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Amdany H, Kiprop JW. Handwritten prescription practices in a public hospital in Uasin Gishu County, Kenya: a best practice implementation project. JBI Evid Implement 2023; 21:345-354. [PMID: 37823409 DOI: 10.1097/xeb.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Prescription writing error is a common phenomenon in the health sector. Appropriate handwritten prescription practices minimize medical errors during medical drug dispensing. OBJECTIVES This project aimed to identify the extent to which clinicians adhere to handwritten drug prescription best practices and implement evidence-based strategies to improve compliance with handwritten prescription best practices in an outpatient department. METHODS The project was conceptually informed by the JBI Model of Evidence-Based Health care and the JBI Evidence Implementation Framework. Baseline and follow-up audit data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. The JBI Getting Research into Practice (GRiP) program was used to identify potential barriers and design intervention strategies. The project was conducted in a public hospital outpatient department in Uasin Gishu County, Kenya. RESULTS There was a 100% improvement in compliance with the number of prescribers who had received education on essential features of a handwritten drug prescription. High compliance was observed in prescriptions that indicated the patient name (99%) and date of prescription (98%) in the follow-up audit. Approximately half of the prescriptions included a diagnosis of the disease in both the baseline and the follow-up audit. However, in the follow-up audit, only 21% of the prescriptions had legible handwriting and 27% prescribed drugs using the generic drug name. CONCLUSION Regular audits and dissemination of audit findings through continuous medical education, hospital communication forums, and notices improved compliance with the number of prescriptions that contained the patient identifier and the date of prescription.
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Affiliation(s)
- Henry Amdany
- Uasin Gishu County Referral Hospital, Nairobi, Kenya
- Research and Evidence, Afya Research Africa, Nairobi, Kenya
| | - Jedidah W Kiprop
- Uasin Gishu County Referral Hospital, Nairobi, Kenya
- Research and Evidence, Afya Research Africa, Nairobi, Kenya
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Khalid Abdullahi A, Senire Fatima I, Abdurrahaman U, Isa Sa’adatu S, Bukhari Hafsat A, Abdullahi Abdulrasheed H, Abubakar U, Dorcas I, Hameed Kehinde S, Ibrahim Bashir A, Kabir Musa M. Assessment of Legibility of Handwritten Prescriptions and Adherence to W.H.O. Prescription Writing Guidelines in Ahmadu Bello University Teaching Hospital Zaria - Kaduna State, Nigeria. Innov Pharm 2023; 14:10.24926/iip.v14i1.5164. [PMID: 38035314 PMCID: PMC10686667 DOI: 10.24926/iip.v14i1.5164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Introduction: The issues of incorrectness and incompleteness for written prescriptions may result to dispensing errors and unintended outcomes of care. The objective of the study was to assess the legibility of handwritten prescriptions and adherence to W.H.O. prescription writing guidelines in Ahmadu Bello University Teaching Hospital Zaria. Method: A cross-sectional prospective study design was used, and existing prescriptions were sampled from selected in-patient and outpatient pharmacy units of Ahmadu Bello University Teaching Hospital Zaria. This was approved by the ethics and research committee of the institution. The prescriptions were then evaluated for quality based on the layout, legibility, and clarity of the details in the prescriptions and screened for medication errors. Result: The extent of prescribing drugs by generic name was (68.37%), the legibility percentage was moderate and the percentage of prescriptions in which details of the drug, route of administration, and duration of treatment were complete was 85.23%, 80.80%, and 82.40%, respectively. The doctor's signature (84.87%) was present in the prescriptions. Many of the prescribers did not use to indicate patients' weight, age, and clinic on prescriptions, these are deviations from good prescribing practices while total medication error was 38.01%. Conclusion: Prescribers have a duty of care to their patient and a professional duty to their colleagues (pharmacists) to ensure drug prescriptions are readily identifiable. Interventional techniques such as the use of printed or electronic prescriptions can improve the ease of interpreting information and reduce medication errors.
