World Journal of Pharmaceutical Research

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Volume 11, Issue 4, 1307-1314. Research Article ISSN 2277– 7105

DRUG PRESCRIBING PATTERN IN THE MEDICAL EMERGENCY

UNIT – THE PATIENT’S FIRST POINT OF CONTACT

Karuna Sree P.1*, Roopa B.2, Venkata Rao Y.3 and P. V. Sai Satyanarayana4

1
Associate Professor, Department of Pharmacology, ESIC Medical College, Sanathnagar,
Hyderabad, Telangana State.
2
Assistant Professor, Department of Pharmacology, Rangaraya Medical College, Kakinada,
Andhra Pradhesh.
3
Professor & Head, Department of Pharmacology, Kamineni Institute of Medical Sciences,
Narketpally, Nalgonda District, Telangana State.
4
Professor & Head, Department of Emergency Medicine, Kamineni Institute of Medical
Sciences, Narketpally, Nalgonda District, Telangana State.

ABSTRACT
Article Received on
01 Feb. 2022, Drug utilization is the marketing, distribution, prescription and use of
Revised on 21 Feb. 2022, drugs in a society affecting the medical, social and economic status.
Accepted on 11 March 2022
DOI: 10.20959/wjpr20224-23538 Drug utilization studies (DUS) provides insight on the pattern, quality,
determinants and outcomes of drug use and facilitates the rational
prescribing. Hence the present study was planned to assess the
*Corresponding Author
Dr. Karuna Sree P. prescribing pattern in the emergency department of a tertiary care
Associate Professor, teaching hospital. Materials and Methods: It was a retrospective
Department of observational study done at tertiary care teaching hospital of
Pharmacology, ESIC
Telangana. The data was collected from the case records of patients
Medical College,
admitted in the emergency unit and was analyzed. Results: A total of
Sanathnagar, Hyderabad,
Telangana State. 104 case sheets were analyzed. 71.15% were males; 29.85% - females
with mean age of 40.31±16.26 years. Road traffic accidents (25.96%)
followed by gastrointestinal diseases (18.27%) were first and second highest cause of
admissions. The mean duration of stay in the emergency unit was 7.52±3.1 hours. Average
number of drugs per prescription was 4.61±2.12 (mean±SD). About 72.86% drugs were
prescribed by trade name and 27.14% by generic. Around 93 drugs of different groups were
prescribed, among which 69.89% were in Essential Medicine List (EML) of India and
30.11% were out of EML. Most prescribed drugs were gastrointestinal (25.26%), antibiotics

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Sree et al. World Journal of Pharmaceutical Research

(23.28%) and analgesics (16.45%). 43.75% of antibiotics belongs to Beta-lactum group.

Among the analgesics, 54.43% were NSAIDs. Fixed Dose Combinations (FDC) constitutes
12.11% of total drugs prescribed. Conclusion: Average of number of drugs per prescription
was on higher side, probably due to emergency condition. Prescribing with generic name is to
be improved. Majority of drugs were prescribed from EML.

KEYWORDS: Prescribing pattern, Emergency Unit, EML, Telangana.

INTRODUCTION
Drug utilization studies (DUS) are aimed to facilitate the rational prescribing of drugs in the
population. DUS provides insight of the pattern, quality, determinants and outcomes of drug
use. Rational prescribing of a drug implies the well documented prescription with correct
drugs at optimal dose, with correct route of administration and at an affordable cost. Irrational
prescribing of drugs causes the unnecessary increase in hospital stay and health care costs
either due to ineffective treatment or adverse events. Hospital admissions due to
consequences of irrational prescribing is about 0.2 – 21.7%.[1] Nearly 70% of the drug related
events are possibly avoidable by rational prescribing which needs skill and updating of one’s
knowledge. Often the physicians face challenge at the patient’s first point of contact in the
emergency units in initiating the therapy. Hence the present study was planned to analyze the
prescribing pattern of drugs in the emergency unit of a tertiary care teaching hospital. This
also aids in framing the guidelines for rational prescription of drugs in a cost effective way in
the emergency department thereby improving the quality of care.

