High Rate of Prescription Deviations in Indian Tertiary Hospitals; Experts Recommend Training and Policy Changes

India: An article in the Indian Journal of Medical Research has highlighted a recent evaluation of prescription practices in tertiary care hospitals across India, examining deviations from treatment guidelines and their potential consequences.

The study found an overall prevalence of 45% in guideline deviations, with 9.8% classified as unacceptable. To reduce these deviations, clinicians suggested implementing online training for rational prescribing and enforcing administrative directives as effective interventions.

Irrational prescribing practices significantly impact patient safety and escalate healthcare costs. Sharing real-life examples of the consequences of such practices could help improve prescribing behaviors.

Yashashr Shetty, Department of Pharmacology & Therapeutics at Seth GSMC & KEM Hospital et. al. conducted the study to assess the prevalence of deviations from treatment guidelines in prescriptions, examine the potential consequences of these deviations, and gather recommended corrective actions from clinicians.

The cross-sectional observational study was conducted in the outpatient departments of tertiary care hospitals across India, specifically where the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions that did not adhere to standard treatment guidelines or were incomplete in terms of formulation, dosage, duration, and frequency were classified as "prescriptions with deviations." Deviations that could lead to drug interactions, lack of therapeutic response, increased costs, preventable adverse drug reactions (ADRs), or antimicrobial resistance were termed "unacceptable deviations."

The study's key findings were:

• Approximately 9.8% of the prescriptions assessed had unacceptable deviations.
• Clinicians adhered to treatment guidelines in 55.1% of the prescriptions.
• Of the 2,171 prescriptions with deviations, 21.9% had unacceptable deviations, with pantoprazole, rabeprazole+domperidone, and oral enzyme preparations being the most commonly involved drugs.
• The most frequent diseases associated with unacceptable deviations were upper respiratory tract infections (URTI) and hypertension.
• The potential consequences of these deviations included increased costs, adverse drug reactions, drug interactions, lack of therapeutic response, and antimicrobial resistance.
• The major corrective actions suggested were issuing an administrative order (196 recommendations) and implementing an online training program.

The researchers concluded that the overall prevalence of deviations was 45%, with 9.8% identified as unacceptable. To reduce these deviations, clinicians suggested online training in rational prescribing and the implementation of administrative directives as potential interventions.

Reference

Shetty, Yashashri1; Kamat, Sandhya1; Tripathi, Raakhi1; Parmar, Urwashi1; Jhaj, Ratinder2; Banerjee, Aditya2; Balakrishnan, Sadasivam†; Trivedi, Niyati3; Chauhan, Janki4; Chugh, Preeta Kaur6; Tripathi, C. D.9; Badyal, Dinesh Kumar10; Solomon, Lydia10; Kaushal, Sandeep11; Gupta, Kanchan11; Jayanthi, M.13; Jeevitha, G.13; Chatterjee, Suparna15; Samanta, Kalyan14; Desai, Chetna5; Shah, Samidh5; Medhi, Bikash12; Joshi, Rupa12; Prakash, Ajay12; Gupta, Pooja7; Roy, Atanu8; Chandy, Sujith16; Ranjalkar, Jaya16; Bright, Heber Rew17; Dikshit, Harihar18; Mishra, Hitesh18; Roy, Sukalyan Saha18; Kshirsagar, Nilima19. Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences. Indian Journal of Medical Research 159(2):p 130-141, February 2024. | DOI: 10.4103/ijmr.ijmr_2309_22