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Affiliation(s)
- Abba Khalid Abdullahi
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
- Department of Pharmaceutics and Industrial Pharmacy, Ahmadu Bello University Zaria, Nigeria
| | - Ibrahim Senire Fatima
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
- Department of Pharmacognosy and Drug Development, Ahmadu Bello University Zaria, Nigeria
| | - Umar Abdurrahaman
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
- Department of Pharmaceutical and Medicinal Chemistry, Ahmadu Bello University Zaria, Nigeria
| | - Salihu Isa Sa’adatu
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
- Department of Pharmaceutics and Industrial Pharmacy, Ahmadu Bello University Zaria, Nigeria
| | - Abubakar Bukhari Hafsat
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
| | - Haruna Abdullahi Abdulrasheed
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
- Department of Pharmaceutical and Medicinal Chemistry, Ahmadu Bello University Zaria, Nigeria
| | - Umar Abubakar
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
| | - Igashi Dorcas
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
| | - Sanni Hameed Kehinde
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
| | - Adam Ibrahim Bashir
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
- Department of Pharmaceutics and Industrial Pharmacy, Ahmadu Bello University Zaria, Nigeria
| | - Muhammad Kabir Musa
- Department of Pharmaceutical Services, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
- Department of Pharmaceutics and Industrial Pharmacy, Ahmadu Bello University Zaria, Nigeria
- Department of Medicine, Nazarbayev University School of Medicine (NUSOM) Astana, Kazakhstan
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Batista AM, Gama ZADS, Hernández PJS, Souza D. Quality of prescription writing in Brazilian primary health care. Prim Health Care Res Dev 2023; 24:e49. [PMID: 37522367 PMCID: PMC10466202 DOI: 10.1017/s1463423623000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE To evaluate the quality of prescription writing in the context of public primary health care. BACKGROUND Prescription errors are one of the leading patient safety problems in primary care and can be caused by errors in therapeutic decisions or in the quality of prescription writing. METHODS Cross-sectional observational study conducted in a municipality in Northeastern Brazil. The assessment instrument (including 13 indicators and one composite indicator) was applied to a representative sample of drug prescriptions from the 24 Family Health Teams providing Primary Health Care in the municipality, dispensed in January 2021. Estimates of compliance and their 95% confidence intervals and graphical analysis of frequencies are assessed globally and stratified by dispensing units and prescribers. FINDINGS The average composite prescription writing quality on a 0-100 scale was 60.2 (95% CI 57.8-62.6). No quality criteria had 100% compliance. The highest compliance rates were found for 'frequency of administration' (98.9%) and 'identification of the prescriber' (98.9%). On the other hand, 'recorded information on allergy' (0.0%), 'patient's date of birth' (1.7%), 'nonpharmacological recommendations' (1.7%), and 'guidance on the use of the drug' (25%) were the indicators with lower compliance, contributing to 69% of the noncompliances found. The type and frequency of the errors in the quality of prescription writing uncovered in this study confirm the continuing need to tackle this problem to improve patient safety. The results identify priority aspects for interventions and further studies on the quality of prescription writing in the context of Primary Health Care in Brazil.
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Affiliation(s)
- Almária Mariz Batista
- Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte, Caicó, Brazil
- Instituto Nacional de Salud Pública, Cuernavaca, México
| | | | | | - Dyego Souza
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Programme in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
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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; 16:617-621. [PMID: 37308401 DOI: 10.1080/17512433.2023.2223972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Prescription and drug order writing are key components of patient care allowing physicians communicate their therapeutic plans. Although electronic prescriptions are becoming more common, handwritten prescriptions are still quite prevalent and a persistent issue with handwritten prescriptions is the illegibility of physician handwritings. Prescriptions have to be legible to avoid delays in healthcare provision and consequences as serious as patient death. AREAS COVERED We did a scoping review of multiple articles that assessed the legibility of prescriptions in different settings (inpatient, outpatient, and pharmacies) and countries, ranging from 1997 to 2020. Studies also elaborated on possible reasons for these suboptimal prescriptions and ways to address them. EXPERT OPINION While the degree of legibility of prescriptions varies widely, it remains a concern because a single incorrectly read prescription can have severe consequences. Various measures exist to possibly minimize illegible prescriptions and while none alone is probably sufficient, combining is likely to yield great results. One is the sensitization and education of physicians and physicians-in-training. Another option is audits and a third and very potent option is the use of computerized provider order entry (CPOE) system which will help improve patient safety by reducing errors due to inappropriately read prescriptions.
