European Journal of Cardiovascular Medicine

Prescription writing is a fundamental and necessary skill that medical students should learn during their undergraduate studies.. A prescription is a written order from the prescriber which gives a detailed instruction about the medicine to be given to a patient [1]. As medical students transition to interns, they must translate theoretical knowledge into practice, and prescription writing is one area where this transition is often tested. Interns are expected to prescribe medications accurately, taking into account drug interactions, contraindications, dosages, and individual patient factors. However, despite its importance, studies have shown that many interns struggle with the intricacies of prescription writing [3]

World Health Organization (WHO) emphasizes on the inclusion of some essential components of prescription which are name, address of the prescriber, date of prescription, name and strength of the drug, dosage form, prescriber’s initials or signature, name, age, and address of the patient.[2]. In addition to listing the names of medications, dosages, and lengths of treatment, a prescription serves as a legal document that gives patients and pharmacists instructions and includes crucial contact details for both the patient and the prescriber. This information may be useful in the event of a drug-related adverse event [5].

Any fault in properly writing a prescription results in prescription errors, which in turn result in medication errors.  Prescription errors can have dire consequences, ranging from mild adverse reactions to severe patient harm or death. Inadequate prescription writing by medical interns may be attributed to several factors, including insufficient formal training in pharmacology, lack of practical exposure, and pressures from a high patient load [4].

To reduce prescribing errors, hospitals should train junior doctors in the principles of drug dosing before they start prescribing, and enforce good practice in documentation [5].

Research conducted at various medical institutions has identified that while interns are typically trained in pharmacology, the hands-on experience of writing prescriptions in real-life clinical situations is often underemphasized [4]. Therefore, it becomes imperative to assess the level of understanding and competence regarding prescription writing among medical interns, as this can inform improvements in educational curriculum and training methods. Enhancing the competence of interns in this essential skill not only supports their professional development but also contributes to reducing preventable medication errors, improving overall patient safety and healthcare outcomes.

This study aims to assess the prescription-writing skills of interns at Konaseema Institute of Medical Sciences and compare them with findings from previous studies. By identifying common errors and areas for improvement, the study seeks to highlight the need for structured training, real-time supervision, and standardized protocols to enhance safe prescribing practices among medical interns.

Aim: To evaluate Knowledge and Competence of prescription writing among interns in  Konaseema Institute of Medical Sciences , Amalapuram .

Objectives:

1. To assess the level of knowledge of prescription writing among medical interns. This objective aims to evaluate how well interns understand the key principles of prescription writing, including drug choice, dosage, route of administration, and frequency.
2. To identify common errors made by interns in prescription writing

This objective focuses on determining the types of prescription errors interns

commonly make, such as incorrect dosages, illegible handwriting, missing

information and drug interactions.

3. To provide recommendations for improving prescription writing education and training for medical interns .Based on the study’s findings, this objective aims to suggest actionable interventions, such as curricular changes, workshops, or additional clinical training, to improve prescription writing competence among interns.
4. To investigate the level of intern awareness regarding common drug-drug interactions and contraindications .This objective seeks to measure how well interns understand drug interactions and contraindications when writing prescriptions, as these are key components of safe Prescribing

BACKGROUND:

Prescription writing is one of the most fundamental skills required of medical professionals, serving as a legal, ethical, and clinical document that ensures accurate communication between healthcare providers, pharmacists, and patients. A well-written prescription not only helps in delivering appropriate treatment but also prevents medication errors, adverse drug reactions, and legal complications. However, multiple studies have shown that interns and junior doctors frequently make prescribing errors, often due to inadequate training, high workload, and lack of supervision.

Despite these guidelines, various studies have highlighted gaps in prescription writing practices among medical trainees, raising concerns about patient safety and treatment efficacy. Studies by Sumalatha R., Nagabushan H., and Meenakshi Gupta et al. have identified common errors such as missing patient details, incorrect drug dosages, omitted administration routes, and unsigned prescriptions, all of which can have serious consequences.

