Detection and correction of prescription errors by an emergency department pharmacy service

Medication errors in emergency departments: a systematic review and meta-analysis of prevalence and severity

BACKGROUND

Medication errors significantly compromise patient safety in emergency departments. Although previous studies have investigated the prevalence of these errors in this setting, results have varied widely.

AIM

The aim was to report pooled data on the prevalence and severity of medication errors in emergency departments, as well as the proportion of patients affected by these errors.

METHOD

Systematic searches were conducted in Embase, PubMed, and the Cochrane Library from database inception until June 2023. Studies provided numerical data on medication errors within emergency departments were eligible for inclusion. Random-effects meta-analysis was employed to pool the prevalence of medication errors, the proportion of patients experiencing these errors, and the error severity levels. Heterogeneity among studies was assessed using the I2 statistic and Cochran's Q test.

RESULTS

Twenty-four studies met the inclusion criteria. The meta-analysis gave a pooled prevalence of medication errors in emergency departments of 22.6% (95% Confidence Interval [CI] 19.2-25.9%, I2 = 99.9%, p < 0.001). The estimated proportion of patients experiencing medication errors was 36.3% (95% CI 28.3-44.3%, I2 = 99.8%, p < 0.001). Of these errors, 42.6% (95% CI 5.0-80.1%) were potentially harmful but not life-threatening, while no-harm errors accounted for 57.3% (95% CI 14.1-100.0%).

CONCLUSION

The prevalence of medication errors, particularly those potentially harmful, underscores potential safety issues in emergency departments. It is imperative to develop and implement effective interventions aimed at reducing medication errors and enhancing patient safety in this setting.

Evaluating the impact of a discharge pharmacy in the emergency department on emergency department revisits and admissions

IMPORTANCE

Medication nonadherence leads to worse health outcomes, increased healthcare service utilization, and increased overall healthcare costs.

OBJECTIVE

To determine whether a discharge pharmacy located in the Emergency Department (ED) reduces ED revisits and hospitalizations.

DESIGN

This is a cohort study where we extracted data from our electronic medical records with adult encounters between 12/2019-10/2021. For the purpose of this study, we defined a revisit to the ED as within 7 days and an admission within 30 days from prior initial ED visit.

SETTING

The University of Chicago Medicine is an academic medical center located in Chicago's South Side.

PARTICIPANTS

Between dates of 12/2019-11/2021, we had 78,660 adult distinct encounters. We created 5 different groups: no medications prescribed, ED discharge pharmacy only, e-prescriptions to outside pharmacies, combination of ED pharmacy and e-prescription sent elsewhere, and printed prescriptions with or without any e-prescriptions.

EXPOSURE

Our ED pharmacy is located within the adult ED, serving only patients seen and discharged from the adult ED.

MAIN OUTCOME(S) AND MEASURE(S)

Our primary endpoint is to evaluate if prescribing and dispensing prescriptions from only our ED pharmacy is associated with decreased ED revisits within 7 days and reduced hospitalizations within 30 days of initial ED visit.

RESULTS

When comparing patients who received prescriptions only from the ED discharge pharmacy, patients who received no prescriptions were 31.6% (P < 0.001) more likely to revisit our ED, and patients who received e-prescriptions sent to other pharmacies were 10.4% (P = 0.017) more likely to revisit. Patients who received e-prescriptions from other pharmacies were 29.2% (P < 0.001) more likely to be hospitalized and mixture of e-prescriptions were 59.5% (P < 0.001) more likely to be hospitalized compared to the ED pharmacy only group.

CONCLUSIONS AND RELEVANCE

We believe having a pharmacy providing medications to patients being discharged from the ED reduces barriers like cost, transportation, and pharmacy access patients face trying to fill prescriptions at their local pharmacy. All of these reductions in barriers provides an easier and more convenient method for patients to obtain their medications at discharge from the ED, reducing the risk of a repeat ED visit and subsequent hospital admission.

The effect of an extended-hours ED clinical pharmacy service on admission medication prescribing errors

OBJECTIVE

The aim of this study was to determine the effect of a 7-day extended-hours clinical pharmacy service in the ED on medication prescribing errors upon hospital admission and time to medication reconciliation.

METHODS

In this retrospective observational study, high-needs patients reviewed by ED pharmacists were compared against those not reviewed, to determine if the service was associated with reduction in admission medication errors. The primary outcome was the rate of medication errors. Errors were independently rated by two senior clinicians using a risk-probability matrix. Secondary outcomes included service's impact on time to best possible medication history (BPMH) and medication reconciliation.

