• A cross-sectional study was conducted across 13 Indian Council of Medical Research (ICMR) Rational Use of Medicines Centres. 

• Outpatient prescriptions were assessed for completeness and adherence to standard treatment guidelines (STGs).

• The study examines the prevalence of deviations from treatment guidelines in prescriptions across Indian tertiary care hospitals and explores their potential consequences.

• Irrational prescribing practices can negatively impact patient safety and increase economic burden.

• Unacceptable deviations were classified as those with potential for drug interactions, lack of response, increased cost, preventable adverse drug reactions, or antimicrobial resistance.

• The results of the study are as follows:

1. Of the 4838 prescriptions analyzed, 9.8% had unacceptable deviations.

2. Community medicine outpatient departments had the highest percentage of unacceptable deviations (24.66%), followed by ENT (13.22%) and Pediatrics (10.79%).

3. The most common diagnoses associated with these deviations were upper respiratory tract infections (URTI) and hypertension.

4. Pantoprazole was the drug most frequently prescribed inappropriately, followed by the combination of rabeprazole + domperidone and oral enzyme preparations.

5. The most common potential consequences of the observed deviations were increased cost (63%) and a higher probability of adverse drug reactions (53%).

• While overall adherence to STGs was observed (55%), the unacceptable deviation rate highlights a need for targeted interventions.

• Physician recommendations include implementing online training on rational prescribing, issuing administrative orders for STG adherence, and providing prescriber feedback. 

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