• Yashashri Shetty, Sandhya Kamat, Raakhi Tripathi, Urwashi Parmar, Ratinder Jhaj, Aditya Banerjee, Sadasivam Balakrishnan, Niyati Trivedi, Janki Chauhan, Preeta Kaur Chugh, C D Tripathi, Dinesh Kumar Badyal, Lydia Solomon, Sandeep Kaushal, Kanchan Gupta, M Jayanthi, G Jeevitha, Suparna Chatterjee, Kalyan Samanta, Chetna Desai, Samidh Shah, Bikash Medhi, Rupa Joshi, Ajay Prakash, Pooja Gupta, Atanu Roy, Sujith Chandy, Jaya Ranjalkar, Heber Rew Bright, Harihar Dikshit, Hitesh Mishra, Sukalyan Saha Roy, and Nilima Kshirsagar.
• Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India.
• Indian J Med Res. 2024 Feb 1; 159 (2): 130141130-141.

Background ObjectivesIrrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians.MethodsIt was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as 'prescriptions having deviations'. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an 'unacceptable deviation'.ResultsAgainst all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108).Interpretation ConclusionsThe overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions.Copyright © 2024 Copyright: © 2024 Indian Journal of Medical Research.

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