RESULTS

There were 242 patients who met the inclusion criteria: 105 intervention vs 137 control. In the intervention arm, 74 patients had at least 1 medication error compared with 113 in the control arm (total errors 206 vs 407). The error rate per 10 medications (interquartile range) was 1.4 (0, 2.9) in the intervention arm compared with 2.7 (1.2, 4.3) in the control arm (risk ratio 0.66 [95% confidence interval: 0.56-0.78]; P < 0.001). There were 33 moderate-risk and no high-risk errors (intervention), compared with 84 moderate-risk and 3 high-risk errors (control). Percent agreement was 98.98% (weighted kappa: 0.62). Time to BPMH and medication reconciliation were reduced from 40.5 and 45.0 h to 7.8 and 40.0 h, respectively.

CONCLUSIONS

The 7-day extended-hours ED clinical pharmacy service was associated with a reduction in medication prescribing errors in high-needs patients and improved time to BPMH and medication reconciliation.

Prescription errors by emergency physicians for inpatients are associated with emergency department length of stay

OBJECTIVES

Adverse drug events are the sixth-leading cause of death in Western countries and are also more frequent in emergency departments (EDs). In some hospitals or on some occasions, ED physicians prescribe for patients who they have admitted. These prescriptions are then followed by the wards and can persist for several days. Our objectives were to determine the frequency of prescription errors for patients over 18years old hospitalized from ED to medical or surgical wards, and whether there exists a relationship between those prescription errors and ED LOS.

METHODS

This was a single center retrospective study that was conduct in the ED of a university hospital with an annual census of 65 000 patients. The population studied consisted of patients over 18years old hospitalized from ED to medical or surgical wards between January 1st, 2012 and January 21st, 2012.

RESULTS

Six hundred eight patients were included. One hundred fifty-four (25%) patients had prescription errors. Prescription errors were associated with increased ED length of stay (OR=2.47; 95% CIs [1.58; 3.92]) and polypharmacy (OR=1.78; 95% CIs [1.20; 2.66]). Fewer prescription errors were found when the patient was examined in the ED by a consultant (OR=0.61; 95% CIs [0.41; 0.91]) and when the medical history was known (OR=0.28; 95% CIs [0.10; 0.88]).

CONCLUSION

Prescription errors occurred frequently in the ED. We assume that a clear communication and cooperation between EPs and consultants may help improve prescription accuracy.

Impact of systematic medication review in emergency department on patients’ post-discharge outcomes—A randomized controlled clinical trial

Introduction

The main objective of this study was to investigate whether systematic medication review conducted by clinical pharmacists can impact clinical outcomes and post-discharge outcomes for patients admitted to the emergency department.

Method

This parallel group, non-blinded, randomized controlled trial was conducted in the emergency department, Diakonhjemmet Hospital, Oslo, Norway. The study was registered in ClinicalTrials.gov, Identifier: NCT03123640 in April 2017. From April 2017 to May 2018, patients ≥18 years were included and randomized (1:1) to intervention- or control group. The control group received standard care from emergency department physicians and nurses. In addition to standard care, the intervention group received systematic medication review including medication reconciliation conducted by pharmacists, during the emergency department stay. The primary outcome was proportion of patients with an unplanned contact with hospital within 12 months from inclusion stay discharge.

Results

In total, 807 patients were included and randomized, 1:1, to intervention or control group. After excluding 8 patients dying during hospital stay and 10 patients lacking Norwegian personal identification number, the primary analysis comprised 789 patients: 394 intervention group patients and 395 control group patients. Regarding the primary outcome, there was no significant difference in proportion of patients with an unplanned contact with hospital within 12 months after inclusion stay discharge between groups (51.0% of intervention group patients vs. 53.2% of control group patients, p = 0.546).

Conclusion

As currently designed, emergency department pharmacist-led medication review did not significantly influence clinical- or post-discharge outcomes. This study did, however pinpoint important practical implementations, which can be used to design tailored pharmacist-led interventions and workflow regarding drug-related issues in the emergency department setting.

Pharmacy Calls for Prescription Clarification at an Academic Emergency Department

BACKGROUND

Approximately two-thirds of patients discharged from an emergency department (ED) are prescribed at least one medication. Prescription clarification by outpatient pharmacies for ED patients can lead to delays for patients and added workload.

