Drug utilization, prescription errors and potential drug-drug interactions: an experience in rural Sri Lanka

Abstract

BackgroundPrescription writing is a process which transfers the therapeutic message from the prescriber to the patient through the pharmacist. Prescribing errors, drug duplication and potential drug-drug interactions (pDDI) in prescriptions lead to medication error. Assessment of the above was made in prescriptions dispensed at State Pharmaceutical Corporation (SPC), Anuradhapura, Sri Lanka.MethodsA cross sectional study was conducted. Drugs were classified according to the WHO anatomical, therapeutic chemical classification system. A three point Likert scale, a checklist and Medscape online drug interaction checker were used to assess legibility, completeness and pDDIs respectively.ResultsThousand prescriptions were collected. Majority were hand written (99.8 %) and from the private sector (73 %). The most frequently prescribed substance and subgroup were atorvastatin (4 %, n = 3668) and proton pump inhibitors (7 %, n = 3668) respectively. Out of the substances prescribed from the government and private sectors, 59 and 50 % respectively were available in the national list of essential medicines, Sri Lanka. Patients address (5 %), Sri Lanka Medical Council (SLMC) registration number (35 %), route (7 %), generic name (16 %), treatment symbol (48 %), diagnosis (41 %) and refill information (6 %) were seen in less than half of the prescriptions. Most were legible with effort (65 %) and illegibility was seen in 9 %. There was significant difference in omission and/or errors of generic name (P = 0.000), dose (P = 0.000), SLMC registration number (P = 0.000), and in evidence of pDDI (P = 0.009) with regards to the sector of prescribing. The commonest subgroup involved in duplication was non-steroidal anti-inflammatory drugs (NSAIDs) (43 %; 56/130). There were 1376 potential drug interactions (466/887 prescriptions). Most common pair causing pDDI was aspirin with losartan (4 %, n = 1376).ConclusionAtorvastatin was the most frequently prescribed substance. Fifteen percent of the prescriptions originate from government sector. SLMC registration number and trade names were seen more in prescriptions originating from the private sector. Most prescriptions were legible with effort. NSAIDs were the commonest implicated in drug class duplication. Fifty three percent of prescriptions have pDDI.Electronic supplementary materialThe online version of this article (doi:10.1186/s40360-016-0071-z) contains supplementary material, which is available to authorized users.

A Comprehensive Analysis of Drug Prescribing Practices of Doctors and Completeness of Prescription in a Government Medical College in Northern India

“…We found that drug class duplication was seen to be present in 17.68% prescriptions. This is comparable to the results in the study by Rathish et al who found 14.65% of prescriptions containing drug class duplication [7]. One or more FDCs were prescribed in 46.27% prescriptions in our study, while the overall percentage of FDCs from the total number of drugs was 17.36%.…”

“…In our study, 67.66% of prescriptions were found to be clearly legible. In studies conducted by Saini et al and Rathish et al, the percentage of legible prescriptions was found to be 66% and 26%, respectively, showing wide variability [6,7]. In our study, 43.85% prescriptions diagnosis was not mentioned, while chief complaints were not mentioned in 51.83% prescriptions.…”

“…who conducted their study in Sri Lanka found that the registration number of the doctor was written in 35% of the prescriptions [7]. In our study, signatures of the doctor were present in 89.32% of the prescriptions.…”

Pattern and Appropriateness of Medicines Prescribed to Outpatients at a University Hospital in Northwestern Ethiopia

“…Studies on potential drug-drug interaction (PDDI) in a number of countries reported varying findings. Studies from India and Sri Lanka, which employed Medscape Interaction Checker, reported PDDIs proportions of 83.42% and 52.5% [ 7 , 8 ]. Findings from Brazil and Italy, using Drug Reax of Micromedex, identified 49.7% and 45.3% pairs of medicines with PDDIs [ 9 , 10 ].…”

Nature of dispensing errors in selected hospitals providing free healthcare: A multi-center study in Sri Lanka

“…There are several studies in Sri Lanka reporting on prescription errors and medication errors (15,18,19,20,21) but only a few on dispensing errors, their types and prevalence. The study by Hettihewa et al, 2011 (22) reported a low dispenser-patient ratio and the need for introducing a well-prepared medicine labeling system but they did not look for all types of dispensing errors.…”