Prescription Audit of 300 Prescriptions at a Community Pharmacy Using WHO Core Prescribing Indicators

This mini-report is written during the 500-hour (three-month) practical training that the PCI D.Pharm ER-2020 regulations require in a hospital or community pharmacy. Instead of filling the training diary with generic notes, the trainee carries out a small, structured prescription audit of 300 prescriptions received at a mid-sized community pharmacy in a district town.

Each prescription is checked against a simple, printed audit sheet that records the WHO core prescribing indicators — average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic, percentage with an injection, and percentage of drugs from the National List of Essential Medicines (NLEM) 2022 — plus the completeness and legibility of the prescription and whether Schedule H, H1 and X medicines were dispensed and recorded as the Drugs and Cosmetics Rules, 1945 require. No patient names or identity details are copied; only the drug data are recorded.

The results are summarised in Excel as percentages, means and charts and compared with the WHO reference values. The report ends with practical suggestions that a community pharmacist can actually act on: maintaining a proper Schedule H1 register, clarifying illegible prescriptions with the prescriber, and counselling on antibiotic completion. The work links directly to the ER-2020 theory papers in Community Pharmacy and Management, Pharmacy Law and Ethics, and Pharmacology, which makes it easy to defend in the practical examination and viva.

Abstract

A descriptive cross-sectional prescription audit was carried out at a community pharmacy during D.Pharm practical training. Three hundred consecutive prescriptions presented over four weeks were evaluated with a structured audit sheet based on WHO core prescribing indicators, prescription completeness and legibility, and Schedule H/H1/X dispensing compliance. Data were entered in Excel and expressed as percentages and means.

Introduction

A prescription is a legal and clinical document. When it is incomplete, illegible or overloaded with drugs, the risk of dispensing errors, drug interactions and unnecessary cost rises. The World Health Organization developed a set of core drug-use indicators in 1993 so that prescribing can be measured in a standard way and compared across settings. Community pharmacists in India see a large volume of prescriptions from private clinics, government hospitals and specialists, which makes the pharmacy counter a practical place to study prescribing patterns.

Existing practice

• Pharmacies dispense prescriptions without recording any systematic data about them.
• Schedule H1 registers are often incomplete, and prescriptions for H1 antibiotics are not always retained or noted.
• Illegible prescriptions are interpreted by guesswork rather than clarified with the prescriber.
• Trainees usually fill training diaries with descriptive notes rather than measured observations.

Proposed work

• Design a one-page audit sheet covering prescriber details, patient age and sex (no name), drugs, dosage form, strength, frequency, duration and legibility.
• Audit 300 prescriptions over four weeks and calculate the five WHO core prescribing indicators.
• Record compliance with Schedule H, H1 and X requirements.
• Compare results with WHO optimal values and recommend improvements.

Feasibility

• Technical: needs only a printed sheet, a pen and Excel.
• Economic: practically zero cost.
• Operational: fits inside the daily training hours with the permission of the registered pharmacist in charge.
• Ethical: no identifiers are copied; the owner's written permission is obtained and data are used only for the training report.

Irrational prescribing — polypharmacy, brand-name prescribing, unnecessary antibiotics and injections, and prescriptions that are incomplete or illegible — increases cost to patients, the chance of dispensing errors and the growth of antimicrobial resistance. In many community pharmacies there is no routine measurement of these problems, and legal requirements such as recording Schedule H1 drugs in a separate register and dispensing Schedule H and X drugs only against a valid prescription are not always followed.

A D.Pharm trainee is in a good position to measure these gaps at the dispensing counter, but training diaries usually record only what was done, not what was observed. This mini-study therefore asks: what is the prescribing pattern, in terms of WHO core indicators, completeness and legibility, among prescriptions received at a community pharmacy, and how well is Schedule H, H1 and X dispensing documented?

In scope

• One community pharmacy in a district town, 300 consecutive prescriptions over four weeks of training.
• WHO core prescribing indicators, completeness, legibility and Schedule H/H1/X compliance.
• Descriptive statistics in Excel and a short list of recommendations.

Out of scope

• Patient-care indicators (consultation and dispensing time) and facility indicators, which need a different set-up.
• Judging the clinical appropriateness of each prescription (that needs the diagnosis and a clinician).
• Inferential statistics or comparison between prescribers — the sample is too small and prescriber identities are not recorded.

Study design: descriptive, cross-sectional prescription audit carried out prospectively at the dispensing counter.

Setting: a community pharmacy (called Sri Venkateshwara Medicals in this report — a fictional name) in a district town, open 12 hours a day, serving two private clinics and patients from the taluk hospital.

Sample size: WHO recommends at least 100 encounters per facility for prescribing-indicator studies; 300 prescriptions were chosen so that each week contributes about 75 and so that sub-groups (for example antibiotic prescriptions) are large enough to describe.

Inclusion criteria: original or duplicate prescriptions presented for dispensing during training hours, any age, any prescriber.

Exclusion criteria: repeat purchases without a prescription, veterinary prescriptions, and prescriptions for only non-drug items (dressings, devices).

Instrument: a one-page audit sheet with four blocks — (1) prescription details (setting, date, age group, sex); (2) drug details (name as written, generic or brand, dosage form, strength, frequency, duration, NLEM yes/no, schedule); (3) completeness and legibility (legible / legible with difficulty / illegible, rated independently by the trainee and the pharmacist); (4) legal compliance (H1 register entry, prescription retained for Schedule X, prescription stamped).

Procedure: week 1 — design and pilot on 20 prescriptions, revise the sheet; weeks 2–5 — collect 300 prescriptions; week 6 — data entry, analysis and report.

Analysis: Excel pivot tables for counts, percentages and means with standard deviation; charts for the distribution of drugs per prescription and the most common drug classes (grouped by WHO ATC first level).

Ethics: written permission from the pharmacy owner; no patient names, addresses, phone numbers or ID numbers are recorded; prescriber names are replaced by codes.