Jyoti Naresh, Kaur Sharanjit
Assistant Professor, Department of Pharmacology, Chintpurni Medical College , Bungal, District, Pathankot, Punjab-145001, India .
J Clin Diagn Res. 2013 Apr;7(4):680-3. doi: 10.7860/JCDR/2013/5441.2880. Epub 2013 Feb 15.
A serial prescription audit in four cycles (three months each) was conducted at Jhalawar Medical College and Hospital and at Chintpurni Medical College and Hospital for two years, one year in each hospital. One cycle included the prescriptions which were collected by using a digital camera from the outdoor patients department every month (n=250 per month), for three months regularly. A baseline prescription audit, as a cross-sectional survey, was done on the last date of the first month. Re-audits were done on the last date of the 2(nd) and 3(rd) months, which concluded one cycle. One cycle was followed by three months of no prescription audit. In total, four cycles were completed in two years. The parameters which were observed were- (a) the formats of the prescriptions (b) the WHO drug core indicators and (c) the legibility of the prescriptions. The clarity of the prescriptions was decided upon by the consensus group. A continuous evaluation and a feedback process were carried out every month by analyzing the prescriptions, based on the extent of conformity to the "WHO Guide to Good Prescribing" and the updated list of the "WHO Essential Medicines." The data was analyzed by using the Chi-square test.
There was a significant improvement in the formats of the prescriptions in terms of the quality of the completeness and the rationality at the end of the 2nd and 3rd months of each cycle. Similarly, the WHO drug core indicators improved with every re-audit in each cycle (p < 0.05). Overall, the total percentage of the core indicators significantly improved in the 2nd and 3rd months as compared to the 1st month in all the cycles (p < 0.05). The clarity of the prescriptions improved in the successive re-audits. There was a sudden decline in the improvement in all the parameters in the first month of the 2nd, 3rd and the 4th cycles as compared to that in the 2(nd) and 3(rd) months of the previous cycles.
Serial prescription audits and an active feedback definitely improve the prescription behaviours in the therapeutic decision making. But discontinuing the prescription audits begins to reverse the improvement in the prescription behaviours.
在贾拉瓦尔医学院及医院和钦图尔尼医学院及医院进行了为期两年的四个周期（每个周期三个月）的系列处方审核，每家医院各进行一年。一个周期包括每月使用数码相机从门诊收集的处方（每月(n = 250)份），持续三个月。在第一个月的最后一天进行了作为横断面调查的基线处方审核。在第二个月和第三个月的最后一天进行重新审核，这标志着一个周期结束。一个周期之后是三个月不进行处方审核。两年内共完成四个周期。观察的参数有：（a）处方格式；（b）世界卫生组织药物核心指标；（c）处方的可读性。处方的清晰度由共识小组决定。每月通过分析处方，根据与《世界卫生组织良好处方指南》和《世界卫生组织基本药物》更新清单的符合程度进行持续评估和反馈。数据采用卡方检验进行分析。
在每个周期的第二个月和第三个月末，处方格式在完整性和合理性质量方面有显著改善。同样，每个周期的每次重新审核中，世界卫生组织药物核心指标都有所改善（(p < 0.05)）。总体而言，与第一个月相比，所有周期的第二个月和第三个月核心指标的总百分比显著提高（(p < 0.05)）。在连续的重新审核中，处方的清晰度有所提高。与前一周期的第二个月和第三个月相比，在第二个、第三个和第四个周期的第一个月，所有参数的改善突然下降。
系列处方审核和积极反馈肯定会改善治疗决策中的处方行为。但停止处方审核会开始逆转处方行为的改善。