In a study by Meenakshi Gupta et al. (2020), prescription writing skills were significantly improved after targeted educational interventions, suggesting that structured training programs can enhance prescribing accuracy [9] .Similarly, Sumalatha R. and Nagabushan H. found that interns who received formal training demonstrated better adherence to MCI guidelines, with 98% of prescriptions being properly signed compared to only 68.84% at Konaseema Institute of Medical Sciences [6]

This study aims to assess the prescription-writing skills of interns at Konaseema Institute of Medical Sciences and compare them with findings from previous studies. By identifying common errors and areas for improvement, the study seeks to highlight the need for structured training, real-time supervision, and standardized protocols to enhance safe prescribing practices among medical interns.

Study Design and Setting

A cross-sectional study was conducted at Konaseema Institute of Medical Sciences, Amalapuram, from February 1 to February 28, 2025, to assess the knowledge and competence of medical interns in prescription writing.

Study Participants

A total of 138 interns from Konaseema Institute of Medical Sciences participated in the study.

Study Procedure

Interns were asked to write prescriptions for various common ailments, including fever, weakness, and cough. A structured 18-item questionnaire, reviewed and approved by medical professionals, was used to assess the completeness and accuracy of the prescriptions.

Data Collection and Analysis

Data from the prescriptions were entered into Microsoft Excel for organization and processing. The results were analyzed using percentage-based summarization to identify common errors and omissions in prescription writing.

Ethical Considerations

Approval for the study was obtained from the Institutional Ethics Committee before initiation. Informed consent was taken from all participants, ensuring voluntary participation. Confidentiality of participant details was maintained throughout the study, and only summary data were used for result declaration.

Total 138 interns participated in this study.  All of them wrote prescriptions for various ailments .Out of them  84 are males, 29 are females, 25 didn't write their names.

The most frequently overlooked information was the Time to be written, which was missing from 65.94% of prescriptions and the Route of Administration, which was missing from 60.14% of cases, potentially resulting in incorrect drug administration.

In contrast, the most accurately documented information was the Symbol Rx, which appeared in 98.55% of prescriptions, and the Frequency of Drug Administration, which was remembered in 79.71% of cases, guaranteeing proper dosage timing; the Legibility of Drug Name was maintained in 76.09% of prescriptions, lowering the likelihood of medication errors; and Patient Age and Dosage Legibility were both accurately documented in 74.64% of prescriptions.

The majority of interns are aware of therapeutic duplication , drug-drug interactions, and food-drug interactions as seen by the 85.5%, 89.9%, and 89.9% respectively who did not do so.

Of the 84 male interns, the majority remembered to write the Rx sign as often as possible with frequency and legible handwriting (98.2%, 85.7%, and 83.0%, respectively), and the majority were aware of therapeutic duplication, drug-drug interactions, and food-drug interactions (82.1%, 87.5%, and 88.4%,respectively)

Every female intern has 100% of the requirements for writing prescriptions met

For medical practitioners, writing prescriptions is an essential skill that guarantees patient safety and clear communication.  We evaluated interns' compliance with prescription-writing guidelines at the Konaseema Institute of Medical Sciences in this analysis. 

Our results show that some important factors were often missed out , including patient age, gender, route of administration  and Doctor’s signature.  These omissions may result in incorrect dosage, prescription mistakes, and even patient injury.  Missing information on drug-drug and food-drug interactions  and the absence of the Rx symbol  point to a lack of knowledge about safe prescribing procedures. 

Positively, interns made sure that dosage clarity was maintained, regularly included frequency of administration , and consistently documented drug names legibly  .This indicates areas that require improvement through focused training and supervision, but it also shows a reasonable awareness of basic prescribing practices.

The impact of missing information :

• Patient Age & Gender : These are important factors in assessing the appropriateness and dose of drugs. Ignoring this information can result in improper dosage, especially for elderly and pediatric patients.
• Route of delivery : Without this, pharmacists or nurses could not know if a medication should be administered intravenously, orally, or in another way, which could result in an improper delivery.
• Time & Signature of Doctor: Accountability is ensured by these. Because prescriptions without authentication may result in malpractice issues, missing them presents ethical and legal question

The Possible explanations for omissions include Lack of Awareness as  Interns could not completely comprehend the importance of every criterion and  Time Constraints as  Prescriptions may be prepared hurriedly in a busy hospital setting, leaving out important details .

