Article Text

Sustainable change: prescribing practice in a rural hospital of a developing nation (South East Asia)
  1. I Lingam1,2,
  2. H Clago2,
  3. V Nanduri1
  1. 1Paediatrics, Watford General Hospital, Watford, UK
  2. 2Health Volunteers, Voluntary Service Overseas, Stung Treng, Cambodia



  • Identify common prescribing errors in a rural hospital in South East Asia and develop prescribing guidelines.

  • Measure the impact of a Paediatric Advisor volunteer placement on the prescribing practice of local doctors.

Methods Data were collected from records of children attending the paediatric ward from 01/08/07 to 31/10/07, then 01/08/10 to 31/10/10, and 01/07/11 to 31/07/11. Each prescription was analysed to determine if the medication was appropriate for the diagnosis.

Criteria for determining inappropriate prescriptions:

  • Overdosing (>2× maximum) or inappropriately frequent administration.

  • Prescribing metamizole – Non-Steroidal Anti-inflammatory drug discontinued in Europe due to serious side effects.

  • Inadequate anti-malarial dosing.

  • Unnecessary drugs for the diagnosis.

  • Inappropriate IV fluids.

Results As detailed in table 1, the overall number of inappropriate prescriptions successively decreased – from 38.4% in 2007, to 26.3% in 2010 and 17.2% in 2011. Between 2010 and 2011, there were a significantly fewer metamizole prescriptions (8.7% to 3.0%), fewer unnecessary medications (10.4% to 8.3%) and inadequate antimalarial treatment (2.7% to 1.7%) with a slight decrease in medication overdoses (4.5% to 4.1%).

Abstract G68(P) Table 1

There were significantly fewer inappropriate fluid prescriptions (25.3% to 9%) with lower incidence of fluid overload and a reduction in unsuitable maintenance fluids.

Conclusion The most common prescribing errors related to prescribing unnecessary drugs for the diagnosed illness and using metamizole as an antipyretic. The reductions in these errors were the result of both formal training sessions as well as regular reinforcement from the volunteers. Our audit demonstrates that it is possible to have a sustainable and measurable impact on the clinical practice of local doctors in a resource poor hospital. Reducing inappropriate prescriptions benefits both patient care as well as conserving already scarce resources.

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