Adherence to the principles of rational use of medicines in Kenyatta National Hospital

Abstract

Background: Medicines are vital in pharmacotherapy but their desired therapeutic outcome is dependent on appropriate use. Studies have revealed that medicines have been used inappropriately. Some of the consequences of inappropriate medicines use include poor patient response, increased expenditure and overall poor patient management. Objectives: To evaluate whether pharmacological treatment given to in-patients at Kenyatta National Hospital complies with rational drug use principles. Methodology: A cross-sectional study was adopted and the study population comprised of patients admitted at Kenyatta National Hospital’s Medical, Pediatric, Surgical and Obstetrics/Gynecology wards in the months of July, August and September 2013. Systematic random sampling method was used to select 385 patients in the wards. A predesigned structured data collection tool was used to abstract data from the patient files and treatment sheets. The data obtained was analysed using Statistical Package for Social Sciences version 19 software and the Stata version 12 software. Results: One hundred and seventy five patients (45.5%) were males and the rest were females patients. These were aged between 3 months - 86 years with a median age of 26.0 years. The 385 prescriptions contained 187 different drugs and 1597 prescribing events. The average number of drugs prescribed per patient was 4.16 (95% CI: 3.97-4.34). Thirty-six percent of all drugs prescribed were by their brand names. The overall prevalence of irrational prescribing practices was 95.6% while the prevalence of medication errors was 45%. Inappropriate duration accounted for 71.2% of the nine hundred and twenty seven (927) medication errors found and it was the most frequent error-type while inappropriate indication (1.4 %) was the least common. The odds of encountering irrational prescribing was high in surgical wards. The prevalence of drug-drug interactions was 158 (41%) and the total number of potential interaction events detected were 210. The interaction between Metoclopramide and Tramadol was the most frequent potential drug-drug. This interaction may increase the risk of seizures because of reduced seizure threshold. Six percent of patients had contraindicated medicines prescribed. The proportion of patients who experienced non – availability of medicine was 28.3%