In contrast to international standards, many nations use electronic prescription systems (e-prescribing) that lower errors.  To make sure all requirements are met before submission, some hospitals use checklists .Numerous studies have demonstrated greater compliance with prescription writing through the use of Continuous Medical Education (CME).

In terms of patient information documentation, in our study interns omitted patient age in 25.36% of prescriptions and patient gender in 28.99%, whereas the study by Sudha et al. reported a higher omission rate of 30% for patient age and 35% for gender. Similarly, regarding legibility of drug names in our study  interns ensured that 76.09% of prescriptions were legible, whereas Sudha et al. reported a slightly lower rate of 70%. [8][10][11]

A critical area of concern in both studies was the omission of the route of administration, which was missing in 60.14% of prescriptions in our study compared to 65% in the study by Sudha et al. This suggests that specifying the administration route remains a major challenge for medical trainees, which could lead to medication errors. Additionally, frequency of drug administration was recorded in 79.71% of prescriptions in our study which was slightly better than the 75% documentation rate found in the Sudha et al. study.[8][12]

One of the most significant issues in prescription writing is the doctor’s signature, which is crucial for legal and accountability purposes. The absence of a signature was observed in 31.16% of prescriptions in our study , whereas Sudha et al. reported a higher omission rate of 40%. This finding highlights that while both groups of medical trainees need improvement in this area, both studies emphasize the importance of structured educational interventions to improve prescription writing skills and enhance patient safety.[8][13]

In our study ,  31.16% of prescriptions were missing the doctor’s signature, In contrast to our study , in Sumalatha and Nagabushan’s study, only 2% of prescriptions lacked a signature, meaning 98% were properly signed. This indicates that interns in the latter study demonstrated significantly better compliance with documentation requirements compared to interns in our study . [6]  

In contrast to our study Gupta et al. conducted an educational intervention and verified the outcomes . In our study 31.16% of prescriptions lacked the doctor's signature. While Gupta et al. did not specify the percentage of unsigned prescriptions, they acknowledged significant deficiencies in prescriber-related components before the intervention [9]. 76.09% of prescriptions were deemed legible, indicating that nearly a quarter were not. Gupta et al. also observed issues with legibility and completeness in prescriptions prior to their educational intervention [9][14].

According to the findings of our investigation, the most commonly missed details, such as patient information, route of administration, and doctor’s signature, emphasize the necessity for structured interventions. The findings highlight the critical role of proper prescription documentation in patient safety. While interns demonstrate competence in some areas (like writing legible drug names and dosages), the frequent omission of patient details, administration routes, and doctor authentication indicates the need for systematic interventions.

In conclusion, prescription writing is an essential skill that medical interns must master to ensure patient safety and quality of care. The competence and understanding of prescription writing among interns are critical, as even minor errors in drug selection, dosage, or administration can lead to adverse outcomes, including medication errors and harm to patients.The study emphasizes that in order to increase adherence to accepted medical practices, interns need continual training in prescription writing. Patient information, the method of administration, and the doctor's signature are among the most frequently overlooked factors, which highlights the need for structured interventions including workshops, computerized prescription systems, and routine audits. 

Hospitals and other healthcare facilities can improve patient safety, lower drug errors, and encourage future doctors to prescribe more responsibly by filling these gaps.Prescription writing training seminars should be made mandatory in order to address these problems.Regular cross-checking of intern prescriptions should be done by supervising faculty. Prescription omissions can be greatly decreased by using a standardized checklist before submission.  The danger of medication errors, legal concerns, and compromised patient safety can be greatly reduced by enhancing prescription-writing practices. This study is a call to action for institutions and medical instructors to improve the way aspiring physicians write prescriptions.

ACKNOWLEDGEMENT:

We thank all the interns who are involved in the study.

