A Study on Prescription Auditing and Patient Satisfaction in a Tertiary Care Teaching Hospital

INTRODUCTION

A prescription auditing is a health care process implemented by a physician or other qualified health care professionals in the form of instruction which governs the plan of care for an individual patient. Prescription audit is defined as surveillance of different components of a prescription to improve patient care which is a tool as well as a technique. Its application is a science as well as an art.^1-3

It helps to reduce the medication error by focusing on the prescribing pattern like name, age, superscription, refill, route, inappropriate abbreviation, signature, remark, and the failure of the patient to adhere to the prescribed medication regimen. When prescribing, there are number of points to be taken into account. Prescription audit and its implementation augment the optimization of treatment and health related outcomes.³

Patient satisfaction survey could be a driving force behind the changes in health care delivery-with institutions and individual clinicians hoping for and actively seeking optimal survey scores. It embodies the patient’s perceived need, his expectations from the health system, and experience in health care. This multidimensional concept includes both medical and non-medical aspects of health care.⁴

Various theories of patient satisfaction in healthcare have been published. These theories include the expectancy value theory, which proposes patients beliefs, values and prior expectations regarding care to influence patient satisfaction. There is another health care quality theory, which emphasizes that interpersonal process of care plays a paramount role in ensuring patient satisfaction.⁵

Prescription audit offers the most comprehensive overview of performance and detailing parameters as per the checklist pertaining to it. Different studies conducted on prescription auditing in different parts of the world produced their own databases for their future comparative study.^6,7 In this perspective, the present study was conducted at the Father Muller Medical College Hospital, Mangalore, Karnataka, India to create our own database for future comparative study on the impact of prescription auditing. It includes the following objectives:

1) Socio-demographic profile of the patients.

2) Contribution of prescription by different OPDs.

3) Analysis of errors of the mechanics of prescription order writing.

4) Frequency of drug administration per prescription.

5) Patients responses towards pharmacy staffmembers.

The overall goal of this study is to monitor the appropriateness of various parameters in a prescription order and analyse the patients satisfaction with the services catered by the pharmacy department.

METHODS

Study site: The study was carried out in the pharmacy department of Father Muller Medical College Hospital (FMMCH), Mangalore, Karnataka.

Study design: This study is a prospective and observational study based in the tertiary care teaching hospital.

Study period: The study was carried out for a period of six months from Sep 2017 to Feb 2018.

Ethical clearance: Ethical clearance was obtained from the Institutional Ethics Committee (IEC) of Father Muller Medical College Hospital, Mangalore. Ethics Approval number is FMMC/ FMIEC/4423/2017 dated 23.10.2017.

STUDY CRITERIA

Inclusion criteria:

1) Study population included both men and women of all age groups.

2) Prescriptions of both inpatients and outpatients

Exclusion criteria:

1) Patients with age less than one year are excluded for the study.

2) Patients who are not willing to participate.

Source of data: Study specific proformas were designed for data collections that are as follows:

a) Patient satisfaction details questionnaire

b) Prescriptions from the Pharmacy department.

Statistical analysis

Statistical analysis was done using Microsoft excel (windows 7; version 2007) and the results were appropriately interpreted and reported.

RESULTS

During the study period, a total of 750 prescriptions were collected and analyzed. Proportion of male patients washigher (54.80%) than female with mean age of the respondents being 32.3±9.41 years. Children (age group 1 to 12years) constituted 18.5% and adolescence (age group between 13 to 18 years) constituted 2.4%. The adults (age group 19 to 60 years) constituted 41.8% and the elderly (61-75 years) is 23.2%. The loop-holes in the prescription order included age not being mentioned in 105 (14.1%) patients followed by gender not being mentioned in 80 (10.7%) patients. The demographic profile of patients is shown in the Table 1.

Majority of patients were unemployed (54.8%).

Majority of the patients (44.6%) belonged to the general medicine Out-Patient Department (OPD) followed by surgery, pediatrics, gynecology and dermatology departments. The contribution details by various departments are shown in the Table 2.

During the analysis of errors of the mechanics of prescription order writing, it was observed that 59.3% of prescriptions had no patients body-weight written while 57.3% of them had inappropriate medications prescribed. Inappropriate instructions were written to the pharmacist and patients who contributed to 29.3% and 59.4% of total prescription, respectively. Follow-up advice was not mentioned in maximum number of prescriptions (69.6%). Detailed result analysis of errors in the mechanics of prescription order writing is shown in the Table 3.

