EVALUATION OF RATIONALITY IN PRESCRIBING FOR CARDIOVASCULAR DISORDERS IN INTENSIVE CARDIAC CARE UNIT: A PROSPECTIVE OBSERVATIONAL STUDY

Objective: To evaluate the prescribing pattern in patients admitted to intensive cardiac care unit, to evaluate direct cost of the treatment in patients admitted in intensive cardiac care unit, to evaluate the rationality of drugs prescribed and to prepare and submit therapeutic guideline for management of ACS. Method: This prospective observational study was carried out in ICCU for a period of ten months. Data were analysed for drug utilisation pattern and direct cost of treatment was calculated using patient’s hospital and pharmacy bills. Rationality of therapy was evaluated based on class of recommendation from Indian guidelines for management of cardiovascular diseases, during the study period 70 prescriptions were screened. Results: The results show that a total of 156 (19.11%) cardiovascular drugs were prescribed to 70 patients admitted in ICCU during the study and anti-anginals 33 (21.15%) were equally used as inotropes 33 (21.15%), followed by anti-platelets 32 (20.51%), anticoagulants 27 (17%), hypolipidemics 21 (14%) and anti-arrhythmics 10(6%). Mean number of drugs per encounter was high (11), which contributed more to the cost of pharmacotherapy. 97.79% of the drugs belonged to NLEM, First class recommendation of Indian guidelines for management of cardiovascular diseases were followed in majority of prescriptions except for use of clopidogrel which belonged to class 2a recommendation for patients undergoing CABG surgery, this minor deviation was seen in 9 cases and the study has also noticed over use of antibiotics, it also revealed that ward bed charge, ICCU bed charge, ventilator charge had more contribution in direct medical cost of hospitalization. Cost of drug therapy accounted very less of direct medical cost of hospitalization. Cost of antimicrobials accounted 31.8% of cost of drug therapy. Conclusion: Irrational drug use in ICCU can be avoided by following standard treatment guidelines, This study will be helpful for hospital administration to monitor their hospital charges to affordable for patients and education to prescribers for affordable prescription of antimicrobials, improve rational drug use in ICCU and better management of patients.