The Pharmacy: NABH Quality Management for Rural Hospitals

INTRODUCTION

Pharmacy is one of the most important revenue generating areas of the hospital and a well-run pharmacy could generate a lot of income for the hospital. We look at the various guidelines given by NABH with respect to management of medication.

One of the first things that medical students learn in Pharmacology is that all the prescriptions should be in pharmacological name. This is the standard given by the Medical Council of India and also the NABH [National Accreditation Board for Health care providers]. If the doctor wants to write the trade name he can do so in brackets. In the Western countries the doctors are allowed to write only the pharmacological names while Pharmacists are the ones authorized to write the trade names.

However, analysis of prescriptions in India would reveal that over 95% of the doctors especially in private and corporate hospitals write only trade names. This is because:

1. The pharmaceutical companies give a lot of gifts to the doctors for using their medicines
2. Many of the doctors [78% in one survey] do not know the pharmacological names of the medicines that they prescribe and their only knowledge about the medicine is from the medical representatives
3. Most of the diseases need only symptomatic treatment. In one of the multi-centric survey, 84.4 percent of the outpatients need only symptomatic treatment as many of the illness is self-limiting. Only few groups of symptomatic medicines are available. What this means is that if you compare the prescriptions of any OPD patients many of them would be similar. The private practitioners hence do the following:
   • They prescribe different trade names of the trade names of the same medicine for similar symptoms. For example, they will prescribe same painkiller [e.g. Diclofenac sodium] with different trade names for pain in the leg, pain in the arm, pain in the neck, headache, etc. so that the patients think different medicines are being prescribed.
   • They will give the same medicine with different trade name and tell the patient that what the previous doctor had prescribed is wrong and only their medicine will work. Since the medicines take a while to act patients might be led to believe that it was the second medicine that worked.
   • Many of the doctors write a lot of unnecessary prescriptions [with their trade names] because the medical representatives give them targets [number of prescriptions] for giving them benefits.

The following series of articles attempt to adapt the NABH [National Accreditation Board for Hospitals and Healthcare Providers] fourth edition standards to rural hospitals. Several examples and suggestions are given.

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