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Affiliation(s)
- Anderson Ariaga
- Internal Medicine Department, Vassar Brothers Medical Center, Nuvance Health Poughkeepsie, New York, NY, USA
| | - Dustin Balzan
- Pharmacy Department, Mater Dei Hospital, Msida, Malta
| | | | - Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Msida, Malta
- Exeter College of Medicine and Health, Exeter University, Exeter, UK
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Bebitoglu BT, Oguz E, Acet NG, Akdeniz E, Sarikaya Ö. The short- and long-term effects of a course on rational drug use: A comparative study between prefinal- and final-year undergraduate medical students who attended the course in different clinical years. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:213. [PMID: 34395650 PMCID: PMC8318193 DOI: 10.4103/jehp.jehp_1152_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/06/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Rational pharmacology use and appropriate prescribing are among the key learning outcomes in medical education. Some medical faculties include rational pharmacotherapy course in their education programs at different years of education in Turkey. The aims of this study were to investigate the differences in effect of rational pharmacotherapy course on short- and long-terms by comparing two cohorts who attended the course in different clinical years of medical education by identifying which parameters of prescription items are different among groups. MATERIALS AND METHODS This quasi-experimental study was conducted in School of Medicine. Participants consisted of 157 students who attended the course in Grade 4 (n = 110, Group A) and Grade 5 (n = 47, Group B). Students were asked to complete a prescribing task both upon completion of the course and 1 year after. The performance in prescribing was determined by prescription scoring form. Repeated measures ANOVA was employed to test the intervention effect between two periods. McNemar test was employed to measure the change in each item on the prescription. Point-biserial correlations between each item on the prescription and their scores on the test as a whole were calculated. RESULTS The mean score of Group A dropped to 59.41 (standard deviation [SD] = 14.06) from 90.43 (SD = 8.90), and the mean score of Group B dropped to 73.37 (SD = 12.56) from 83.91 (SD = 10.03). All the prescription components in the scripts of the Group A students worsened significantly, except the "name of drug," whereas Group B students maintained most of them after 1 year. CONCLUSIONS This study shows that the long-term retention effect of rational pharmacotherapy course conducted in later years of education is better than the course conducted in earlier years of education, which may be related to the fact that students in later years are more likely to take on responsibility for patient therapy process in clinical education.
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Affiliation(s)
- Berna Terzioglu Bebitoglu
- Department of Medical Pharmacology, School of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Elif Oguz
- Department of Medical Pharmacology, School of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Nazife Gökçe Acet
- Department of Medical Pharmacology, School of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Esra Akdeniz
- Department of Medical Education, School of Medicine, Marmara University, İstanbul, Turkey
| | - Özlem Sarikaya
- Department of Medical Education, School of Medicine, Marmara University, İstanbul, Turkey
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Sisay M, Gashaw T, Amare F, Tesfa T, Baye Y. Hospital-Level Antibacterial Prescribing and Its Completeness in Ethiopia: Did It Adhere to Good Prescribing Practice? Int J Gen Med 2020; 13:1025-1034. [PMID: 33192086 PMCID: PMC7654516 DOI: 10.2147/ijgm.s280696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background Antibacterial agents are an integral part of chemotherapy and play a critical role in the prophylaxis and treatment of bacterial infections. However, prescribing errors such as incomplete prescriptions that do not adhere to good prescribing practice have become a contemporary concern in hospitals in resource-limited settings. Therefore, this study aimed to assess antibacterial prescribing and its completeness among prescriptions dispensed at four governmental hospitals in Eastern Ethiopia. Methods A cross-sectional study was employed to assess a total of 1308 prescription encounters containing at least one antibacterial agent obtained with simple random sampling from annual antibacterial-containing prescription data of four hospitals. The data were collected retrospectively using a structured checklist. Results A total of 2,855 drugs were prescribed from 1308 prescribing encounters with 1496 (52.39%) being antibacterial agents. The name, age, sex, and diagnosis of the patients were written in 1158 (88.3%), 815 (62.31%), 796 (60.58%), and 183 (13.99%) prescriptions, respectively. Besides, the route of administration, strength, duration, quantity, dose, and dosage form of the drug were recorded in 2322 (81.33%), 2118 (74.19%), 1516 (53.10%), 1525 (53.42%), 746 (26.13%) and 563 (19.72%) prescriptions, respectively. Nearly 50% of the prescribing encounters were documented without a prescriber name. Dispenser name and signature were also obtained in less than 10% of the prescriptions. Combining the data of all hospitals, amoxicillin, ceftriaxone, and ciprofloxacin were identified as the top three prescribed antibacterial drugs, whereas diclofenac, paracetamol, and tramadol were the most frequently co-indicated drugs. Regarding the pharmacologic class of antibiotics, penicillins were the most commonly prescribed antibiotics (n = 596, 39.77%) followed by cephalosporins (n = 318, 21.26%) and fluoroquinolones (n=285, 19.05%). Conclusion Incomplete information about patient-related factors and major diagnosis, medication regimens, prescribers and dispensers was identified as a potential prescribing error and did not adhere to good prescribing practice. This can be considered as one part of the inappropriate use of antibacterial agents, a driving force for the emergence of antimicrobial resistance. This problem requires immediate and sustained action from the management of the hospitals to ensure the accountability of health professionals involved in the medication use process and to establish antimicrobial stewardship programs in such resource-limited settings.
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Affiliation(s)
- Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- Microbiology Unit, Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Baye
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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