TRENDS IN PRESCRIPTION PATTERN IN MEDICAL INDIAN ICU AND IT’S IMPACT ON PATIENT OUTCOME
Keywords:Prescription pattern, Intensive care unit, Antimicrobial agents
Objective: The objective of this study is to evaluate the trends in prescribing pattern in medical ICU concerning patient age, gender, past, and current illness along with comorbidities for the evasion of polypharmacy and to improve patient outcomes.
Methods: A prospective analysis of the case records of patients admitted to the ICU of Yashoda hospital in India was carried out.
Results: 120 patients were evaluated, consisting of 77% male patients. The mean±SD of age is 53.81±14.63. The majority of the study subjects belonged to the age group of 50-67 y (32%) Most common causes for admission to the ICU were Respiratory diseases and Stroke. Diabetes mellitus and Hypertension are the most common co-morbidities identified. The total number of drugs used were 1502 during this study period. The average number of drugs per prescription is 12. The range is between 2-30. The average number of antibiotics per prescription is 3. Commonly prescribed drug classes were the GI agents in 100% of patients, followed by antimicrobial agents (AMAs) in 95.8% of patients. About 42.5% of patients received 3 antibiotics per day. 55 potential drug-drug interactions were interpreted in 46 patients. 30(55%) were moderate interactions 25(45%) were major interactions, which were addressed. De-escalation of antibiotics was seen in 29% of patients while escalation in 13%. The death rate is only 5% in our ICU setting.
Conclusion: This prescription pattern study can provide a framework for continuous prescription audit in the ICU
Patanaik SK, Pattanayak C, Prasad A, Chauhan AS. Drug utilization pattern in an intensive care unit setting in Eastern India. Int J Basic Clin Pharmacol 2003;4(6):1136-41. doi: 10.18203/2319-2003.ijbcp20151347.
Nagashree BN, Manchukonda RS. Prescription audit for evaluation of present prescribing trends in a rural tertiary care hospital in South India: an observational study. IJBCP. 2016 Sep-Oct;5(5):2094-7. doi: http://dx.doi.org/10.18203/2319-2003.ijbcp20163242.
Kaur SJ, Rajagopalan S, Kaur N, Shafiq N, Bhalla A, Pandhi P, Malhotra S. Drug utilization study in the medical emergency unit of a tertiary care hospital in North India hindawi publishing corporation. Emerg Med Int 2014;5. https://doi.org/ 10.1155/2014/973578
Sunny D, Roy K, Benny SS, Mathew DC, Gangadhar Naik J, Gauthaman K. Prescription audit in an outpatient pharmacy of a tertiary care teaching hospital-a prospective study. J Young Pharm. 2019;11(4):417-20. doi: 10.5530/jyp.2019.11.85.
Al-Zakwani I, Al-Thuhli M, Al-Hashim A, Al Balushi KA. Drug utilization pattern in an intensive care unit at a tertiary care teaching hospital in Oman. Asian J Pharm Clin Res. 2017;10(2):194-7. doi: 10.22159/ajpcr.2017.v10i2.15148.
Patel MK, Barvaliya MJ, Patel TK, Tripathi C. Drug utilization pattern in critical care unit in a tertiary care teaching hospital in India. Int J Crit Illn Inj Sci. 2013 Oct–Dec;3(4):250-5. doi: 10.4103/2229-5151.124128, PMID 24459622.
Paudel R, Palaian S, Bishnurath G, Hom KC, Anil KS, Poudel A, Khanal S, Shankar PR. Clinical profile and drug utilization pattern in an intensive care unit of a teaching hospital in Western Nepal. Arch Pharm Pract. 2011;2(4):163-9.
Nibrad VV, Nayak BB, Raul AR, Vijayprasad S, Vakade KP, Jadhav AR. Drug utilization pattern in a medical intensive care unit (MICU) in a tertiary care teaching hospital in rural area of Maharashtra. Int J Appl Biol Pharm Technol. 2015;6(1):148-53.
Shankar PR, Partha P, Dubey AK, Mishra P, Deshpande VY. Intensive care unit drug utilization in a teaching hospital in Nepal. Kathmandu Univ Med J (KUMJ). 2005;3(2):130-7. PMID 16415608.
Panda RK, Abhisek PA, Sika LM, Pradhan SS, Routray SS, Mohanty S. Utilisation of antimicrobial agents in intensive care unit at a tertiary care teaching hospital in eastern India. Int J Basic Clin Pharmacol 2019 Sep;8(9). doi: 10.18203/2319-2003.ijbcp20193672.
