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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 2  |  Page : 306-309

Prescription errors in family practice in Menoufia governorate


Department of Family Medicine, Faculty of Medicine, Menoufiya University, Menoufia, Egypt

Date of Submission02-May-2013
Date of Acceptance14-Oct-2013
Date of Web Publication26-Sep-2014

Correspondence Address:
Shimaa M Mohamed Sammara
MBBCh, Department of Family Medicine, Menouf Family Health Center, 9 Talaat Street, Menouf City, Menoufia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.141682

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  Abstract 

Objective
The aim of this study was to improve drug prescriptions in family practice through assessment of the types and frequency of prescription errors in family practice.
Background
Prescription is a written directive, as for the compounding or dispensing and administration of drugs, or for other services to a particular patient. Prescriptions should be clear, legible, and written in plain English. A prescription has three components: superscription (patient and prescriber data, diagnosis, and date), inscription: the body of the prescription (Rx symbol, drug data, and instructions for drug intake), and subscription (refills and prescriber signature). Prescribing faults and prescription errors are major problems among medication errors; although they are rarely fatal, they can affect patients' safety and quality of healthcare.
Patients and methods
A retrospective study of all available prescriptions (No. 691) during the period of the study (323 prescriptions from the Menouf family health center and 368 prescriptions from Monshaat Soltan family health unit) was carried out. The site of the study was selected using a stratified multistage random sampling technique to select a family health center and unit representing the urban and rural family practice sites in Menoufia governorate. These prescriptions were examined according to the ideal prescription writing mentioned in the article.
Results
Only 33.3% prescriptions were dated, whereas patients' weight, height, and address were absent in all of the prescriptions studied. Prescriber information was present in 64.3% and prescriber signature was present in 98.6%. The generic name of the drugs was mentioned in only 31.3% of the prescriptions. Only about one-third of the prescriptions were complete.
Conclusion
Prescribing errors contribute significantly toward adverse drug events. The frequency of drug prescription errors is high. Physicians should be trained more rigorously to learn the art of prescription writing.

Keywords: Medical prescription, prescribing in family practice, prescription errors


How to cite this article:
Farahat TM, Al-Kot MM, Ahmed MF, Mohamed Sammara SM. Prescription errors in family practice in Menoufia governorate. Menoufia Med J 2014;27:306-9

How to cite this URL:
Farahat TM, Al-Kot MM, Ahmed MF, Mohamed Sammara SM. Prescription errors in family practice in Menoufia governorate. Menoufia Med J [serial online] 2014 [cited 2019 Jul 20];27:306-9. Available from: http://www.mmj.eg.net/text.asp?2014/27/2/306/141682


  Introduction Top


A prescription is a health-care program implemented by a physician or other qualified practitioner in the form of instructions that govern the plan of care for an individual patient [1]. Commonly, the term prescription is used to mean an order to take certain medications [2]. Prescription order is the most frequent outcome of the outpatient physician visit. An estimated 61% of patient visits for a new medical problem will result in the patient receiving at least one prescription [3].

The importance of the prescription is exaggerated by the fact that it becomes a medico-legal document once it is signed by the prescribing authority, and must thus be written completely and legibly [4].

All prescriptions should be written in ink or typed: prescriber information, patient information, date prescription issued, Rx Symbol, medication information, dispensing directions for pharmacist, directions for use, refill, other information and prescriber signature [5].

Errors in prescribing may be classified into three main types: errors of superscription, inscription, and subscription. Prescribing errors may have various detrimental consequences [6].

Many studies have identified and documented problems associated with prescribing errors. The extent of such errors varied from 2.6 to 15.4%. Studies have shown that 15-21% of prescriptions contain at least one prescribing error [6]. Approximately 7.1% prescribing errors were detected during the study of 1580 prescriptions at a teaching hospital in Saudi Arabia [7].

For several reasons, the current methods of medical prescription have deficiencies. There is a lack of knowledge of clinical pharmacology among physicians [8], and some prescribers may also always be in a hurry and hence unwilling to spend a little more time in writing clear and complete prescriptions [9].

The aim of this study was to improve drug prescriptions in family practice through assessment of the types and frequency of prescription errors in family practice.


  Patients and methods Top


This was a retrospective study.

The site of the study was selected using a stratified multistage random technique to choose a rural and an urban area to represent the Menoufia government.