OBJECTIVES

This study aims to describe prescriptions requiring clarification prior to being dispensed by an outpatient pharmacy for patients recently discharged from an ED.

METHODS

This study was conducted at an urban, 61-bed academic ED. Prescription clarification forms were used to identify common causes for outpatient pharmacies to contact the ED to clarify prescriptions prior to dispensation. Clarification types were reviewed and classified. Descriptive statistics were used to present the classification types.

RESULTS

There were 1278 documented calls to the ED for prescription clarification that were classified as clarification of directions for use (611, 47.7%), insurance or affordability issues (182, 14.2%), dose (172, 13.4%), medication availability (126, 9.8%), lost or missing prescription (93, 7.3%), patient allergy or adverse event (62, 4.8%), duplication in therapy (17, 1.3%), and clarification of medication ordered (17, 1.3%). When grouped into provider, system, or patient-related issues, provider issues were noted to be most frequent clarifications (862 clarifications, 67.3%), followed by system issues (325 clarifications, 25.4%), and finally, patient-related issues (93 clarifications, 7.3%).

CONCLUSIONS

Clarification of directions for use, insurance or affordability issues, and clarification of the dose were the most common reasons that outpatient pharmacies contacted an ED regarding a prescription for a recently discharged patient.

A mixed‐methods needs assessment to identify pharmacology education objectives for emergency medicine residents

Objectives

Medication errors represent a significant threat to patient safety. Pharmacotherapy is one of the 23 Accreditation Council of Graduate Medical Education milestones for emergency medicine, yet there is minimal understanding of what content should be prioritized during training. The study aim was to develop objectives for a patient‐safety focused pharmacology curriculum for emergency medicine residents.

Methods

We incorporated data from a de‐identified safety event database and survey responses of 30 faculty and clinical pharmacists at a single‐site suburban university hospital with 24‐hour emergency medicine pharmacists and an annual volume of approximately 70,000. We reviewed the database to quantify types and severity of medication errors over a 5‐year period for a total of 370 errors. Anonymous surveys included categorical items that we analyzed with descriptive statistics and short answer questions that underwent thematic analysis by 2 coders. We summarized all data sources to identify curriculum gaps.

Results

Common medication errors reported in our database were wrong dose (43%) and computer order entry errors (14%). Knowledge gaps were medication cost (63%), pregnancy risk information (60%), antibiotic stewardship (53%), interactions (47%), and side effects (47%). Qualitative analysis revealed the need to optimize computer order entry, understand the scope of critical medications, use references, and consult pharmacists. Integration of data suggested specific medications should be covered in curricular efforts, including antibiotics, analgesics, sedatives, and insulin.

Conclusion

We developed objectives of pharmacology topics to prioritize during emergency medicine training to enhance prescribing safety. This study is limited due to its small sample and single institution source of data. Future studies should investigate the impact of pharmacology curriculum on minimizing clinical errors.

Integrating the clinical pharmacist into the emergency department interdisciplinary team: a study protocol for a multicentre trial applying a non-randomised stepped-wedge study design

INTRODUCTION

The 'emergency department (ED) pharmacist' is an integrated part of the ED interdisciplinary team in many countries, which have shown to improve medication safety and reduce costs related to hospitalisations. In Norway, few EDs are equipped with ED pharmacists, and research describing effects on patients has not been conducted. The aim of this study is to investigate the impact of introducing clinical pharmacists to the interdisciplinary ED team. In this multicentre study, the intervention will be pragmatically implemented in the regular operation of three EDs in Northern Norway; Tromsø, Bodø and Harstad. Clinical pharmacists will work as an integrated part of the ED team, providing pharmaceutical care services such as medication reconciliation, review and/or counselling. The primary endpoint is 'time in hospital during 30 days after admission to the ED', combining (1) time in ED, (2) time in hospital (if hospitalised) and (3) time in ED and/or hospital if re-hospitalised during 30 days after admission. Secondary endpoints include time to rehospitalisation, length of stay in ED and hospital and rehospitalisation and mortality rates.

METHODS AND ANALYSIS

We will apply a non-randomised stepped-wedge study design, where we in a staggered way implement the ED pharmacists in all three EDs after a 3, 6 and 9 months control period, respectively. We will include all patients going through the three EDs during the 12-month study period. Patient data will be collected retrospectively from national data registries, the hospital system and from patient records.

