Prescribing Patterns and Medication Appropriateness in General Medicine: Evaluation of Adherence to WHO Guidelines at a Tertiary Care Teaching Hospital in South Delhi, India

TL;DR

This study evaluates prescription practices at a hospital in India and finds that while basic documentation is good, there are issues with recording diagnoses and using generic drugs.

Contribution

The study provides a detailed audit of prescription adherence to WHO guidelines in a South Delhi hospital, highlighting specific areas for improvement.

Findings

Only 29% of prescriptions included a recorded diagnosis.

81% of prescribed drugs were available in the hospital pharmacy.

Polypharmacy was present in 71% of prescriptions.

Abstract

Background: Rational prescribing is vital to ensure patient safety, reduce medication errors, and optimize healthcare resource utilization. Prescription audits serve as essential tools for evaluating and improving prescription practices in clinical settings.

Objectives: The objectives of the study are to assess the prescription patterns and the completeness of prescriptions in the outpatient department of a tertiary care teaching hospital, using the World Health Organization (WHO) core prescribing indicators, and to identify areas for improvement.

Methods: A retrospective observational study was conducted by analyzing 300 randomly selected printed prescriptions from the Department of Medicine over six months. Data were extracted on patient demographics, prescription completeness, drug categories, and adherence to WHO prescribing indicators. Descriptive statistics summarized the findings.

Results: All prescriptions included basic patient and prescriber information; however, only 87 (29%) stated a diagnosis, and 14 (4.7%) used generic drug names. The average number of drugs prescribed per prescription was 6.8 ± 1.7, with 213 (71%) of prescriptions involving polypharmacy (≥3 drugs). Antibiotics were prescribed in 137 (45.7%) of encounters, with complete adherence to the local antibiotic policy observed in 300 (100%) of the prescriptions. Injectable drugs were prescribed in 12 (4%) of the prescriptions. About 183 (61%) of prescribed drugs were from the National List of Essential Medicines, and 243 (81%) were available in the hospital pharmacy. Documentation of treatment duration and dosage schedules was present in 174 (58%) and 231 (77%) of prescriptions, respectively.

Conclusions: While basic prescription documentation meets standards, significant gaps remain in diagnosis recording, generic prescribing, and reduction of polypharmacy. Regular prescription audits and targeted educational interventions are recommended to enhance rational drug use and patient safety in the hospital.

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