Assessment of Prescription Writing

Skills and Impact of an Educational

Intervention on Safe Prescribing
Practices among Senior Clerks and
Post-Graduate Interns (PGI) in Cebu
Velez General Hospital (CVGH)

Group 9 - Elective Rotation

Allosada, Amparado, Curso, Duarte, Imperial,
Lara, Otadoy, Payod, Sevilla, Uy, Yu
Prescription Writing

responsibility of a physician
requires understanding:
pharmacokinetics of drugs
pharmacodynamics of drugs
laws and regulations of certain medications
patient-specific factors
Choose the proper medication, dosage, method,
and frequency of administration while taking into
consideration predicted individual variability
Prescription

97.8% prevalence of medication errors in

admitted patients
Prescribing medications as the most common
type
8th leading cause of death

Katzung BG, Vanerah TW. Basic & Clinical Pharmacology. New York: McGraw-Hill; 2021.
Maxwell, S. R. J. (2016). Writing prescriptions: How to avoid common errors. Medicine, 44(7), 448–452. https://doi.org/10.1016/j.mpmed.2016.04.007
Pasco, P. D., Caro, R. M., Cruz, C. L., Dando, N. M., Isip-Tan, I. C., Panganiban , L. R., (2017). Prevalence of medication errors in admitted patients at the Philippine General Hospital. Acta Medica Philippina, 51(2), 61-64
 Parts of a
Prescription

Superscription Inscription or Subscription

Date Body
Name, strength, Instruction to
Patient's Name
and dosage of the pharmacist
Patient's Age
Patient's Gender the medication
Patient's Names and
Address strengths of
Patient's Weight each
Rx (Take) ingredient

Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e Brunton LL, Hilal-Dandan R, Knollmann BC. Brunton L.L., & Hilal-Dandan R, & Knollmann B.C.(Eds.),Eds. Laurence L. Brunton, et al.
 Parts of a
Prescription

Signa or Sig Bottom of the

Prescription
Directions to the
patient Name and
Signature of the
prescriber with
license number

Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e Brunton LL, Hilal-Dandan R, Knollmann BC. Brunton L.L., & Hilal-Dandan R, & Knollmann B.C.(Eds.),Eds. Laurence L. Brunton, et al.
 Prescription Errors

Maxwell, S. R. J. (2016). Writing prescriptions: How to avoid common errors. Medicine, 44(7), 448–452. https://doi.org/10.1016/j.mpmed.2016.04.007
“Assessment of Prescription Writing Skills and Impact of an Educational
Intervention on Safe Prescribing Practices among Senior Clerks and Post-
Graduate Interns (PGI) in Cebu Velez General Hospital (CVGH)”

OBJECTIVES:

1. To assess the prescription writing skills of Senior Clerks and Post-Graduate

Interns (PGIs) in Cebu Velez General Hospital (CVGH)
2. To assess the impact of an educational intervention on safe prescribing
practices among Senior Clerks and Post-Graduate Interns (PGIs) in Cebu Velez
General Hospital (CVGH)
PLAN
Questions Have the senior clerks and post-graduate
interns learned prescription writing previously?

Prediction: A high percentage of senior clerks

and post-graduate interns have learned
prescription writing previously.

Were there any questions regarding prescription

in the summative assessment of pharmacology in
their second year of medical school?
Prediction: Majority of the senior clerks and post-
graduate interns have encountered questions
regarding prescription writing in the summative
assessment of pharmacology
 Have the senior clerks and post-graduate interns
Questions written a prescription previously for any common
ailments?

Prediction: Majority of the respondents have

written a prescription previously for any
common ailments

Do the senior clerks and post-graduate interns

feel that their medical school training prepared
them to prescribe?

Prediction: Majority of the respondents feel

that their undergraduate training prepared
them to prescribe
Questions Do clinicians discuss prescription writing?

Prediction: Majority of the respondents had

discussions with the clinicians regarding
prescription writing

Have the senior clerks and post-graduate

interns written prescriptions in the case
discussion classes?

Prediction: Majority of the respondents did

not write any prescriptions during case
discussions.
Questions Do such discussion and writing help in
efficient prescribing?

Prediction: Majority of the respondents

believe that discussing and writing
prescriptions can make prescribing
efficient.

Do the senior clerks and post-graduate interns

need any reinforcing class during 3rd and 4th
year of medical school for prescription
writing?
Prediction: Majority of the respondents believe
that there is a need of reinforcing class during
3rd and 4th year of medical school for
prescription writing.
 Do the post-graduate interns need any
Questions reinforcing class
internship training?
during post-graduate

Prediction: Majority of the post-graduate

interns believe that there is a need of
reinforcing class during post-graduate
internship training

Which do the senior clerks and post-graduate

interns prefer while prescribing a drug, trade
name or generic name?