ETHICS AND DISSEMINATION

The Regional Committee for Medical and Health Research Ethics and Local Patient Protection Officers in all hospitals have approved the study. Patients will be informed about the ongoing study on a general basis with ads on posters and flyers.

TRIAL REGISTRATION NUMBER

NCT04722588.

Impact of Clinical Pharmacist Interventions in Prescribing Errors in Hospitalized Diabetic Patients with Major Polypharmacy

Background: While clinical pharmacists are expected to have a potential role in minimizing prescribing errors (PEs) in patients with diabetes, the effectiveness of their interventions on the incidence and clinical significance of PEs remains unclear. Objectives: To investigate the effectiveness of clinical pharmacist interventions in correcting PEs in diabetic patients with major polypharmacy. Methods: This was a prospective pre-post study conducted in a secondary care hospital in Jordan over 4 months. There were 2 phases: Control, in which PEs were identified and categorized and active, in which clinical pharmacists intercepted and corrected PEs. Clinical severity of prescribing incidents was evaluated by an expert panel, comprising a senior clinical pharmacist, an internist, and cardiologist. SPSS V26 was used for data analysis. Results: Of 928 patients, 432 were followed and reviewed during the control phase and 496 during the active phase. Clinical pharmacist interventions reduced PEs by 89.5%; from 27.6% (control) to 2.9% (active). PEs per patient and PEs per medication orders were reduced from 2.1 to 0.2 and from 0.3 to 0.03, respectively. Electronic selection errors, wrong dose frequency, duplicate drugs, and allergy errors disappeared in the active phase. Significant, serious, and lethal errors were significantly reduced from 35.4%, 11.6%, and 0.2% (control) to 13.5%, 3.1%, and 0.0% (active), respectively. drugs related to CVS (OR = 5.2; 95% CI, 3.1-8.6; P < .05) versus drugs related to endocrine system was more likely to be associated with the occurrence of PEs versus no PEs. However, drug belonging to infectious (OR = 0.6; 95% CI, 0.1-0.9; P < .05) versus drugs related to endocrine system was less likely to be associated with the occurrence PEs versus no PEs. Conclusion: Clinical pharmacist interventions significantly reduced PEs in patients with diabetes by 89.5% and most of these interventions were clinically significant.

Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United States

Background Emergency medicine (EM) pharmacists may be uniquely positioned to optimize discharge prescriptions for emergency department (ED) patients but the clinical significance of interventions and association with patient outcomes are not well-described. Objective To evaluate the clinical significance of EM pharmacist interventions completed during review of ED discharge prescriptions. Setting This study was conducted in an academic medical center ED. Methods: This was a retrospective observational study of patients discharged with prescriptions from the ED over two months. EM pharmacists reviewed discharge prescriptions and provided drug therapy recommendations. Two independent reviewers rated the clinical significance of interventions. High risk criteria were proposed a priori and included in a multivariable logistic regression analysis to identify variables independently associated with pharmacist intervention. Main Outcome Measure The primary outcome measure was the rate, type, and clinical significance of interventions associated with EM pharmacist review of discharge prescriptions. Results A total of 3107 prescriptions for 1648 patients were reviewed. Interventions occurred for 7.3% of patients with 29% of interventions rated as significant. The intervention rate was higher in patients with at least 1 high risk criteria versus those without (9.6% vs. 3.7%, p < 0.0001). An incremental increase in the number of discharge prescriptions was independently associated with pharmacist intervention. The 30 day readmission rates did not differ between patients with and without pharmacist review (27.4% vs. 26.2%, p = 0.38). Conclusion: Pharmacist review of discharge prescriptions resulted in clinically significant interventions but did not impact readmission rates. An incremental increase in the number of discharge prescriptions was associated with pharmacist intervention.

Investigating prescribing errors in the emergency department of a large governmental hospital in Jordan

Background

Although prescribing errors (PEs) are the most common type of medication errors and cause morbidity and mortality, they have been rarely studied.

Objective

The study aimed to investigate PEs incidence, types, severity, causes, predictors, pharmacists' interventions accepted by doctors and computer-related errors.

Setting

This study was conducted in the emergency department of the largest governmental hospital in Jordan.

Method

This was a retrospective observational 4-week study. A validated definition of PEs was adopted, and errors were identified by direct observation of all prescriptions. Structured interviews with doctors to assess the causes of errors were conducted within three days of the prescription date; the severity of PEs was rated by a committee.

