|Year : 2011 | Volume
| Issue : 5 | Page : 684-687
|"Rx - The mistakes we make!!": A short study
Arun Rathnam, Nidhi Madan
Department of Pedodontics and Preventive Dentistry, K.L.E.S's Institute of Dental Sciences, Belgaum, Karnataka, India
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|Date of Submission||30-Oct-2009|
|Date of Decision||13-Sep-2010|
|Date of Acceptance||11-Apr-2011|
|Date of Web Publication||7-Mar-2012|
| Abstract|| |
Context: There is concern regarding the irrational production, prescription and use of drugs in India.
Aim: This study aimed to describe the quality of prescriptions by dental practitioners of one particular college in a short period of time.
Materials and Methods: A survey of all prescriptions dispensed from the various departments of K.L.E.S.'s Institute of Dental Sciences, Belgaum, Karnataka, was conducted by collecting them from the patients exiting the college premises. The prescriptions were photocopied and handed back to the patients. The samples were collected over a period of 7 days. The samples were then analyzed for their content based on an ideal prescription format and the results were tabulated.
Results: The findings of the study suggest that most of the prescriptions given are woefully inadequate in content.
Conclusions: It can be concluded that a clear policy about the standard of prescriptions and periodic internal monitoring is the answer for quality prescriptions. Computerization of the prescription format is also a thought-provoking alternative.
Keywords: Dental, ideal prescriptions, prescriptions
|How to cite this article:|
Rathnam A, Madan N. "Rx - The mistakes we make!!": A short study. Indian J Dent Res 2011;22:684-7
In the absence of a clear, comprehensive and rational drug policy, the production of pharmaceutical preparations in India is grossly distorted.  Thus, Indian markets are flooded with over 70,000 formulations, compared to roughly 350 preparations listed on the WHO Essential Drugs List. There are thousands of drug companies, and several companies manufacture generic preparations using different brand names. In addition, thousands of formulations of vitamins, tonics and multi-drug combinations that are unique to the Indian market are manufactured and marketed here.
The aim of this study was to survey the quality and content of prescriptions provided by the various students and staff of all departments of K.L.E.S's Institute of Dental Sciences as part of an internal monitoring program. Our focus was not on whether the drugs were indicated for the patient's illness, but on the layout and content of the prescription. In particular, we wished to study the quality of the prescriptions in terms of the adequacy and clarity of the information contained therein.
| Materials and Methods|| |
The present study was conducted in the Department of Pedodontics and Preventive Dentistry, K.L.E.S.'s Institute of Dental Sciences, Belgaum.
A cross-sectional survey of all prescriptions received by the patients over a period of 7 consecutive days in July 2007 (01/07/07-07/07/07) was conducted. All the patients who were exiting the institution after obtaining treatment were approached for involvement in the study. Any prescriptions that they had obtained were photocopied and returned to the patients. The patients were approached so as to ensure that the doctors providing the prescriptions did not have knowledge of the study being conducted. This was done to avoid bias. No attempt was made to assess whether the prescriptions were written by students, interns or staff doctors. The prescriptions obtained therein were photocopied and returned to the patients [Figure 1]. The photocopies were retained as the sample proof of the study.
The layout of the prescriptions was assessed on the basis of the presence or absence of the understated details. Eleven parameters were assessed in each prescription.  They were as follows.
An overall rating system based on the above criteria was also given:
- Patient information (five parameters)
Doctor's information (four parameters)
- Name, Age, Sex, Address, Date of treatment
Documentation of the drugs in the case paper
- Department name, Name of Doctor, Signature, Contact Number
- Instructions given to the patient (verbal/written)
- The clarity of prescriptions was assessed on the basis of the following points: 
- Whether the prescription was legible (4-point rating system):
- Score 1: Prescription details are clear and legible
- Score 2: Clear but requires effort to read
- Score 3: One aspect not clear (patient name/drug name)
- Score 4: More than one aspect not clear
- The details of drugs prescribed were also rated (4-point rating system)
- Score 1: Clear and legible, Drug details present
- Score 2: Clear but requires effort to read
- Score 3: Criteria not met for one drug
- Score 4: Criteria not met for more than one drug
Scoring: Parameter present (1), absent (0)
Drug details: 1-4
Maximum and minimum scoring: 19 and 2, respectively
The prescriptions were rated by the lead author. Hence, there was no possibility of inter-examiner variability or bias. The results were tabulated and the data were analyzed using SPSS software version 11.
| Results|| |
A total of 122 samples of prescriptions were procured. An overall rating for all the prescriptions showed 93% of the samples to be in the average category with one or more details missing.
