NTA Level 4 • Semester 1 • PST04101

Irrational Prescribing of Medicines

Dispensing • Source Session/Topic 16

Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability.

Session 16: Irrational Prescribing of Medicines

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define irrational prescribing

• Distinguish types of irrational prescribing practices

• Describe common patterns of irrational prescribing

• Identify irrational prescriptions

• Explain factors contributing to Irrational Prescribing

• Describe Measures to alleviate Irrational Prescribing

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Worksheet 16.1 to 16.5: Irrational Prescriptions

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Irrational Prescribing (5 minutes)

• Medicines should be prescribed only when they are necessary, and in all

cases the benefit of administering the medicine should be considered in

relation to the risk involved

• Irrational use of Medicines may be defined as: Patients receive

medications inappropriate to their clinical needs, in doses that do not

meet their own individual requirements, for inadequate period of time,

and the highest cost to them and their community

STEP 3: Types of Irrational Prescribing Practices (30 minutes)

|Activity: Small Group Discussion ( 15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the types of irrational prescribing practices? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

• The following are the types of irrational prescribing:Extravagant

Prescribing: This occurs when:

o A less expensive drug would provide comparable efficacy and safety

o Symptomatic treatment of mild condition diverts funds from treating

serious illness

o A proprietary product is used where less expensive generic equivalent

is available

• Over prescribing: This occurs when:

o The drug is not needed

o The dose is too large

o The treatment period is too long

o The quantity dispensed is too much for the current course of treatment

• Incorrect prescribing: This occurs when:

o The drug is given for an incorrect diagnosis

o A wrong drug is selected for the indication

• Multiple prescribing: This occurs when a drug is prescribed when:

o Two or more medication are used where one or two would achieve

virtually the same effect

o Several related conditions are treated when one or two would achieve

virtually the same effects

o Several related conditions are treated where treatment of the primary

condition will improve or cure the other conditions

• Under prescribing: This occurs when a drug is prescribed when:

o Dosage is inadequate

o length of treatment is too brief

o Need medications are not prescribed

STEP 4: Common Patterns of Irrational Prescribing (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the common patterns of irrational prescribing? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Irrational prescribing may be manifested in the following ways:

Over-prescribing

This occurs if a drug is prescribed when:

• The drug is not needed

• The dose is to large

• The treatment period is to long

• The quantity dispensed is too great for the current course treatment

Incorrect Prescribing

• The drug is given for the incorrect diagnosis

• The wrong drug is selected for the indication

• The prescription is prepared incorrectly

• Adjustments are not made for co-existing medical, genetic,

environmental, or other

• factors

Multiple Prescribing

• Two or more medications are used where one or two would achieve

virtually the same

effect

• Several related conditions are treated where treatment of the primary

condition would

alleviate or cure the other conditions

Under-prescribing

• Dosage is inadequate

• Length of treatment is too brief

• Needed medications are not prescribed

STEP 5: Irrational Prescriptions (30 minutes)