1. Lofholm, PW, and BG Katzung. Rational Prescribing & Prescription Writing. In Katzung, BG, and TW Vanderah, editors. Basic & Clinical Pharmacology, 15e. McGraw-Hill, 2021. Available from: https://accesspharmacy.mhmedical.com/content.aspx?bookid=2988&sectionid=250605584.
2. Babar, HS, et al. "Adherence to Prescription Format and Compliance with WHO Core Prescribing Indicators." J Pharm Sci Res, vol. 6, no. 4, 2014, pp. 195-199.
3. Azizi, P., et al. "The Challenges of Medical Students in Their Internship: A Qualitative Study from Iran." BMC Res Notes, vol. 17, no. 1, 2024, p. 241. doi: 10.1186/s13104-024-06883-9. PMID: 39223655; PMCID: PMC11370231.
4. Ravinandan, AP, et al. "A Study of Prescription Errors in South Indian City, Karnataka: An Observational Study." IP Int J Comprehensive Adv Pharmacol, vol. 8, no. 2, 2023, pp. 125-129.
5. Dean, B., et al. "Causes of Prescribing Errors in Hospital Inpatients: A Prospective Study." Lancet, vol. 359, no. 9315, 2002, pp. 1373-1378. doi: 10.1016/S0140-6736(02)08350-2. PMID: 11978334.
6. Sumalatha, RH, and H. Nagabushan. "Assessment of Knowledge, Attitude, and Practice of Prescription Writing as per Medical Council of India Guidelines among Interns in a Medical College." Int J Pharmacol Res, vol. 6, no. 2, 2016. doi: 10.7439/ijpr.v6i2.2939.
7. Kumari, R., et al. "Assessment of Prescription Pattern at the Public Health Facilities of Lucknow District." Indian J Pharmacol, vol. 40, no. 6, 2008, pp. 243-247. doi: 10.4103/0253-7613.45148. PMID: 21279178; PMCID: PMC3025139.
8. Sudha, MJ, et al. "Assessment of Prescription Writing Skills among Undergraduate Medical Students." Int J Basic Clin Pharmacol, vol. 5, no. 4, 2017, pp. 1586-1593.
9. Gupta, M., et al. "Assessment of Prescription Writing Skills and Impact of an Educational Intervention on Safe Prescribing among the First-Year Postgraduate Medical Students of Tertiary Care Hospital." AMEI’s Curr Trends Diagn Treat, vol. 4, no. 1, 2020, pp. 51-59.
10. Phalke, VD, et al. "Prescription Writing Practices in a Rural Tertiary Care Hospital in Western Maharashtra, India." Australas Med J, vol. 4, no. 1, 2011, pp. 4-8. doi: 10.4066/AMJ.2011.515. PMID: 23393497; PMCID: PMC3562966.
11. Shetty, Y., et al. "Evaluation of Prescriptions from Tertiary Care Hospitals across India for Deviations from Treatment Guidelines & Their Potential Consequences." Indian J Med Res, vol. 159, no. 2, 2024, pp. 130-141. doi: 10.4103/ijmr.ijmr_2309_22. PMID: 38528817; PMCID: PMC11050754.
12. Brinkman, DJ, et al. "Do Final-Year Medical Students Have Sufficient Prescribing Competencies? A Systematic Literature Review." Br J Clin Pharmacol, vol. 84, no. 4, 2018, pp. 615-635. doi: 10.1111/bcp.13491. PMID: 29315721; PMCID: PMC5867102.
13. Afrah, Abdulla LM, et al. "Refining Patient Care: Evaluating Prescription Practices of Medical Residents and Interns in a Teaching Hospital through an Audit." SAGE Open Med, vol. 12, Nov. 2024, p. 20503121241300902. doi: 10.1177/20503121241300902. PMID: 39575311; PMCID: PMC11580091.
14. Ciapponi, A., et al. "Reducing Medication Errors for Adults in Hospital Settings." Cochrane Database Syst Rev, vol. 11, 2021, CD009985. doi: 10.1002/14651858.CD009985.pub2. PMID: 34822165; PMCID: PMC8614640.