Abstract

Background:
Medication decisions during early ED care affect prescribing quality and patient safety.

Aim:
This study aimed to characterize early ED medication use, assess World Health Organization (WHO) prescribing indicators and prescription rationality, and compare retrospective and prospective phases.

Methods:
This hospital-based observational retro-prospective study included 300 pharmacologically treated ED encounters: 150 retrospective records (1 September-30 November 2025) and 150 prospective encounters (1 December 2025-28 February 2026). Early management extended from initial ED assessment to patient disposition. Untreated visits were excluded; therefore, the encounter-level denominator was the 300 treated encounters. WHO indicators and a prespecified rationality checklist were applied. Categorical phase differences were tested using the chi-square test.

Results:
Most patients were 21-40 years old, and 58% were male. Intravenous fluids (80%) and analgesics (70%) were the most frequently administered medication categories. The mean number of medicines per encounter was 2.3. Generic and essential-list medicines comprised 90% and 95% of prescribed medicines, respectively. Antibiotics and injectables occurred in 30% and 80% of treated encounters, respectively. Polypharmacy (>5 medicines) occurred in 15% of encounters; 90% of prescriptions met all rationality criteria. Generic prescribing increased from 85% to 95% (approximate p = 0.008); differences in antibiotic and injectable prescribing were not statistically significant.

Conclusion:
Indicators suggested generally appropriate use among treated encounters, but interpretation is limited by convenience sampling, exclusion of untreated visits, incomplete case-mix comparison, and documentation-based rationality assessment. The results provide an audit baseline but not proof of improvement. Electronic prescribing, stewardship, pharmacist review, and repeat evaluation are recommended.

Key words: Drug utilization; Emergency department; Pharmacoepidemiology; Rational prescribing.