|Activity: Exercise (20 minutes) |

| |

|DIVIDE students into small manageable groups. |

| |

|[pic]REFER students to Worksheet 16.1 to 16.5: Irrational Prescriptions|

| |

|READ or ASK one student to read and then comment on the following |

|prescription orders and CLARIFY |

| |

|Prescription 16.1 |

|A patient came with prescription written as Septra tabs 960 mg bd 7/7, |

|Panadol tabs 1 gm tds 3/7 and Cough syrup 10 ml tds 5/7. The diagnosis |

|Cough with chest pain. Comment |

|Answer |

|This is Extravagant Prescribing: Septra is a brand of cotrimoxazole |

|tabs. It cost more than generic drug. The prescription should have been|

|prescribed using generics. Panadol is a trade name too, instead it |

|should have been written paracetamol which is cheaper than panadol |

| |

|Prescription 16.2 |

|A patient aged 55 years, came with prescription written as Paracetamol |

|tabs 1 gm tds 7/7,Metronidazole tabs 400 mg tds 1/12, Diagnosis tooth |

|extraction |

|Answer |

|This is over prescription: Duration for paracetamol is too long, proper|

|is just 3days or as needed Metronidazole duration is too long it |

|should have been 5-7 days. For tooth extraction another antibiotic is |

|needed, ampiclox, Flucamox. |

| |

|Prescription 16.3 |

|A patient aged 23 years came with prescription written as BBE 25% w/v |

|od 3/7 |

|Diagnosis scabies |

|Answer |

|This is incorrect prescription: The instruction are not correct BBE 25%|

|od x 3/7 does not tell route of administration. BBE is a topical |

|medication. Need to apply after bath whole body except face and head. |

|Patient should not shower until after 24hrs. Should be applied after |

|every one day (repeat on the third day, and then on fifth day). That |

|means the course is three times |

| |

|Prescription 16.4 |

|A patient came with prescription written as Flucamox caps 500 mg tds |

|10/7, Pen V tabs 500 mg tds 5/7, Ampiclox 500mg tds 5/7, Diagnosis |

|tonsillitis, typhoid, and boils. |

|Answer |

|This is multiple prescription/polypharmacy: The three diseases; |

|tonsillitis, boils and typhoid can well be treated with flucamox. Is a |

|wide antibiotic which is indicated for all the three diseases. There |

|was no need of prescribing ampiclox and Pen V |

| |

|Prescription 16.5 |

|A patient aged 10 years came with prescription written as Paracetamol |

|syrup 5mL tds 3/7 ( available paracetamol syrup 125mg/5mL) |

|Co-trimoxazole syrup 5mL bd 3/7 ( available co-trimoxazole syrup |

|240mg/5mL). Diagnosis pneumonia |

|Answer |

|This is under prescribing : For a child of that age, the dose is too |

|small and the treatment will not be achieved. That is a dose for below |

|6 years child. |

| |

|ASK all groups to answer the above 5 questions for 15 minutes. |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY if there are any questions |

STEP 6: Factors Contributing to Irrational Prescribing (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What factors contribute to Irrational Prescribing? |

| |

|ALLOW few students to respond? |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

The following are factors contributing to irrational Prescribing:

• Inadequate training in clinical pharmacology and therapeutics

• Lack of continuing education and supervision

• practitioner's inappropriate desire for prestige

• promotional activities of company representatives

• Lack of time due to heavy patient load

• Pressure from patient

• Incorrect generalization about a drug from limited experience

STEP 7: Measures to Alleviate Irrational Prescribing (10 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the Measures to alleviate Irrational Prescribing? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Measures to alleviate irrational prescribing

o Proper use of Standard Treatment Guideline

o Regular supervision of subordinates

o Participating in developing standard treatment protocols

o Participate in continuing education programs through informal one-to-

one teaching and through hospital seminars

o Make appropriate use of available laboratory investigations to confirm

diagnosis and hence appropriate treatment

o Availability of current drug information through reference manuals and

drug news periodical

o Use of hospital formulary to provide scientific justification for

appropriate therapeutic intervention

o Educate and counsel patients on proper use of medicine

o Promotion of cost consciousness among prescribers

STEP 8: Key Points (5 minutes)

• In developed and developing world, medically inappropriate, ineffective,

and economically inefficient use of pharmaceuticals commonly occurs in

health care facilities

• The costs of such irrational drug use are enormous in terms of both

scarce resources and the adverse clinical consequences of therapies that

may have real risks but no objective benefits

• Promoting appropriate use of drugs in the health care system is needed

not only because of the financial reasons but also quality of care

which is the most concern to practitioners

• Actions or intervention programs to promote the appropriate use of

drugs should, therefore, be continuously implemented and

systematically incorporated as an integral part of the health care

system

STEP 7: Evaluation (5 minutes)

• What are the commonly encountered irrational prescribing practices?

• What is irrational prescribing?

• What are the types of irrational prescribing?

• What factors contribute to irrational prescribing?

• What are the Measures to alleviate irrational prescribing?

References

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall.

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).

London, United Kingdom: Churchill Livingstone

Management Sciences for Health (1988). Health Center Prescribing and Child

Survival in East Java and West Kalimantan, Indonesia. Boston: United States

of America

Quick, J.D., Foreman, P., Ross-Degnan, D., et al. Where Does the

Tetracycline Go?

Ross-Degnan, D., Laing, R.O., Quick, J,D., et al. (1992). Soc Sci and Med:A

strategy for promoting improved pharmaceutical use: The International

Network for Rational Use of Drugs. 35 (11) 1329–41.

Senya ,S. S, Mwasha, C.Y, Muyinga, A. M, Amiri,R. I. and Mauga E.A.S.K.

(2011) Tanzania Pharmaceutical Handbook ( 2nd ed. ) Dar eS Salaam,

Tanzania: School of Pharmaceutical Sciences

Vance, M.A., Millington, W.R., (1986). Int J Health Serv: Principles of

irrational drug therapy. 1986;16(3):355–61.

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