In this study, it was observed that only 7.7% of total prescriptions contained single drug as mono-therapy and rest of the prescriptions contained poly-therapy with maximum portion of the prescriptions (29.8%) containing three drugs. Frequency of drug administration per prescription is shown in Table 4.

Patient satisfaction

The patients were asked about their overall satisfaction with the pharmacist. Out of the total, 735 (98%) patients reported satisfaction with the pharmacist (Fig. 1). The pharmacist-patient interaction was explored and analysed on a 5-point like scale including: 1= strongly agree, up to 5= strongly disagree. Various aspects of pharmacistpatient interaction were explored, including verbal and non-verbal communications like personal appearance, respect, privacy, comfort, communication skills, care, facial gestures, behavior, and addressing the patients’ queries.

The patients’ responses towards pharmacy staff are shown in Table 5. All the patients(n=750) agreed that pharmacy staff-members wear a clean and appropriate personal appearance. A majority(n=740) of them agreed that it is easy to approach pharmacy staff-members as they speak politely and appropriately (98.6%). Few of the patients felt that they did not receive enough care and consideration 55 (7.3%). Some of the patients reported of not feeling comfortable by pharmacist voice, facial expressions or behavior 80 (10.6%). But a vast majority of patients were satisfied with the overall service of pharmacists.

DISCUSSION

Prescription audit is the process of reviewing the instructions towards the delivery of medical care in order to identify deficiencies so that they may be mitigated. Benefits to patient care and health related services have been commonly identified through various audits in different parts of the world. Several studies have also reported that clinicians have felt that they have been benefited from prescription audits and that has been instrumental in improving the communication, knowledge and satisfaction across professional groups. The outcome of the prescription auditing is to improve the patient care and their satisfaction.

In this study, out of the total prescriptions (n=750), majority of the prescriptions contain three drugs 29.8% followed by four drugs (24%), and more than four drugs in 24% prescriptions,indicating a definitive practice of poly-pharmacy. This may increase chances of adverse drug reactions and interactions.

In this study, 59.3% of the prescriptions did not have weight of the patient mentioned. Consequently, determination of accurate dose was not possible. Follow-up visit was not mentioned in 69.6% and 57.3% of inappropriate. All these glitches encountered in the collected data indicated that there is a huge scope for improvements in the prescriptions patterns in the hospital where the study was conducted.

Patient satisfaction is a multi-dimensional concept, which is not only influenced by pharmacist related factors but also aspects of patients’ experience. It is also an indirect or a proxy indicator of the quality of pharmacist or hospital performance. The present study was an attempt to assess the mechanics of the prescription and the level of satisfaction of the patients with the hospital pharmacy. It was observed in the present study that 98% of the patients were satisfied with their pharmacists on overall basis (pharmacy cleanliness, adequate ventilation, availability of seats, and toilet facility in the waiting area).

Out of 750 patients, all were satisfied with pharmacy staff personal appearance, majority of patients (92.7%) agreed with enough care and considerations. But some patients (10.6%) conveyed that they felt difficult to enquire further information because the pharmacist’s voice and facial expressions were not encouraging. Majority of the patients were of the view that pharmacist did not explain the side effects of medication and the indication pertaining to the prescription order. In a study conducted by Dr. Fathima Mukhtaron patient satisfaction: OPD services in a tertiary care teaching hospital of Lahore, they found that patient satisfaction in terms of waiting time, accessibility of services, and cleanliness of the facility washigh.

Such flaws mentioned which involve the attitude of pharmacy staff towards patients can greatly influence the reputation of a pharmacy and hospital. This subsequently funnels down as an important factor towards patient satisfaction.

CONCLUSION

The information garnered from this study is an indicator to the trends in prescribing patterns. The present study could serve as a frame work upon which further studies in prescription audit and patient satisfaction can be launched to investigate the scope for continuing medical education and improvement in prescribing patterns. Prescription audit is an important tool to improve the quality of patientscare. Conclusion ends with patients were highly satisfied with the pharmacy staff. They found them well-mannered and paying attention towards the patients. The health facility was clean and adequately ventilated. Majority of the patients were ready to re-visit the hospital pharmacy.

ABBREVIATIONS: OPDs: Out-patient departments, IEC: Institutional Ethics Committee.

FMMCH: Father Muller Medical College Hospital, Mangalore

ACKNOWLEDGEMENTS

Authors are thankful to the authorities of Hospital Pharmacy of Father Muller Medical College and Pharmacy Practice Department, Karavali College of Pharmacy for providing the facilities for conducting this study.

CONFLICTS OF INTEREST

The authors declare no conflicts of interests.