Main outcome measure

Prescribing errors incidence, types, severity, causes, predictors, pharmacists' interventions accepted by doctors and computer-related errors.

Results

For 1330 patients, 3470 medication orders were recorded. Almost one in five patients had PEs (n = 288, 21.65%), and the total number of medication orders for patients who had errors was 610. The PEs incidence was 12.5% (95% CI 11.4%–3.5% (n = 450/3597)). Analgesics were the most common medications associated with PEs (232/610, 38.03%). The top two types of PEs detected were wrong drug (165/450, 36.6%) and wrong dose (142/450, 31.5%) respectively. Most PEs were clinically significant errors (342/450, 76%). Doctors refused pharmacists' interventions on their orders in 132 (45.8%) prescriptions. The most common cause of errors was poor skills of doctors in electronic prescribing system (266/450, 59%). Predictors of PEs were the following: drug with multiple dosage forms (OR 2.998; 95% CI 1.41–6.34; P = 0.004) and a prescription with polypharmacy (OR 1.685; 95% CI 1.25%–2.26%; P = 0.001).

Conclusion

A national approach for observing, intervening on and correcting PEs is necessary to improve patient safety.

Identification of potential drug name confusion errors in the Sentinel System

PURPOSE

In July 2015, the US Food and Drug Administration (FDA) published a drug safety communication regarding errors in prescribing and dispensing of the antidepressant Brintellix (vortioxetine) and the antiplatelet Brilinta (ticagrelor) that arose due to proprietary drug name confusion. Brintellix is indicated for major depressive disorder; Brilinta is indicated to reduce cardiovascular death, myocardial infarction, and stroke in patients with acute coronary syndrome or history of myocardial infarction. Brintellix was renamed to Trintellix in May 2016. Using Brilinta and Brintellix as a proof-of-concept feasibility use case, we assessed whether drug name confusion errors between the pair could be identified in electronic health care data via the combination of a claims-based algorithm and limited manual claims data review.

METHODS

Using data from the Sentinel System, we defined potential errors as Brintellix users without an on- or off-label indication for Brintellix, without a dispensing for a drug with the same indications as Brintellix, and with an on- or off-label indication for Brilinta between -365 and +30 days after index Brintellix dispensing; the reverse was done for Brilinta. We manually reviewed claims profiles of potential cases.

RESULTS

We identified 27 (0.1%) potential errors among 21 208 Brintellix users; 16 appeared to be likely errors based on claims profile review. Fifty-one (0.3%) of the 16 779 Brilinta users were identified as potential errors, and four appeared to be likely errors.

CONCLUSIONS

A claims-based algorithm combined with manual review of claims profiles could identify potential drug name confusion errors, and narrow down likely errors that warrant further investigation.

Clinical pharmacy services in the emergency department

The emergency department (ED) is a fast-paced, high-risk, and often overburdened work environment. Formal policy statements from several notable organizations, including the American College of Emergency Physicians (ACEP) and the American Society of Health-System Pharmacists (ASHP), have recognized the importance of clinical pharmacists in the emergency medicine (EM) setting. EM clinical pharmacists work alongside emergency physicians and nurses at the bedside to optimize pharmacotherapy, improve patient safety, increase efficiency and cost-effectiveness of care, facilitate antibiotic stewardship, educate patients and clinicians, and contribute to scholarly efforts. This paper examines the history of EM clinical pharmacists and associated training programs, the diverse responsibilities and roles of EM clinical pharmacists, their impact on clinical and financial outcomes, and proposes a conceptual model for EM clinical pharmacist integration into ED patient care. Finally, barriers to implementing EM clinical pharmacy programs and limitations are considered.

Introducing a structured prescription form improves the quality of handwritten prescriptions in limited resource setting of developing countries

INTRODUCTION

Incomplete or illegible prescriptions can lead to serious errors in administration of the prescribed medication, which can become hazardous.

OBJECTIVE

Our aim is to determine if a structured prescription form can improve the quality of handwritten prescription in terms of completeness and legibility.

METHODS

We conducted a prospective, non-randomized, time series study of quality of written prescriptions of general practitioners at a tertiary teaching hospital in Peshawar, Pakistan. The study involved an intervention, composed of the introduction of a pre-printed structured prescription form. The data were collected within 4 weeks including a 2-week pre-intervention phase and 2-week post-intervention phase. Completeness, quality of prescriptions and legibility were compared before and after the intervention of the pre-printed structured prescription form.

