The Adherence to WHO Prescribing Indicators in a Specialist Hospital in North-Central, Nigeria

Abstract

Background: Rational use of medicine contributes to a global reduction in morbidity and mortality associated with diseases. Thus, routine assessment of prescriptions written at healthcare facilities is a vital exercise in determining rationality of drug use so as to improve healthcare outcomes in patients receiving treatment and reduce the incidence of drug resistance.The core component of WHO prescribing indicator includes the average number of drug per encounter, the percentage of drug prescribed by generic name, the percentage of encounter with an antibiotic and injection, and the percentage of drugs prescribed from the national essential medicines list

Objective: This study assessed the rational use of medicine by evaluating the adherence to World Health Organization prescribing indicators at the University of Ilorin Teaching Hospital (UITH) in North-central, Nigeria.

Methods: This was a descriptive retrospective study conducted between January and June 2023. All prescriptions written by doctors of various cadres in UITH stored at the main pharmacy of the hospital within the study period were retrieved. Patients less than 18 years were excluded because they frequently receive off-label medications, which can introduce variability and make it difficult to standardize our findings. A validated data capture form was used for the study following the World Health Organization (WHO) prescribing indicator guidelines. The data analysis was done using Statistical Package for the Social Sciences (SPSS) version 27.0 software, and the data generated were presented in simple frequencies, percentages, and average values.

Results: A total of 2500 stored prescriptions were retrieved; 1000 prescriptions were for pediatric patients and were excluded. The average number of drugs per encounter in the facility was 2.83. Generic prescribing and antibiotic prescription were 83.4% and 30.0%, respectively. This percentage of generic prescription showed that the institution is cost-ineffective in procurement and use of drugs, while that of antibiotic prescription showed overuse, which could worsen the menace of antibiotic resistance with increased morbidity and mortality associated with infections. Injections were prescribed in 47.8% of encounters, indicating overuse of injections, while 22.5% and 3.3% of encounters had analgesics and antimalarials prescribed, respectively. A total of 13, 845 errors were encountered, at 9.23 errors per prescription. Errors of omission related to patient (9618; 69.5%) were the most observed, followed by errors of omission related to prescriber (2527; 18.3%), and lastly, errors of omission related to drug (1700; 12.3%).

Conclusion: Prescriptions were mostly incomplete, and the WHO prescribing indicators were not met by most prescribing clinicians. Antibi-otics were mostly prescribed with the possibility of worsening the problem of resistance. There is a need for continuing medical education on the rational use of medicines among prescribers with a regular audit of prescription practices. We advised appropriate training of prescribers and policy formation to promote rational prescribing and use of medicines in healthcare facilities.