Background: The quality of a prescription reveals the attitude of the prescriber towards rational prescribing. Rational use of drugs is an essential element in achieving high quality patient care. This study aims to audit the outpatient first encounter prescriptions using the WHO core prescribing indicators for rational use of drugs.

Materials and Methods: 2469 prescriptions were audited over a period of three months in a tertiary care teaching hospital. Prescriptions were assessed with criteria for completeness, legibility and WHO core prescribing indicators values.

Results and Conclusion: Prescribing errors were common. Poor legibility and polypharmacy were common. Generic drug names were rarely used. Antibiotic use was more than optimal. However, more than 80% of medications were prescribed from essential drug list. Percentage of injections was well within the optimal limit. Our recommendations for reducing prescribing errors are regular education and training of prescribers, ongoing monitoring, awareness and communication. Other safeguards against prescription errors are electronic prescribing, prescription review by clinical pharmacists and use of standard treatment guidelines by the prescribers. Teaching hospitals have a special responsibility to society to promote rational prescribing by their staff and, through them, the future generations of physicians.

Keywords: WHO core prescribing indicators, rational drug use, tertiary care teaching hospital.

1. Medicines: rational use of medicines. Fact sheet No. 338. World Health Organization [online] (http://www.who.int/media-centre/factsheets/fs338/en/, accessed 16 September 2012).
2. The world medication situation 2011: rational use of medication. Geneva, World Health Organization, 2011.
3. National Institute for Clinical Excellence (NICE): Principles for Best Practice in Clinical Audit. Oxford: Radcliffe Publishing 2002.
4. Rational use of medicines by patients and prescribers. Geneva, World Health Organization, 2005.
5. How to investigate drug use in health facilities: selected drug use indicators. Geneva, World Health Organization, 1993 (EDM Research Series No. 007).
6. Guide to good prescribing: a practical manual. Geneva, World Health Organization, 1994.
7. Sheldon MG. Self-audit of prescribing habits and clinical care in general practice. J R Coll Gen Pract. 1979 Dec; 29(209): 703-6, 710-1.
8. The use of essential drugs. Seventh report of WHO Expert Committee (including the revised model list of essential drugs). Geneva, World Health Organization, 1997.
9. Ahsan M, Shaifali I, Mallick AK, Singh HK, Verma S, Shekhar A. Prescription auditing based on World Health Organization (WHO) prescribing indicators in a teaching hospital in North India. Int J Med Res Rev 2016; 4(10): 1847-52. doi: 10.17511/ijmrr. 2016.i10.22.
10. Seden K, Kirkham JJ, Kennedy T. Cross sectional study of prescribing errors in patients admitted to nine hospitals across North West England. BMJ Open 2013; 3: e002036. doi: 10.1136/bmjopen-2012-002036. [Pub Med]
11. Model prescription format. (http://www.delhimedicalcouncil.org/pdf/modelprescription.pdf, accessed 26 September 2016).
12. Potharaju HR, Kabra SG. Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra. Indian J Pharmacol. 2011 Apr; 43(2): 150-6. doi: 10.4103/0253-7613.77350.
13. El Mahalli AA. WHO/INRUD drug prescribing indicators at primary health care centres in Eastern province, Saudi Arabia. East Mediterr Health J 2012; 18(11): 1091-6. [Pub Med]
14. Desalegn AA. Assessment of drug use pattern using WHO prescribing indicators at Hawassa University teaching and referral hospital, south Ethiopia: a cross-sectional study. BMC Health Serv Res 2013 May 7; 13: 170. doi: 10.1186/1472-6963-13-170.
15. Guidelines on the use of international non-proprietary names (INNs) for pharmaceutical substances. Geneva. World Health Organization, 1997 (http://apps.who.int/medicinedocs/en/d/jh1806e/, accessed 18 September 2012).
16. Irrational drug use causing rise of anti-microbial resistance. Geneva, World Health Organization, 1997.
17. Abidi A, Gupta S, Kansal S. Prescription auditing and drug utilization pattern in a tertiary care teaching hospital of Western UP. Int J Basic Clin Pharmacol. 2012; 1(3): 184-90. doi: 10.5455/2319-2003.ijbcp003812.
18. Aravamuthan A, Arputhavanan M, Subramaniam K, Udaya Chander JSJ. Assessment of current prescribing practices using World Health Organization core drug use and complementary indicators in selected rural community pharmacies in Southern India. J Pharm Policy Pract. 2016 Jul 19;10:1. doi: 10.1186/s40545-016-0074-6. eCollection 2017.
19. Naseeb TA, Nasser MA. Drug prescribing indicators in primary health care centres in Bahrain. Saudi Med J. 2005;26(9):1436-38.
20. Hogerzeil HV, Walker GJ, Sallami AO, Fernando G. Impact of an essential drugs programme on availability and rational use of drugs. Lancet. 1989 Jan 21;1 (8630):141-42.

Rajwinder Singh, MD

Associate Professor, Department of Dermatology, Venereology and Leprosy, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, 173229 (Himachal Pradesh), India

Cell 09501300469, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.