To analyze the Impact of Serial Prescription Audits with Active Feedback on Quality of Prescription Behaviour.

Material And Methods: A serial prescription audit in four cycles (three months each) was conducted at Jhalawar Medical College and Hospital and at Chintpurni Medical College and Hospital for two years, one year in each hospital. One cycle included the prescriptions which were collected by using a digital camera from the outdoor patients department every month (n=250 per month), for three months regularly. A baseline prescription audit, as a cross-sectional survey, was done on the last date of the first month. Re-audits were done on the last date of the 2(nd) and 3(rd) months, which concluded one cycle. One cycle was followed by three months of no prescription audit. In total, four cycles were completed in two years. The parameters which were observed were- (a) the formats of the prescriptions (b) the WHO drug core indicators and (c) the legibility of the prescriptions. The clarity of the prescriptions was decided upon by the consensus group. A continuous evaluation and a feedback process were carried out every month by analyzing the prescriptions, based on the extent of conformity to the "WHO Guide to Good Prescribing" and the updated list of the "WHO Essential Medicines." The data was analyzed by using the Chi-square test.

Results: There was a significant improvement in the formats of the prescriptions in terms of the quality of the completeness and the rationality at the end of the 2nd and 3rd months of each cycle. Similarly, the WHO drug core indicators improved with every re-audit in each cycle (p < 0.05). Overall, the total percentage of the core indicators significantly improved in the 2nd and 3rd months as compared to the 1st month in all the cycles (p < 0.05). The clarity of the prescriptions improved in the successive re-audits. There was a sudden decline in the improvement in all the parameters in the first month of the 2nd, 3rd and the 4th cycles as compared to that in the 2(nd) and 3(rd) months of the previous cycles.

Conclusion: Serial prescription audits and an active feedback definitely improve the prescription behaviours in the therapeutic decision making. But discontinuing the prescription audits begins to reverse the improvement in the prescription behaviours.