Original Research

Rx The mistakes we make!!: A short study

Arun Rathnam, Nidhi Madan

Department of Pedodontics and

Preventive Dentistry, K.L.E.Ss
ABSTRACT
Institute of Dental Sciences,
Belgaum, Karnataka, India
Received : 30-10-09
Review completed : 13-09-10
Accepted : 11-04-11
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.
Key words: Dental, ideal prescriptions, prescriptions

In the absence of a clear, comprehensive and rational drug
policy, the production of pharmaceutical preparations in
India is grossly distorted.[1] 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.Ss Institute of Dental Sciences
as part of an internal monitoring program. Our focus was
not on whether the drugs were indicated for the patients
illness, but on the layout and content of the prescription.
Address for correspondence:
Dr. Arun Rathnam
E-mail: planetrathnam@yahoo.com
Access this article online
Quick Response Code: Website:
www.ijdr.in
PMID:
***
DOI:
10.4103/0970-9290.93457
Indian Journal of Dental Research, 22(5), 2011
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
(01/07/0707/07/07) 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.[2] They were
as follows.
684
Rx The mistakes we make Rathnam and Madan

Patient information (five parameters) Signature: 16

Name, Age, Sex, Address, Date of treatment Phone no.: 97
Doctors information (four parameters)
Department name, Name of Doctor, Signature, In a comparison of the legibility of the samples, the following
Contact Number could be noted:
Documentation of the drugs in the case paper (4-Point scoring scale)
Instructions given to the patient (verbal/written) Score 1: 39%
The clarity of prescriptions was assessed on the basis of Score 2: 54%
the following points:[2] Score 3: 7%
Whether the prescription was legible (4-point rating Score 4: 0%
system):
Score 1: Prescription details are clear and legible Documentation of the prescription in the patients case paper
Score 2: Clear but requires effort to read was also checked and verified. This was found to be positive
Score 3: One aspect not clear (patient name/drug in 69% of the case papers.
name)
Score 4: More than one aspect not clear DISCUSSION
The details of drugs prescribed were also rated (4-point
rating system) A well-written prescription reflects both on the doctor and
Score 1: Clear and legible, Drug details present the institution concerned. Hence, it is the prerogative of
Score 2: Clear but requires effort to read all the doctors and the institutions to make a concentrated
Score 3: Criteria not met for one drug effort to standardize the quality of prescriptions emanating
Score 4: Criteria not met for more than one drug from the various hospitals in the country.

An overall rating system based on the above criteria was The results of this study have thrown up some interesting
also given: and depressing results. In most prescriptions, one or more
Scoring: Parameter present (1), absent (0) aspects of the patients personal details were missing
Legibility: 14 [Figure 2]. In most cases, it was also noted that the concerned
Drug details: 14 doctors details were also lacking [Figure 3]. The legibility
of the prescriptions were also suspect in many instances
Maximum and minimum scoring: 19 and 2, respectively [Figure 4]. This will pose a problem for proper record
maintenance and give rise to many medico-legal
The prescriptions were rated by the lead author. Hence, complications. From the patients point of view, he will
there was no possibility of inter-examiner variability or not be in a position to intimate the doctor concerned if a
bias. The results were tabulated and the data were analyzed particular brand of medicine is not available. This puts the
using SPSS software version 11. onus of selecting a suitable alternative on the shoulders of
the pharmacist.
RESULTS
Another aspect of the issue is the documentation of the
A total of 122 samples of prescriptions were procured. An prescription on the case paper [Figure 5]. A reading of the
overall rating for all the prescriptions showed 93% of the case paper should give all the pertinent information required
samples to be in the average category with one or more by the doctor to make a correct choice regarding the patients
details missing. treatment protocol. The error of not noting the prescriptions
on the case record will lead to problems of repeated drug
On analysis of the separate details of the prescriptions, the intake for the same problem, posing a threat to the health
following were the discrepancies noted in brief. of the patient. The overall rating given for the prescriptions
is also provided [Figure 6].
Personal details (percentage of prescriptions
showing missing information) It is also interesting to note that most of the instructions
Name: 4 given to the patient about the procedure of intake of
Age: 91 medicines were verbal [Table 1].[3] This is a very troubling
Sex: 100 aspect as it is dependent on the patients understanding,
Address: 100 the doctors communication and the language barriers
between both. This facet should be discouraged and clear
Doctors details written instructions should be provided in the prevailing
Doctors name: 92 language/languages of the region. It is also a fact that self-
Department: 12 medication is rampant in India based on earlier prescriptions
or pharmacists advice.[4]
685 Indian Journal of Dental Research, 22(5), 2011
Rx The mistakes we make Rathnam and Madan