RESULTS

A total of 463 prescriptions were obtained (260 in the pre-intervention phase and 203 in the post-intervention phase). Between pre-intervention phase and post-intervention phase, the Pakistan Medical and Dental Council registration number presence in prescriptions improved from 73.1% to 100% (P < 0.0005). The presence of prescriber's signature improved from 92.7% to 99% (P = 0.001). Drug duration was not missing in 99.5% in post-intervention phase as compared with 90.4% in pre-intervention phase (P < 0.0005). Prescriptions with no legibility problems improved from 76.2% to 94.1% (P < 0.0005). Although not statistically significant, prescriptions in which drug dosage was not missing improved from 85% to 90.6% (P = 0.07).

LIMITATIONS

We have a limited single-center study. A larger study in multiple settings is needed to develop adequate evidence for such interventions. Subjective nature of prescription legibility can also be considered as a limitation.

CONCLUSION

Structuring a prescription form alone may improve certain aspects of quality of written prescription in terms of completeness and legibility.

Do Orthogeriatric Inpatients Have a Correct Medication List? A Pharmacist-Led Assessment of 254 Patients in a Swedish University Hospital

Introduction:

Comorbidities and polypharmacy complicate the treatment of geriatric patients with acute orthopedic injuries. A correct medication history and an updated medication list are a prerequisite for safe treatment of these debilitated patients. Published evidence suggests favorable outcomes with comanaged care. The aim of this study was to assess the accuracy of the inpatient medication lists generated at admission and investigate the efficacy of a dedicated ward-based pharmacist to find and correct mistakes in these lists.

Methods:

A total of 254 patients were enrolled. The ward-based pharmacist performed the assessment regarding the accuracy of the medication list generated at admission by the method of medication reconciliation. Number of discrepancies and types of discrepancy were noted.

Results:

The 254 patients (176 women) had a mean age of 85 years (standard deviation 7.4 years, range 42-100 years). The most common reason for orthopedic admission was hip fracture. The mean number of discrepancies was 2.1 for all patients (range 0-13). Omission of a prescribed drug was the most common mistake. Fifty-six (22%) of the 254 assessed patients had a correct medication list.

Discussion:

The many discrepancies in our study may have several explanations but highlight the difficulties in taking a correct medication history of patients in a stressful environment with an extremely high workload. Moreover, electronic medication lists create challenges. Implementing new electronic tools for health care requires feedback, redesign, and adaptation to meet various needs of the users.

Conclusion:

In conclusion, orthogeriatric patients have an unsatisfactory high number of discrepancies in their medication lists. Clinical pharmacists can accurately identify many of these mistakes.

Imprudent Gastro-protective Approach in Majority of Specialists' Clinics of a Tertiary Hospital

INTRODUCTION

One out of four prescriptions in out-patient departments contains a gastro-protective drug (APUD) - PPI/ H2 Blockers/ Antacids/ Ulcer Protective's. These drugs should be prescribed only when there is a justified indication. To assess the prescriptions of gastro-protective agents for appropriateness and rationality, in a tertiary care hospital setup.

MATERIALS AND METHODS

It was a cross-sectional observational study conducted from Aug 2013 to Dec 2013 at OPDs of a Tertiary Care Teaching Hospital, Pune. A total of 260 prescriptions containing gastro-protective agents were analysed for appropriateness and rationality. Rationality of drug use was assessed by referring to standard textbooks and guidelines. Cost difference data was analysed by Wilcoxon signed rank test using GraphPad Prism 6.

RESULTS

Most common class of gastro-protective agents was Proton pump inhibitors (PPIs)-73.77% (Pantoprazole & Dexrabeprazole). Only 37.3% prescriptions had an adequate indication for these drugs {GI prophylaxis (29.6%) and Acid Peptic Disease treatment (7.7%)}. Two irrational Fixed dose combinations found in the study were PPI with prokinetic agent (n=65) and Proton Pump Inhibitor + NSAID combination (n=2). Formulation, spelling and strength errors were found with 75 prescribed drugs. Medication instructions were lacking with most of the drugs. Drug interactions with co-prescribed drugs could be anticipated in 79 cases. Injudicious use of anti-peptic ulcer agents significantly increased the cost of prescriptions (p<0.0001).

CONCLUSION

Anti-ulcer drugs are overenthusiastically prescribed by all specialties which can predispose to adverse effects, drug interactions, increased cost and even erroneous prescriptions.