Menouf discrete were selected using a stratified simple random technique The Menouf family health center was selected to represent an urban area and the Monshaat Soltan family health unit was selected to represent a rural areas.

Preliminary visits to the selected sites were performed to have an idea about the present prescription errors and to ascertain the qualifications of the present physicians. In this visit, we found that the physicians in both the family health center of Menouf city and the family health unit in Monshaat Soltan did not have any postgraduate degree in family medicine studies, but the physicians of the Menouf family health center had received only a condensed course in family practice for 6 weeks.

A copy of all available prescriptions (No. 770) in the period from 1 July 2009 to the end of December 2009 was obtained (392 prescriptions from the Menouf health family health center and 378 prescriptions from the Monshaat Soltan family health unit).

All prescriptions were selected according to inclusion and exclusion criteria, which resulted in the selection of 691 prescriptions after exclusion of 79 prescriptions (69 prescriptions from the Menouf health family health center and 10 prescriptions from the Monshaat Soltan family health unit).

Inclusion and exclusion criteria

Inclusion criteria

0Prescriptions written with readable clear handwriting were included in the study.

Exclusion criteria

Prescriptions with very poor handwriting were excluded from the study.

The ideal medical prescription writing was studied carefully to identify the prescription errors; the prescriptions were examined according to ideal prescription writing by Goodman and Gillman and also according to the classification of prescription errors by Jeetu and Girish.


  Results Top


Only 33.3% of prescriptions were dated. The name and age of the patients were mentioned in 79.6 and 37% of the prescriptions, respectively, whereas patients' weight, height, and address were absent in all the studied prescriptions. Prescriber information (name and qualification) was present in 64.3%, prescriber signature was present in 98.6%, and the diagnosis present in 65.7% of the prescriptions. The generic name of the drugs was mentioned in only 31.3% of the prescriptions. The concentration and dosage of drug were present in 39.5 and 81.6% of the prescriptions, respectively. The handwriting was clear in 84.4% of the prescriptions.


  Discussion Top


The prescriber's full name and qualification were mentioned in 64.3% of the prescriptions, which is similar to the results obtained by Amira et al. [10] in Khartoum, who found that prescriber name was present in 60.7% of the prescriptions, and lower than the results of the Ni et al.'s [11] study (98.2%). The study of Ni and colleagues was carried out in the Outpatient Pharmacy Department of a major teaching hospital in Malaysia in 1998. This Outpatient Pharmacy Department received an average of 1057 prescriptions per day.

The results of the present study showed that 20.4% of the prescriptions did not include the patient's full name (three names required), which is similar to the results obtained by Amira et al.'s [10] study (18.6%). However, in the Kuan et al.'s [11] study, patients' full name was written in all of the prescriptions studied and in the Irshaid et al.'s study [12] patients' full name was written in 5.4% of the prescriptions; this study was carried out in Asir Central Hospital, Asir Central Hospital, which is located in Abha city, and is the main referral hospital in Asir Region, which has a population of 1.2 million individuals. This center is utilized by the College of Medicine, King Khalid University, for training of medical students.

The prescription date were missing in 66.7% of the prescriptions, which is similar to the results of Irshaid et al.'s [12] study (64.3%) and higher than that of Balbaid and Al-Dawood [13], and Francois et al. [14] who found that the date was missing in 8.7 and 4.5% of the prescriptions, respectively.

The diagnosis was missing in 34.3% of the prescriptions, which is similar to the results obtained in a study carried out in Asir Central Hospital in Saudi Arabia by Irshaid et al. [12], who found that the diagnosis was missing or unreadable in one-third (34.0%) of the prescriptions.

The prescribed drugs were written in the present study by generic name in 31.3% of the prescriptions and in the remaining (68.7%), the brand name was written, which is lower than the standard WHO value (100%).

Drug concentration was present in 39.5% and drug dosage was present in 81.6% of the prescriptions in the present study; this is higher than that reported by Amira et al. [10] (60.3%). The Amira and colleagues study was carried out in three pediatric teaching hospitals in Khartoum on 900 prescriptions. The first 300 prescriptions from each hospital were collected randomly and analyzed. Second, a case scenario was assigned to 300 doctors and they were asked to write a prescription for it. These were also collected and analyzed for their completeness. Using the simple random technique, prescriptions were collected from each hospital until the desired number was reached (n = 300) from each hospital. Doctors of different jobs were randomly asked to write prescriptions for the case scenario on the same day during which prescriptions were collected.