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[2] and Uttaranchal.[5]
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

140

120

100

80

60

40

20

0
PT Name PT Age PT Sex OPD No PT Add

Figure 1: Example of collected prescription Figure 2: Patients details what is missing

140
70
120
60
100
50
80
40
60
30
40
20
20
10
0
Dept Sign Doc Ph No 0
Name Score 1 Score 2 Score 3 Score 4

Figure 3: Doctors details what is missing Figure 4: Legibility of prescriptions

Present Absent

Figure 5: Documentation present or absent Figure 6: Overall rating for prescriptions

Indian Journal of Dental Research, 22(5), 2011 686

Rx The mistakes we make Rathnam and Madan

Table 1: Model prescription sample be used to hone prescription skills of the people involved.
Patients instructions General information
Name: __________________ Prescription date: ___/___/___ These initiatives will provide the pathway for standardized,
Age: _______ OP Number: _________________ evidence-based dental pharmacotherapy in India.
Address: __________________
__________________
__________________ CONCLUSIONS
Sex: Male / Female
Contact number: ___________
Rx
The present data depict the following:
Most of the prescriptions obtained in this study were
Drug Quantity Dosage instructions
Prescribed Dosage (tick whichever applicable/fill the inadequate and had several important details missing.
blanks) The overall legibility of the prescriptions also required
1) Morning/Afternoon/Night thought as they were deemed average in rating.
to be taken ____ times a day
after/before food for ____ days
(space for printing instructions in
To have better prescriptions and better health care facilities
vernacular language) in the various dental colleges in India, a computerized
2) Morning/Afternoon/Night format would be the answer.
to be taken ____ times a day after/
before food for ____ days
(space for printing instructions in ACKNOWLEDGMENTS
vernacular language)
3) Morning/Afternoon/Night All my post graduate colleagues, teaching staff and non-teaching
to be taken ____ times a day after/
staff of Department of Pediatric dentistry are acknowledged. A
before food for ____ days
(space for printing instructions in special mention of Dr. Indushekar KR, Dr. Anand L Shigli and
vernacular language) Dr. Dayanand Shirol.
Doctors information Departmental information
Doctors name: _____________ Supervising doctor: ____________
Designation: _______________ Sign: _______________________ REFERENCES
Sign: _____________________ Dept Seal:
Contact no.: 1. Sarkar PK. A rational drug policy. Indian J Med Ethics 2004;1:11-2.
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
for each prescription. This number should be inserted in the J Med Ethics 2004;1:13-4.
case report for proper documentation. This will go a long 4. Greenhalgh T. Drug prescription and self-medication in India: An
way toward the provision of standardized, understandable exploratory survey. Soc Sci Med 1987;25:307-18.
5. Rishi RK, Sangeeta S, Surendra K, Tailang M. Prescription audit:
prescriptions by the doctors of this country. Experience in Garhwal (Uttaranchal), India. Trop Doct 2003;33:76-9.

Short problem-based training courses, continuing education How to cite this article: Rathnam A, Madan N. "Rx - The mistakes we make!!":
programs and workshops can be conducted to provide updated A short study. Indian J Dent Res 2011;22:684-7.
Source of Support: Nil, Conflict of Interest: None declared.
and current information on pharmacotherapy. They can also

687 Indian Journal of Dental Research, 22(5), 2011

Copyright of Indian Journal of Dental Research is the property of Medknow Publications & Media Pvt. Ltd. and
its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.