Prediction: Majority of the respondents

prefer generic names when prescribing a
drug.
Questions Do the senior clerks and post-graduate
interns provide patient education on their
medicines?
Prediction: Majority of the respondents
provide patient education on their
medicines.

Do the senior clerks and post-graduate

interns provide discharge counseling on
medication use?

Prediction: Majority of the respondents

provide discharge counseling on
medication use.
 Do the senior clerks and post-graduate
Questions interns find it difficult to prescribe for
special populations (such as pregnant
women, children, heart failure, liver failure,
renal failure, etc.)?

Prediction: Majority of the respondents find it

difficult to prescribe for special populations.

Do senior clerks and post-graduate interns

get pharmacists to contribute to medication
use during practice?

Prediction: Majority of the respondents do

get pharmacists to contribute to medication
use during practice
 Do the senior clerks and post-graduate
Questions interns think that collaboration with
pharmacists will enhance drug-related
patient safety?

Prediction: Majority of the respondents think

that collaboration with pharmacists will
enhance drug-related patient safety.

Do the senior clerks and post-graduate

interns think that pharmacists are a reliable
source of clinical drug information?

Prediction: Majority of the respondents think

that pharmacists are a reliable source of
clinical drug information
Questions Have the senior clerks and post-graduate
interns ever dispensed medication?

Prediction: Majority of the respondents have

not dispensed medications previously

Did the senior clerks and post-graduate

interns have enough training about
pediatric drugs?

Prediction: Majority of the respondents had

enough training regarding pediatric drugs
Questions

Where do the senior clerks and post-

graduate interns obtain drug-related data
(internet, reference books, or both)?

Prediction: Majority of the respondents

obtain drug-related information from the
internet
Questions Is there any improvement in
prescription writing skills among senior
the

clerks and post-graduate interns based on

the parameters (Date, Name, Age, Gender,
Address, Rx symbol, Brand/Generic name,
Dosage, Drug form, Number of drugs to be
dispensed, Route, frequency, Duration,
Directions for use, Prescriber's signature,
Name of prescriber, Qualification, PRC,
Mention of incorrect dose, Legibility, Use of
abbreviations)?

Prediction: There is a significant

improvement in prescription writing skills
among senior clerks and post-graduate
interns
Basis

350 4th to 8th semester medical undergraduate students and

Population interns invited
281 participants in the study

Pilot-tested, pre-evaluated questionnaire PART 1

Exposure
Prescribe for a common clinical scenario
Basis

169 participants (60.1%) agree that they have not written a formal
prescription to any patient
134 participants (47.6 %) feel that undergraduate training has not
prepared them for prescribing properly
PART 1
90% of participants said reinforcing classes during 3rd, 4th year
and during Compulsory Routine Rotatory Internship will be
Outcome
beneficial
220 participants have opined that generic name should be used
while prescribing
only 124 have actually used generic names in their
prescriptions
121 interns in the study have used brand names
Basis

Methodology Qualitative cross-sectional survey

PART 1
Basis

Population 58 First-year Postgraduate Students

PART 2

Pre-evaluated questionnaire addressing the issues of

prescription writing
Exposure
Prescribe for a common ailment
Educational interventional session
Basis

49% of participants felt that their undergraduate

training had not prepared them for prescribing
properly.
Only, 17%, 7%, 5%, and 27% had written prescriber name,
PART 2
qualification, registration number, and signature,
respectively.
Outcome
Patient name, age, gender, and address were not
written in 69%, 73%, and 93% of the prescriptions.
There was a significant improvement in all the above
areas after the educational intervention.
Handwriting was legible and comprehendible in 98% of
the prescriptions.
Basis

Methodology Qualitative cross-sectional study

PART 2
 CHANGE IMPLEMENTED
Whether the provision of instructional videos on
prescription writing improves the skills in
prescription writing among senior clerks and
post-graduate interns
METHODOLOGY
Assessing prescription writing skills after
showing an instructional video
PROPONENTS
Group 9 Senior Clerks of Cebu Institute of
Medicine
VENUE
Cebu Velez General Hospital
DATE
November 11-15, 2022

Implementation Plan
 REQUIRED DATA
Prescription writing skills of senior clerks and
post-graduate interns
INVESTIGATOR
Group 9 Senior Clerks of Cebu Institute of
Medicine
VENUE
Cebu Velez General Hospital

DATE
November 11-15, 2022

DATA COLLECTION TOOL

A questionnaire, via google forms, will be sent
through email, to obtain the data from the study
population

