Prescription writing in public and private hospitals in Benin City, Nigeria: the effects of an educational intervention

Abstract

Background: Writing a prescription is a vital part of the process of rational therapeutics; a badly written prescription could undermine a clinical consultation.

Objectives: To determine how far prescriptions meet accepted standards, identify factors underlying poor prescription writing, intervene by educational methods, and evaluate the effects of intervention.

Methods: Prescriptions (1,197) were collected retrospectively from 40 doctors (public and private hospitals). Handwriting was assessed using a rating scale. Intervention was by face-to-face education and group seminar in public hospitals, and face-to-face education only in private hospitals, with impact evaluation 4 to 6 weeks later. Non-parametric statistics were used to assess differences in means for pre- and post-intervention values.

Results: At baseline, more prescriptions from private hospitals had hospitals' addresses (p=0.005) and patients' ages (p=0.015); more from public hospitals were signed (p=0.001) and 20% of prescriptions were clearly legible. Post-intervention, more prescriptions from public hospitals were signed (p=0.017); more from private hospitals had the doses (p=0.04) and routes (p=0.05) of administration, and the intervention group in private hospitals wrote patients ages more frequently than controls (p=0.05). Doctors who had group seminar wrote frequencies and routes of administration (p=0.03 and 0.04 respectively) more than those who had face-to-face education. Handwriting worsened (p=0.04, 0.02 in public and private hospitals respectively). Poor quality of prescriptions was blamed partly on heavy workload and non-availability of prescription order blanks.

Conclusions: Prescriptions lacked details and most were not clearly legible. Intervention resulted in modest changes, which in public hospitals were more significant among doctors who had group seminars.