Rajathilagam AR, Malathy SS, Kothai G. Prescription pattern in a medical ICU of a tertiary care teaching hospital of south India. BPJ. 2018;11(1):405-10.
Pichala PT, Mukkillapati BK, Thomas SZD, Saunchez L. Gerardo AU an interventional study on intensive care unit drug therapy assessment in a rural district hospital in India. JBCP. 2013;4(3).
Chatterjee S, Mandal A, Lyle N, Mukherjee S, Singh AK. Drug utilization study in a neonatology unit of atertiary care hospital in eastern India. Pharmacoepidemiol Drug Saf. 2007;16(10):1141-5. doi: 10.1002/pds.1469, PMID 17823977.
John L, Devi P, John J, Guido S. Drug utilization study of antimicrobial agents in medical intensive care unit of a tertiary care hospital. AJPCR 2011;4:814.
Abideen S, Vivekandan K, Mishra P. Assessment of the prevalence of potential drug-drug interactions in medical intensive care unit of a tertiary care hospital in India. AJPCR. 2015;8:125-30.
Barot PA, Malhotra SD, Rana DA, Patel VJ, Patel KP. Drug utilization in emergency medicine department at a tertiary care teaching hospital: A prospective study. J Basic Clin Pharm. 2013;4(4):78-81. doi: 10.4103/0976-0105.121650, PMID 24808677.
Mali NB, Deshpande SP, Tullu MS, Deshmukh CT, Gogtay NJ, Thatte UM Mali. A prospective antibacterial utilization study in pediatric intensive care unit of a tertiary referral center. Indian J Crit Care Med. 2018 Jun;22(6):422-6. doi: 10.4103/ijccm.IJCCM_365_17, PMID 29962742.
Williams A, Mathai AS, Phillips AS. Antibiotic prescription patterns at admission into a tertiary level intensive care unit in Northern India. J Pharm Bioallied Sci. 2011;3(4):531-6. doi: 10.4103/0975-7406.90108, PMID 22219587.
Bobek M, Hoffman Hogg L, Bair N, Mion L, Arroliga A, Slomka J. Utilization patterns, relative costs, and length of stay following adoption of MICU sedation guidelines. Formulary. 2001;36:664-73.
Remesh A, Retnavally K, Salim S, Gayathri A, Nair U. Antibiotics prescribing pattern in the in-patient departments of a tertiary care hospital. Arch Pharma Pract. 2013;4(2):71-6. doi: 10.4103/2045-080X.112987.
Badar VA, Navale SB. Study of prescribing pattern of antimicrobial agents in medicine intensive care unit of a teaching hospital in Central India. J Assoc Physicians India. 2012;60:20-3. PMID 23029737.
Askari M, Eslami S, Louws M, Dongelmans D, Wierenga P, Kuiper R, Abu-Hanna A. Relevance of drug-drug interaction in the ICU- perceptions of intensivists and pharmacists. Stud Health Technol Inform. 2012;180:716-20. PMID 22874285.
Ujwala P, Gawali UP, Khobragade RS. Drug utilization and prescription pattern study in medicine intensive care unit at tertiary care teaching hospital. NJPPP. 2019;9(7):674-7.
Mukhopadhyay D, Dudhraj V, Mukherjee D. A descriptive study on the prescription audit of prescribing patterns in primary, secondary, tertiary healthcare facilities in India. ISBN; 2020 Nov: 979-8566362175.
Nourmand N, Thomas S. Prescription auditing and study of drug utilization pattern in an outpatient pharmacy of a tertiary care hospital, Bengalu. IAJP. 2018 Oct-Dec;12(4):S119.
Afroz A, Gupta S, Saurabh Kansal S, Ramgopal. Prescription auditing and drug utilization pattern in a tertiary care teaching hospital of western. IJBCP. 2012 Dec;1(3):184-90.
Badar VA, Navale BSK. Study of prescribing pattern of antimicrobial agents in medicine intensive care unit of a teaching hospital in Central India. JAPI. 2012;60:31.
Biswal S, Mishra P, Malhotra S, Puri GD, Pandhi P. Drug utilization pattern in the intensive care unit of a tertiary care hospital. J Clin Pharmacol. 2006;46(8):945-51. doi: 10.1177/0091270006289845, PMID 16855079.
How to Cite
Copyright (c) 2022 Dr. Venkat Raman Kola, Hemasree Meda, Sharon Rose, Kishore
This work is licensed under a Creative Commons Attribution 4.0 International License.