Data Collection Plan

DO
Observations not part of the plan:
Some of the respondents used E-
prescription instead of writing on a blank
paper which made it difficult to assess
whether their handwritings are legible
The population target was not reached
since some participants were not able to
answer the questionnaire due to time
constraint
Modifications done to the original plan:
Once e-prescription was used, the
prescription was automatically considered
legible
A sample size was used instead of using the
target population
STUDY
Analysis of the feedback questionnaire
Analysis of the feedback questionnaire
Analysis of the feedback questionnaire
Analysis of the feedback questionnaire
Analysis of the feedback questionnaire
Analysis of the pre-test and post-test prescription written
Table 3: Prevalence of Superscription components written by the participants in the Pretest and Posttest
Table 4: Prevalence of Inscription components written by the participants in the Pretest and Posttest
Table 5: Prevalence of Subscription components written by the participants in the Pretest and Posttest
Table 6: Prevalence of Other technical components written by the participants in the Pretest and Posttest
Conclusion
Majority of participants are knowledgeable about prescription writing based on
previous trainings and clinical experiences
Participants prefer to have reinforcements regarding prescription writing during
different phases of learning especially about prescribing to special population

such as children, pregnant women, and patients with comorbidities and chronic
conditions

Participants believe that a collaboration with other healthcare providers such as

pharmacists will enhance drug-related patient safety especially since they are

considered to be reliable source of clinical drug information

Conclusion
At the pretest, the components of prescription writing were present in the majority

of prescriptions with deficiencies in some details such as PRC/Registration number

being the lowest in occurrence (66.30%). This reflects that the majority of

participants were already knowledgeable with prescription writing.

There is a clinically significant improvement in prescription writing skills after
educational intervention.
ACT
 Recommendations
Placement of prescription writing infographic in every nurse station
Displaying of infomercial regarding prescription safe practices at strategically located
areas in CIM and CVGH
Include prescription writing in the learning objectives during small group discussions to

apply their learnings in different modules, particularly in PBL 3

Incorporate questions regarding the principles of prescription writing during

assessments, especially during end-of-rotation exams of senior clerks

 Recommendations
Have lectures regarding prescription writing headed by the PGIs
Allow senior clerks to provide discharge instructions and counseling not only to patients
admitted under pediatric, surgery, and OB-GYN department but as well as patients

admitted under internal medicine

To give feedback to the participants of the study, to avoid committing the same errors in

their future practice

 References
Katzung BG, Vanerah TW. Basic & Clinical Pharmacology. New York: McGraw-Hill;
2021.
Maxwell, S. R. J. (2016). Writing prescriptions: How to avoid common errors.
Medicine, 44(7), 448–452. https://doi.org/10.1016/j.mpmed.2016.04.007
Gupta M, Tikoo D, Pal S. Assessment of prescription writing skills and impact of an
educational intervention on safe prescribing among the first-year postgraduate
medical students of Tertiary Care Hospital. AMEI's Current Trends in Diagnosis &
Treatment. 2020;4(1):51-59. doi:10.5005/jp-journals-10055-0087
Hendee WR. To err is human: Building a safer health system. Journal of Vascular and
Interventional Radiology. 2001;12(1). doi:10.1016/s1051-0443(01)70072-3
Al Khaja KA, James H, Sequeira RP. Effectiveness of an educational intervention on
prescription writing skill of preclerkship medical students in a problem-based
learning curriculum. The Journal of Clinical Pharmacology. 2013;53(5):483-490.
doi:10.1002/jcph.68
 References
Vollebregt JA, Metz JC, de Haan M, Richir MC, Hugtenburg JG, de Vries TP.
Curriculum development in pharmacotherapy: Testing the ability of preclinical
medical students to learn therapeutic problem solving in a randomized controlled
trial. British Journal of Clinical Pharmacology. 2006;61(3):345-351.
doi:10.1111/j.1365-2125.2005.02571.x
Banerjee I, Bhadury T. Prescribing pattern of interns in a Primary Health Center in
India. Journal of Basic and Clinical Pharmacy. 2014;5(2):40. doi:10.4103/0976-
0105.134980
Babar HS, Hussain S, Maqsood Z, Dad HA, Khan M, et al. Adherence to Prescription
Format and Compliance with WHO Core Prescribing Indicators. Journal of
Pharmaceutical Sciences and Research; Cuddalore. 2014; 6(4):195-199.
 References
Sudha M, Viveka S, Remya S. Assessment of prescription writing skills among
undergraduate medical students. International Journal of Basic and Clinical
Pharmacology. 2016:1586-1593. doi:10.18203/2319-2003.ijbcp20162477
Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e Brunton LL,
Hilal-Dandan R, Knollmann BC. Brunton L.L., & Hilal-Dandan R, & Knollmann B.C.
(Eds.),Eds. Laurence L. Brunton, et al.
Pasco, P. D., Caro, R. M., Cruz, C. L., Dando, N. M., Isip-Tan, I. C., Panganiban , L. R.,
(2017). Prevalence of medication errors in admitted patients at the Philippine
General Hospital. Acta Medica Philippina, 51(2), 61-64
Administrative Order 2020-0007 of February 11, 2020; National Policy on Patient
Safety in Health Facilities pp https://dmas.doh.gov.ph:8083/Rest/GetFile?id=651501
Thank You!