Original Research

Adherence to prescription-writing guidelines for outpatients in Southern Gauteng district hospitals

Jacques G. Nkera-Gutabara, Laurel B. Ragaven
African Journal of Primary Health Care & Family Medicine | Vol 12, No 1 | a2263 | DOI: https://doi.org/10.4102/phcfm.v12i1.2263 | © 2020 Jacques G. Nkera-Gutabara, Laurel B. Ragaven | This work is licensed under CC Attribution 4.0
Submitted: 06 October 2019 | Published: 15 June 2020

About the author(s)

Jacques G. Nkera-Gutabara, Department of Family Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Johannesburg Metro Health District, Gauteng Department of Health, Johannesburg, South Africa
Laurel B. Ragaven, Department of Family Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Family Medicine, Gauteng Department of Health, Johannesburg, South Africa


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Abstract

Background: Medical prescription writing is legally and professionally regulated in order to prevent errors that can result in patients being harmed. This study assesses prescriber adherence to such regulations in primary care settings.

Methods: A cross-sectional study of 412 prescriptions from four district hospital outpatient departments (OPDs) was conducted in March 2015. Primary outcome data were obtained by scoring prescriptions for accuracy across four categories: completion of essential elements, use of generic names of medications, use of recommended abbreviations and decimals and legibility. Secondary outcome data sought associations between accuracy scores and characteristics of the OPDs that might influence prescriber adherence.

Results: Completion of the essential elements, including patient identifiers, prescriber identifiers, treatment regimen and date scored 44%, 77%, 99% and 99% respectively. Legibility, the use of generic names of medications and the use of recommended abbreviations and decimals scored 90%, 39% and 35%, respectively. Only 38% of prescriptions achieved a global accuracy score (GAS) of between 80% and 100%. A significant association was found between lower GAS and the number of prescriptions written per day (p = 0.001) as well as with the number of prescribers working on that day (p = 0.005), suggesting a negative impact on prescribers’ performance because of workload pressures.

Conclusion: Low GAS values indicate poor adherence to prescription-writing regulations. Elements requiring substantial improvement include completion of patient and prescriber identifiers, use of generic medication names and the use of recommended abbreviations and decimals. This study provides baseline data for future initiatives for improvement in prescription-writing quality.


Keywords

medical prescription writing; prescribers; adherence to guidelines; scoring

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