On analysis of the separate details of the prescriptions, the following were the discrepancies noted in brief.
Personal details (percentage of prescriptions showing missing information)
Doctor's name: 92
Phone no.: 97
In a comparison of the legibility of the samples, the following could be noted:
(4-Point scoring scale)
Score 1: 39%
Score 2: 54%
Score 3: 7%
Score 4: 0%
Documentation of the prescription in the patient's case paper was also checked and verified. This was found to be positive in 69% of the case papers.
| Discussion|| |
A well-written prescription reflects both on the doctor and the institution concerned. Hence, it is the prerogative of all the doctors and the institutions to make a concentrated effort to standardize the quality of prescriptions emanating from the various hospitals in the country.
The results of this study have thrown up some interesting and depressing results. In most prescriptions, one or more aspects of the patient's personal details were missing [Figure 2]. In most cases, it was also noted that the concerned doctor's details were also lacking [Figure 3]. The legibility of the prescriptions were also suspect in many instances [Figure 4]. This will pose a problem for proper record maintenance and give rise to many medico-legal complications. From the patient's point of view, he will not be in a position to intimate the doctor concerned if a particular brand of medicine is not available. This puts the onus of selecting a suitable alternative on the shoulders of the pharmacist.
Another aspect of the issue is the documentation of the prescription on the case paper [Figure 5]. A reading of the case paper should give all the pertinent information required by the doctor to make a correct choice regarding the patient's treatment protocol. The error of not noting the prescriptions on the case record will lead to problems of repeated drug intake for the same problem, posing a threat to the health of the patient. The overall rating given for the prescriptions is also provided [Figure 6].
It is also interesting to note that most of the instructions given to the patient about the procedure of intake of medicines were verbal [Table 1].  This is a very troubling aspect as it is dependent on the patient's understanding, the doctor's communication and the language barriers between both. This facet should be discouraged and clear written instructions should be provided in the prevailing language/languages of the region. It is also a fact that self-medication is rampant in India based on earlier prescriptions or pharmacist's advice. 
The path forward in this issue is computerization. A well-formatted and properly worded prescription format can be created that is to be used by all the doctors. This will also allow them the flexibility of highlighting the instructions already printed on the prescription format. Computerized individual billing and prescription will also allow a ready entry and track check for the medicines that the patient has been consuming in the particular period. It would be heartening if all the dental colleges of the country adopt a unified prescription format which will also allow national standardization. This is an aspect requiring thought by the eminent faculty of Dentistry in India. On my part as a humble contribution, I have provided a modified version of the prescription format I have availed from a similar study done in Goa  and Uttaranchal. 
The format given below provides for ease of prescribing with the need of either highlighting the right choices or filling in the blanks to complete the prescription. The provision of providing the same information in the regional language of that particular geographic area also allows for the patient to read and understand the dosage instructions provided. This form can be made computerized with a particular number for each prescription. This number should be inserted in the case report for proper documentation. This will go a long way toward the provision of standardized, understandable prescriptions by the doctors of this country.
Short problem-based training courses, continuing education programs and workshops can be conducted to provide updated and current information on pharmacotherapy. They can also be used to hone prescription skills of the people involved.
These initiatives will provide the pathway for standardized, evidence-based dental pharmacotherapy in India.
| Conclusions|| |
The present data depict the following:
To have better prescriptions and better health care facilities in the various dental colleges in India, a computerized format would be the answer.
- Most of the prescriptions obtained in this study were inadequate and had several important details missing.
- The overall legibility of the prescriptions also required thought as they were deemed average in rating.
| Acknowledgments|| |
All my post graduate colleagues, teaching staff and non-teaching staff of Department of Pediatric dentistry are acknowledged. A special mention of Dr. Indushekar KR, Dr. Anand L Shigli and Dr. Dayanand Shirol.
| References|| |
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|2.||Patel V, Vaidhya R, Naik D, Borker P. Irrational Drug use in India: A Prescription survey from Goa. J Postgrad Med 2005;51:9-12. |
|3.||Srinivasan S. A network for the rational and ethical use of drugs. Indian J Med Ethics 2004;1:13-4. |
|4.||Greenhalgh T. Drug prescription and self-medication in India: An exploratory survey. Soc Sci Med 1987;25:307-18. |
|5.||Rishi RK, Sangeeta S, Surendra K, Tailang M. Prescription audit: Experience in Garhwal (Uttaranchal), India. Trop Doct 2003;33:76-9. |
Department of Pedodontics and Preventive Dentistry, K.L.E.S's Institute of Dental Sciences, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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