PESHAWAR: The poorly handwritten prescriptions are putting patients’ health at risk as they often buy wrong drugs and fail to follow appropriate dosage or get the right strength of medicines, according to pharmacists.

“In the era of computer and artificial intelligence, majority of our prescriptions aren’t readable by educated people but amazingly an illiterate and non-qualified boy at a medical store guesses the medicines by observation and give it to patient without confirming the right drug having right strength (mg),” Saad Salman, a research fellow at pharmacy department, University of Peshawar, told Dawn.

He said that it increased risk of medication error as sometimes highly toxic narrow therapeutic index medicine was administered to patient due to illegibility.

Pharmacist says most of doctors not following SOPs

The research fellow said that standard operating procedures (SOPs) for prescription were not followed by majority of physicians in government hospitals as well as in private sector.

A standard prescription comprises eight parts including date, patients’ information, superscription, inscription, subscription, signature and information about prescribers.

The date should be present or written at the time of writing prescription, as it predicts the duration of therapy and helps the pharmacist in dispensing medicines to guide the patient and to keep the record.

The patients’ information contains name, age, sex, weight and address as it identifies person for whom the medication is prescribed and helps in writing and dispensing right medication and dose according to patient age and weight.

Mr Saad said that inscription was the most important part of the prescription as it contained the name and dosage of the medication to be used.

“Badly handwritten prescriptions can lead to mistakes. It is the legal duty of the doctor to write legibly,” he added.

He said that subscription contained the prescriber’s direction to the pharmacist including dosage form to be prepared and number of doses to be dispensed, which must be legibly written to minimise the risk of a medication error.

Every prescription should bear the signature of the physicians and complete information on the prescribers such as their names, addresses, telephone numbers, qualifications and registration numbers.

The information of the prescriber helps a pharmacist, healthcare provider or patient to contact the physician for clarification of the prescribed medicines.

“The missing sign and information may raise questions regarding the authority of a medical doctor,” said Mr Saad.

He said that all health protocols were followed in the United States but it still had high number of deaths due to medication error. In the third world countries, especifically in Pakistan, the deaths due to medication error should be more than any other country, he said.

Javed Mohammad, a pharmacist, said that at times the pharmacist dispensing the prescription might make mistake issuing another drug with altogether different chemical composition and meant entirely for some other disease than what the patient suffered from.

“Look alike and sound alike (Lasa) is the phenomenon of foremost importance in hospital pharmacy services. At retail where mostly the drugs dispensing personnel aren’t pharmacy graduates, the importance of legible and clearly written prescription with proper dose and potency of the drugs and frequency (time interval in between the doses) become more important to avoid wrong dispensing and potential risk of damage to patients which may even be fatal,” he said.

Mr Javed said that it was possible mostly with minor overlapping of the spellings of the different names of sound alike drugs.

A letter issued by then health secretary Abid Majeed three years ago asked the doctors to write clear prescriptions to avoid the damage occurring due to wrong drugs in dispensing for a disease, all due to lacking of clarity as prescribing faults and prescription errors where proper dosing was not readable etc but the physicians have continued to write prescriptions which are unreadable.

“Some of the physicians follow the SOPs,” said Mr Javed.

Published in Dawn, September 20th, 2021

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