Effectiveness of the Prospective Prescription Review System in Reducing Irrational Prescriptions at a Tertiary Specialty Hospital: Retrospective Cohort Study

Abstract Background The prospective prescription review system can improve prescription rationality, but its effectiveness in high-volume specialty care settings is not well established. Objective We aimed to evaluate the effectiveness of the prospective prescription review system in reducing irrational prescriptions and to analyze factors associated with successful interception. Methods This retrospective cohort study analyzed all outpatient and emergency prescriptions issued between January 1 and December 31, 2024, at an eye, ear, nose, and throat tertiary hospital in Shanghai, China. Among 2,559,342 prescriptions, 123,914 (4.84%) flagged as irrational by the prospective prescription review system were included. Results The overall interception success rate was 32.99% (40,877/123,914). The prescription rationality rate increased from 95.23% (2,476,305/2,600,219) to 96.79% (2,477,144/2,559,342) after excluding intercepted prescriptions ( . Higher review levels were strongly associated with higher interception success rates: 0.99% (517/52,146) for reminder, 54.2% (37,039/68,341) for warning, and 96.91% (3321/3427) for mandatory ( P P P P P ). Conclusions The prospective prescription review system substantially reduced irrational prescriptions and improved prescription rationality. Higher review levels were associated with higher interception rates, and physicians’ attitudes also played a critical role. Paired-organ dose standardization emerged as an important consideration in ophthalmology and otolaryngology practice. Collaboration between the prospective prescription review system and pharmacists is essential for optimizing prescription review outcomes.