The prescriber signature was found in 98.6% of the studied prescriptions, similar to that reported by Ni et al. [11] (99.7%).

It was found that only about one-third of the prescriptions were complete; this is in agreement with the result reported by Amira et al. [10], who found that (34.7%) of the doctors wrote complete prescriptions.


  Conclusion Top


This study found widespread errors in prescription writing by the physicians.

Recommendations

A short course on prescription writing should be incorporated into the curriculum of undergraduate students at the level of basic pharmacology and potentiate postgraduate studies in family practice to deal with this problem.

Family medicine should be part of the curricula at the level of Bachelor degree [Table 1],[Table 2] and [Table 3].
Table 1: Number and percentage distribution of superscription errors (prescriber information, patient's information, date, and diagnosis)


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Table 2: Number and percentage distribution of inscription errors (Rx symbol, medications' information, instructions for the pharmacist, and instructions for the patient) in the prescriptions studied

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Table 3: Number and percentage distribution of the subscription errors (refills and prescriber signature ) in the prescriptions studied

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  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.Allen F, Ronald O. Prescription-writing patterns and errors in a family medicine residency program. J Family Practice 1989; 29 :290.   Back to cited text no. 1
    
2. Belknap SM, Moore H, Lanzotti SA, Yarnold PR, Getz M, Deitrick DL, et al. Application of software design principles and debugging methods to an analgesia prescription reduces risk of severe ýnjury from medical use of opioids. Clin Pharmaco Ther 2008; 84 , 385.   Back to cited text no. 2
    
3. Yousif E, Ahamed AM, Abdalla ME, Abdelgadir MA. Deficiencies in medical prescriptions in Sudanese hospital. East Medit Health J 2006; 6 :915-918.  Back to cited text no. 3
    
4. De Vries TP, Henning RH, Hogerzeil HV, Fresle DA. Guide to good prescribing. A practical manual. World Health Organization Action Programme on Essential Drugs 2006. Available at: http://whqlibdoc.who.int/hq/1995/WHO_DAP_94.11.pdf  Back to cited text no. 4
    
5. Goodman & Gillman the pharmacological basis of therapeutics: principles of prescription order writing and patient compliance 2001-1907.  Back to cited text no. 5
    
6. Jeetu G, Girish T. Prescription drug labeling medication errors: a big deal for pharmacists. J Young Pharm 2010; 2 :107-111.  Back to cited text no. 6
    
7. Al-Dhawailie AA. Inpatient prescribing errors and pharmacist intervention at a teaching hospital in Saudi Arabia. Saudi Pharm J 2011; 19 :193-196.  Back to cited text no. 7
    
8. Blatt A, Chamban R, Lemardeley P. Legal format and costs of prescription at the Central hospital in Yaounde. Cam J 1997; 57 :37-40.  Back to cited text no. 8
    
9. Cohen MR, Davis NM. Complete prescription orders reduce medication errors. Am Pharm NS 1992; 32 :24.  Back to cited text no. 9
    
10.Amira E, Sirageldin M, K Abdelrahman. Prescription writing quality in paediatric teaching hospitals in Khartoum. Sudanese J Paediatrics 2012; 12 :64.  Back to cited text no. 10
    
11.KM Ni, CS Siang, MN Bin Ramli. "Noncompliance with prescription writing requirements and prescribing errors in an Outpatient Department". Malaysian J Pharmacy 2002; 1 :45.  Back to cited text no. 11
    
12.Irshaid YM, Al Homrany M, Hamdi AA, Adjepon-Yamoah KK, Mahfouz AA. Compliance with good practice in prescription writing at outpatient clinics in Saudi Arabia. East Mediterr Health J 2005; 11 :922-928.  Back to cited text no. 12
    
13.Balbaid OM, Al-Dawood KM. Assessment of physician′s prescribing practices at Ministry of Health Hospitals in Jeddah City, Saudi Arabia. Saudi Med J 1998; 19 :28.  Back to cited text no. 13
    
14.François P, Chirpaz E, Bontemps H, Labarère J, Bosson JL, Calop J. Evaluation of prescription- writing quality in a French University Hospital. Clin Perform Qual Health Care 1997; 5 :111-115.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
Acknowledgements
References
Article Tables

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