Assessment of completeness and legibility of handwritten prescriptions in six community chain pharmacies of Asmara, Eritrea: a cross-sectional study

Abstract

Background Incompleteness and illegibility of prescriptions are prescription errors that account for a high proportion of medication errors that could potentially result in serious adverse effects. Thus, the objective of this study was to assess the completeness and legibility of prescriptions filled in the community chain pharmacies. Methods An analytical and cross-sectional study was conducted in the six government owned community chain pharmacies of Asmara, Eritrea from June 3rd to 10th, 2019 using a stratified random sampling technique. A total of 385 prescriptions were analyzed for completeness and legibility by three pharmacists (two experienced and one intern pharmacist). Descriptive statistics and multinomial logistic regression were employed using IBM SPSS® (Version 22). Results A total of 710 drugs were prescribed from the 385 prescriptions assessed. On average, a prescription was found to have 78.63% overall completeness. In the majority of the prescriptions, patient’s information such as name, age, sex, and prescriber’s identity were present. Prescribed drugs’ information such as dose, frequency and quantity and/or duration were present in 83.7, 87.7, and 95.1% respectively. Moreover, generic names were used in 83.3% of the drugs prescribed. About half (54.3%) of the prescriptions’ legibility were classified in grade four (clearly legible) and 30.6% in grade three (moderately legible). It was observed that legibility significantly increased with an increase in percentage completeness (rs = 0.14, p = 0.006). However, as the number of drugs written in brand name increased, legibility decreased (rs = − 0.193, p < 0.001). Similarly, as the number of drugs prescribed increased, legibility decreased (rs = − 0.226, p < 0.006). Conclusion Majority of the handwritten prescriptions received in the community pharmacies of Asmara are complete and clearly legible.

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“…[ 18 ] In another study of prescriptions in pharmacy in Eritrea, prescriptions’ format was analyzed and dose, frequency, and quantity and/or duration were present in 83.7%, 87.7%, and 95.1%, respectively. [ 19 ] In the study of Singh et al ., the correct dose and dosage was noted in 73.3% of the prescriptions of a hospital. In the same study, the diagnosis was mentioned in 64.2% of the prescriptions.…”

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“…18 Our finding was also much lower than a study conducted in Asmara, Eritrea where the percentage of prescriptions with patient name, age, and sex were 99.7%, 83.4%, and 89.6%, respectively. 12 Full patient-related components including age and body weight are essential for consideration of dose adjustment and recognition of possible contraindications. To this end, the study showed a profound gap in documenting the required patient information.…”

“…2,23 Better prescribing practice was reported from Asmara, Eritrea, where information on prescribed drugs such as dose, frequency, and duration were present in 83.7, 87.7, and 95.1%, respectively. 12 Since one of the limiting factors in the effectiveness of antibacterial agents is the concentration of the drug attained in the site of action, 24 which in turn depends on the dose administered, neglecting this information might lead to the failure of achieving positive treatment outcomes. Dispensers can ascertain the legality of the prescription by checking the presence of prescriber name and signature upon receiving it from the patient.…”

“…11 Likewise, a study conducted in Asmara, Eritrea, found the overall completeness of prescriptions to be 78.63%. 12 A study conducted at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia indicated that about 25% of prescribing encounters had patient information such as age and sex and less than 10% of the prescription contained dosage forms as a part of the medication regimen. 13 In contrast, good prescribing practice manuals developed by the Food Medicine Healthcare Administration and Control Authority (FMHACA), currently renamed as Ethiopian Food and Drug Administration (EFDA), and World Health Organization (WHO) 14,15 emphasized that information on patient-related factors, major diagnosis or international classification of diseases (ICD) code, medication regimen components and responsible health professionals should be duly and legibly recorded on prescription papers prepared with a preprinted format.…”

“…30 To lower prescription writing errors, prescribers should write in compliance with the national and international prescription guidelines and the concerned bodies should strengthen the existing laws and regulations. 12 Evidence showed that antibiotic prescribing is influenced by psychosocial factors including lack of accountability, clinician workload, and habit. 31 In this regard, continuous professional development programs are recommended to improve the quality of prescription writing among prescribers.…”