AIM
 To assess the prescribing pattern in the emergency department of a tertiary care teaching
hospital.

OBJECTIVES
 To assess the average number of drugs per patient
 To assess percentage of drugs prescribed by generic name
 To categorize the drugs by organ system and assess the percentage of drugs used under
each category.
 To assess the percentage of fixed dose combination drugs used.
 To assess the average duration of stay in the emergency unit.

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Sree et al. World Journal of Pharmaceutical Research

MATERIALS AND METHODS

It was a retrospective observational study. The study was carried out in the medical records
department of Kamineni Institute of Medical Sciences (KIMS), Narketpally. Medical records
of patients admitted in the emergency unit of KIMS hospital, during the period of 2 months
were reviewed. Case sheets were selected by simple random sampling and every third case
sheet was reviewed for data collection. Data was collected using a case record form. It
includes the demographic data, diagnosis, drug history; average duration of stay in the
emergency unit was collected. In the drug history, information regarding number of drugs per
prescription, category of the drug, name by which it was prescribed (generic/brand), dose,
dosage form, route of administration and duration of drug usage was noted.

From the obtained information the WHO drug use core and complementary indicators was
calculated as below.
1. Average number of drugs per patient was calculated by dividing the total number of
different drug products prescribed by the number of patients surveyed.
2. Percentage of drugs prescribed by generic name was determined by dividing the number
of drugs prescribed by generic name by the total number of drugs prescribed, multiplied
by 100.
3. Average duration of stay per patient was calculated by dividing the total duration of stay
by the number of patients surveyed.
4. Percentage of drugs prescribed from essential medicines list of India was calculated.

The collected data was expressed in Microsoft excel sheet. Quantitative data was expressed in
the mean and standard deviation. Qualitative data expressed in percentages.

RESULTS
In the present study, the total number of case sheets reviewed during the two months period
was 104. Out of them, 74 (71.15%) case sheets were of males and 30 (29.41%) of females.
The mean±SD of the patients age admitted into emergency unit was 40.31 ± 16.26. The mean
duration of stay in the emergency unit was 7.52 ± 3.1 hours. Highest percentage of
admissions were due to road traffic accidents (25.96%) followed by gastrointestinal diseases
(18.27%) and fever (14.42%). The percentage of the patients admitted under each disease
category along with number of drugs prescribed per patient was given in table 1.

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Sree et al. World Journal of Pharmaceutical Research

Table 1: Number of drugs per prescription in different disease categories.

Number of Number of drugs
Disease category patients per prescription
admitted (%) (mean ± SD)
Gastro intestinal 19(18.27%) 5.05 ± 1.27
Cardiovascular 6(5.77%) 4.33 ± 3.14
Respiratory system 7(6.73%) 4.14 ± 2.19
Central nervous system 9(8.65%) 3.67 ± 1.66
Renal 3(2.88%) 4.67 ± 2.08
Genito-urinary 3(2.88%) 4.00 ± 1.0
Fever 15(14.42%) 5.27 ± 1.28
Swellings (gland/lymph nodes) 4(3.85%) 4.75 ± 0.96
Road traffic accident 27(25.96%) 4.63 ± 1.78
Poisoning 4(3.85%) 4.25 ± 0.52
Burns 2(1.92%) 5.00 ± 1.41
Allergic 1(0.96%) 2.00
Metabolic 4(3.85%) 4.25 ± 1.26

A total of 479 drugs were prescribed to 104 patients. Average number of drugs per
prescription was 4.61 ± 2.12 (mean ± SD). Less than 3 drugs were prescribed in 11.54%, 3 to
5 drugs in 57.9% patients and more than 6 drugs in 30.77% of prescriptions. Most of the
drugs were prescribed using trade name (72.86%) rather than generic name (27.14%). Out of
479 drugs prescribed, 93 drugs belong to different classes and the remaining drugs were the
repetition of these drugs. Out of these 93 drugs, 65 (69.89%) were in essential medicine list
(EML) of India and 28 were not in EML (30.11%).

