji J, Montague K. Medico-legal issues related to emergency physicians documentation in Canadian emergency departments. CJEM. 2023 Sep;25(9):768-75. doi: 10.1007/s43678-023-00576-1, PMID 37646956, PMCID PMC10495505.
13. Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian Tertiary Care Centers: a multicentric study by rational use of medicines centers Indian council of medical research network under national virtual centre clinical pharmacology activity. Indian J Pharmacol. 2022 Sep-Oct;54(5):321-8. doi: 10.4103/ijp.ijp_976_21.
14. Bhagavathula AS, Vidyasagar K, Chhabra M, Rashid M, Sharma R, Bandari DK. Prevalence of polypharmacy, hyperpolypharmacy and potentially inappropriate medication use in older adults in India: a systematic review and meta-analysis. Front Pharmacol. 2021 May 19;12:685518. doi: 10.3389/fphar.2021.685518, PMID 34093207, PMCID PMC8173298.
15. Rakesh KB, Chowta MN, Shenoy AK, Shastry R, Pai SB. Evaluation of polypharmacy and appropriateness of prescription in geriatric patients: a cross-sectional study at a Tertiary Care Hospital. Indian J Pharmacol. 2017 Jan-Feb;49(1):16-20. doi: 10.4103/0253-7613.201036, PMID 28458417, PMCID PMC5351231.
16. Costanzo S, Di Castelnuovo A, Panzera T, De Curtis A, Falciglia S, Persichillo M. Polypharmacy in older adults: the hazard of hospitalization and mortality is mediated by potentially inappropriate prescriptions findings from the Moli-Sani study. Int J Public Health. 2024 Oct 24;69:1607682. doi: 10.3389/ijph.2024.1607682, PMID 39513180, PMCID PMC11540657.
17. Kaur U, Reddy J, Reddy NT, Gambhir IS, Yadav AK, Chakrabarti SS. Patterns, outcomes and preventability of clinically manifest drug-drug interactions in older outpatients: a subgroup analysis from a 6 y long observational study in North India. Naunyn Schmiedebergs Arch Pharmacol. 2025 Jan;398(1):687-98. doi: 10.1007/s00210-024-03294-2, PMID 39046529.
18. Priyadharsini RP, Ramasamy K, Amarendar S. Antibiotic prescribing pattern in the outpatient departments using the WHO prescribing indicators and AWaRe assessment tool in a Tertiary Care Hospital in South India. J Fam Med Prim Care. 2022 Jan;11(1):74-8. doi: 10.4103/jfmpc.jfmpc_527_21, PMID 35309648, PMCID PMC8930124.
19. Gujar A, Gulecha DV, Zalte DA. Drug utilization studies using WHO prescribing indicators from India: a systematic review. Health Policy Technol. 2021;10(3):100547. doi: 10.1016/j.hlpt.2021.100547.
20. Chaudhary RK, Philip MJ, Santhosh A, Karoli SS, Bhandari R, Ganachari MS. Health economics and effectiveness analysis of generic anti-diabetic medication from jan aushadhi: an ambispective study in community pharmacy. Diabetes Metab Syndr. 2021 Oct 1;6:102303. doi: 10.1016/j.dsx.2021.102303, PMID 34626923.
21. Klein EY, Impalli I, Poleon S, Denoel P, Cipriano M, Van Boeckel TP. Global trends in antibiotic consumption during 2016-2023 and future projections through 2030. Proc Natl Acad Sci USA. 2024;121(49):e2411919121. doi: 10.1073/pnas.2411919121, PMID 39556760.
22. Bhattacharjee S, Mothsara C, Shafiq N, Panda PK, Rohilla R, Kaore SN. Antimicrobial prescription patterns in Tertiary Care Centres in India: a multicentric point prevalence survey. Eclinical Medicine. 2025 Mar 28;82:103175. doi: 10.1016/j.eclinm.2025.103175, PMID 40224675, PMCID PMC11992528.
23. Priyadharsini RP, Ramasamy K, Amarendar S. Antibiotic prescribing pattern in the outpatient departments using the WHO prescribing indicators and AWaRe assessment tool in a Tertiary Care Hospital in South India. J Fam Med Prim Care. 2022 Jan;11(1):74-8. doi: 10.4103/jfmpc.jfmpc_527_21, PMID 35309648, PMCID PMC8930124.
24. Kumar S, Siwach P, Mehta K, Mathur A. Assessment of antibiotic prescribing pattern using WHO access watch and reserve classification (AWaRe) at a Tertiary Care Centre of Northern India: a cross-sectional study. J Clin Diagn Res. 2025 Mar;19(3):12-6. doi: 10.7860/JCDR/2025/76248.20757.
25. Ofori Asenso R. A closer look at the World Health organizations prescribing indicators. J Pharmacol Pharmacother. 2016 Jan-Mar;7(1):51-4. doi: 10.4103/0976-500X.179352, PMID 27127400, PMCID PMC4831494.
26. Chebolu Subramanian V, Sundarraj RP. Essential medicine shortages procurement process and supplier response: a normative study across Indian states. Soc Sci Med. 2021;278:113926. doi: 10.1016/j.socscimed.2021.113926, PMID 33892243.
27. Yahanda AT, Mozersky J. What’s the role of time in shared decision making? AMA J Ethics. 2020;22(5):E416-422. doi: 10.1001/amajethics.2020.416, PMID 32449658.
28. Goruntla N, Ssesanga J, Bommireddy BR, Thammisetty DP, Kasturi Vishwanathasetty V, Ezeonwumelu JO. Evaluation of rational drug use based on WHO/INRUD core drug use indicators in a secondary care hospital: a cross-sectional study in Western Uganda. Drug Healthc Patient Saf. 2023 Sep 14;15:125-35. doi: 10.2147/DHPS.S424050, PMID 37727328.
Published
How to Cite
Issue
Section
Copyright (c) 2025 Dr. Mukundam Borah, Atifa Ahmed, Dr. Pran Pratim Saikia, Dr. Swopna Phukan, Dr. Mukhlesur Rahman

This work is licensed under a Creative Commons Attribution 4.0 International License.