# Prescription Audit as a Quality Improvement Tool: Impact of Repeated Interventions in Paediatric Outpatient Department (OPD) and Inpatient Department (IPD) Settings

## TL;DR

Repeated audit-feedback cycles improved prescription quality in a pediatric hospital in a low-income country, showing that manual interventions can enhance drug use and documentation.

## Contribution

Demonstrates the effectiveness of manual audit-feedback in improving prescribing practices in resource-limited settings without digital systems.

## Key findings

- Prescription documentation and legibility improved significantly after repeated audit cycles.
- Antibiotic use and the number of drugs per prescription decreased substantially.
- Sustained improvement requires institutionalizing audit processes within governance structures.

## Abstract

Background

In many low- and middle-income country (LMIC) hospitals, prescription auditing is rare due to limited digital infrastructure and weak quality-assurance systems. We evaluated whether repeated audit-feedback cycles could improve prescription completeness and rational drug use in an LMIC tertiary pediatric setting.

Methodology

Prospective, repeated cross-sectional audits (10 cycles; Nov 2023-Nov 2024) were performed in Pediatrics/Neonatology at a tertiary hospital in India. Cycles used a manual, paper-based process with structured feedback and brief prescriber education; a re-audit occurred eight months later (Plan-Do-Study-Act (PDSA) model). The primary objective of this study was to evaluate the effectiveness of a targeted audit and feedback intervention as a strategy to achieve sustained improvement in the overall quality of prescribing practices and documentation standards within our paediatric facility over consecutive PDSA cycles. IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, New York, United States) with the Cochran-Armitage Trend Test for trend and paired t-tests at p<0.05 were performed.

Results

Documentation of OPD numbers improved substantially from 50% to 99%; legibility increased from 30% to 90%; and generic prescribing rates rose from 60% to 92%. The mean number of drugs per prescription declined significantly from 4.4 to 1.5 (p<0.01), and antibiotic use decreased markedly from 80% to 20% (p<0.01). Allergy documentation rose modestly (0%→32%). Re-audit showed small regressions (e.g., antibiotics 30%), indicating need for continuous reinforcement.

Conclusions

Even without electronic systems, cost-neutral, audit-feedback cycles in an LMIC setting produced substantial gains in prescribing quality and stewardship. Sustained improvement requires institutionalization of audits within governance structures.