It was observed that gastrointestinal drugs (25.26%) and antibiotics (23.28%) are the most
prescribed drugs in the emergency unit followed by the other groups of drugs. Drug
prescribing pattern in the emergency unit was given in Fig. 1.

Fig. 1: Drug utilization pattern in emergency unit.

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Sree et al. World Journal of Pharmaceutical Research

In this study we observed gastro-intestinal drugs were one of the commonly prescribed
groups, among which anti-peptic ulcer drugs were more common, followed by anti-diarrhoeal
with oral rehydration salt powder and anti-emetics. Among the prescribed anti peptic ulcer
drugs, 53(67.09%) were proton pump inhibitors followed by H2-blockers 25(31.65%) and
ulcer healing drugs 1(1.27%).

Among the chemotherapeutic drugs prescribed majority were beta-lactum antibiotics

(43.75%) such as ampicillin, amoxicillin, amoxicillin with clavulanic acid and combinations
of cloxacillin with ampicillin / cefixime (Fig. 2). Next major group of drug prescribed was
Anti-protozoal / anti-helmintic drugs accounting to 25.89%. Other groups of antibiotics
prescribed were fluoroquinolones (15.18%), aminoglycosides (4.46%), macrolides (2.68%)
and tetracyclines (1.79%).

Fig. 2: Prescribing pattern of antibiotics.

Among the analgesics, commonly prescribed were non-steroidal anti-inflammatory drugs

(NSAIDs) with 43(54.43%) followed by opioids 28 (35.44%). About 3(3.8%) received the
combination of opioids and NSAIDs. Anti spasmodic drugs were prescribed to 5(6.33%)
patients.

The drugs prescribed by fixed dose combination (FDC) were 58(12.11%). Majority of the
drugs prescribed in fixed dose combination were multivitamins 32(55.17%) followed by
chemotherapeutic drugs (18.97%) and respiratory drugs (15.52%). The other FDCs
prescribed were analgesics (6.9%) and gastrointestinal drugs (3.45%). About 6.9% of the
FDC drugs prescribed were irrational belonging to chemotherapy group. The combinations

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Sree et al. World Journal of Pharmaceutical Research

are ampicillin (250mg) with cloxacillin (250mg) and cefixime (200mg) with cloxacillin
(500mg).

DISCUSSION
Drug utilisation has been defined by World Health Organisation as “the marketing,
distribution, prescription and use of drugs in a society, with special emphasis on the resulting
medical, social and economic consequences”.[2] The virtual explosion of new drugs in the
market, variation in the patterns and extent of drug prescribing, the rising concern about
adverse drug reactions (ADR) and cost of drugs led the health care professionals to conduct
drug utilization studies.[3] Drug utilization studies help in analysing the prescribing pattern,
rational use and the cost efficacy of drugs. Hospital admissions due to events arising out of
irrational prescribing accounts for 0.2 – 21.7%.[1] Nearly 70% of the drug related events are
possibly avoidable by rational prescribing which needs skill and updating of knowledge.[4]
World Health Organization specifies drug use indicators[5,6] for adoption in drug utilization
studies.

The errors in prescriptions are not uncommon. This could be due to ignorance or inadequate
knowledge about the disease and the pharmacology of the drugs prescribed. Erroneous
prescriptions are recognized even in tertiary care hospital. Moreover, prescribing habits differ
from doctor to doctor. Several factors influence drug prescription such as patient related /
pharmaceutical related etc. It has been proposed that prescribing variability was due to
differences in therapeutic approach among doctors in different countries.

