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ORIGINAL ARTICLE |
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Year : 2014 | Volume
: 27
| Issue : 2 | Page : 306-309 |
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Prescription errors in family practice in Menoufia governorate
Taghreed M Farahat, Mohammad M Al-Kot, Mohamed F Ahmed, Shimaa M Mohamed Sammara
Department of Family Medicine, Faculty of Medicine, Menoufiya University, Menoufia, Egypt
Date of Submission | 02-May-2013 |
Date of Acceptance | 14-Oct-2013 |
Date of Web Publication | 26-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
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/1110-2098.141682
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 2024 Mar 29];27:306-9. Available from: http://www.mmj.eg.net/text.asp?2014/27/2/306/141682 |
Introduction | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
Conflicts of interest
There are no conflicts of interest.
References | | |
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[Table 1], [Table 2], [Table 3]
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