Implementation of internal audit system on non-essential drug prescribing at Srinagarind Hospital

Abstract

Background and Objective: The Comptroller General’s Department (CGD) has announced a measure namely “The Non-essential Drug Prescription Criteria” (NPC or A-F items) to encourage the rationale drug use for patients under civil servant medical benefit scheme (CSMBS) in 168 public hospitals since the fiscal year 2013. This study aimed to monitor and assess the implementation of this measure using internal an audit system at Srinagarind hospital.

Method: The outpatient prescribing of non-essential drugs (NED) in four drug groups; cyclooxygenase-2-receptor inhibitors, angiotensin-2-receptor blockers, proton pump inhibitors and HMG coA reductase inhibitors, for patients under CSMBS who visited Srinagarind hospital after 1 November 2012 were assessed until complete 100 prescribing per each drug group. The consistency of the NPC specified in prescriptions and patient medical record were assessed. In addition, the rationale of prescribing was evaluated using the drug use criteria.

Result: NPC were indicated in all 400 prescribing and the most common NPC were item C (47.5%) followed by item B (40.5%) and item A (10.0%). The data recorded in patient medical charts that supported the use of NED were found and could be assessed in only 199 prescribing (49.8%) and their consistency to NPC were found in 92 prescribing (46.2%). The rationale of prescribing could be assessed in 332 prescribing (83.0%), in which appropriate use of these NED was found in 103 prescribing (31.0%).

Conclusion: The consistency between NPC and data supporting the NPC was found in only half of the cases but the rational of drug use was found in one third of assessable cases. Internal audit system may be set up to assess and support the rational NED use in the hospital