Puneet et al[1] in their study observed that average number of drugs prescribed per patient as
1.9, with antibiotics and supplements as highly prescribed drugs. They suggested the revision
of prescription policies. Whereas Chakrapani et al[8] in their study observed the prescribing
pattern was not adherent with the WHO criteria of rational use of drugs and the average
number of drugs per prescription was 4.2 ± 1.2. This indicates the variation in the average
number of drugs per prescription from one area to other.

This study gave us an idea regarding the drug prescribing pattern in our emergency medicine
set up during the initial contact by doctors in emergency department with an average number
of drugs prescribed per patient was 4.60 ± 2.8 similar to the study done by Chakrapani et al
with an average length of stay around 7.5 ± 3.1 hours. However, it is always preferred to have
the less number of drugs per prescription to avoid poly pharmacy and thereby the drug

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Sree et al. World Journal of Pharmaceutical Research

interactions and adverse effects. This eventually diminishes the individual cost of treatment.
In our study, 25.96% of admissions were due to road traffic accidents with highest cause of
admissions probably, due to the fact that the hospital is situated on the national highway with
tertiary care facilities. Second most common cause of admission was gastrointestinal
diseases, among which acute pancreatitis with etiology of alcohol consumption contributed
major cause followed by others (Acute Gastroenteritis, Peptic Ulcers, intestinal
obstruction/perforation etc).

Prescribing of drugs by generic name was 28.14%. Prescribing by generic name helps in
maintaining uniformity and is convenient to the patient and pharmacist. Hence, the clinicians
are to be encouraged, to use generic names by regular sensitization sessions regarding the
prescription practices to the clinicians.

Among the drugs prescribed, highest prescribed drugs were gastrointestinal related drugs
(25.26%) and antibiotics (23.28%) followed by analgesics. Among the antibiotics, usage of β
lactam antibiotics was high followed by anti-protozoal drugs and fluoroquinolones. When it
comes to the prescribing of FDC (12.11%), majority of FDC’s were nutraceuticals, followed
by gastrointestinal drugs.

To conclude, average of number of drugs per prescription was on the higher side, probably
due to emergency condition of the patient. Prescribing with generic name is to be improved.
Regular drug utilization survey helps in identifying the prescribing pattern of that hospital
and accordingly the essential medicine list may be prepared. It helps in framing the
guidelines for rational prescription of drugs in a cost effective way in the emergency
department thereby improving the quality of care. Educational intervention by regular
sensitization sessions on rational prescribing to the clinicians also help in improvement of
prescribing practices.

REFERENCES
1. Dhamija P, Bansal D, Srinivasan A, Bhalla A, Hota D, Chakrabarti A. Patterns of
prescription drug use and incidence of drug-drug interactions in patients reporting to
medical emergency. Fundam Clin Pharmacol, 2013; 27(2): 231-7. doi: 10.1111/j.1472-
8206.2011.00990.x. Epub 2011 Sep 5.
2. WHO regional publications. “www.whocc.no filearchive publications drug utili ation
research.pdf” Introduction to drug utilization research.Oslo, Norway, 2003.

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3. Bakssasl, Lunde PKM. National drug policies: The need for drug utilization studies.
Trends Pharmacolsci, 1999; 7: 331.
4. Pattanaik S, Dhamija P, Malhotra S, Sharma N, Pandhi P. Evaluation of cost of treatment
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prospective study. Br. J. Clin. Pharmacol, 2009; 67: 363–369.
5. Lawson DH: Pharmacoepidemiology, a new discipline BMJ, 1984; 289: 940-41.
6. Strom BL: Promise of Pharmacoepidemiology, Ann, Rev, Toxical, 1987; 27: 71-86.
7. Cheekavolu C, Pathapati RM, babasaheb Laxmansingh K, Saginela SK, makineedi VP,
Siddalingappa et al. Evaluation of Drug Utilization Patterns during Initial Treatment in
the Emergency Room: A Retroprospective Pharmacoepidemiological Study, 2011;
261585. doi: 10.5402/2011/261585. Epub 2011 Dec 25.

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