Abstract Aim To analyze prescription review results in Beijing and to provide references for improving prescription rationality. Methods This study included outpatient prescriptions which were randomly extracted in Beijing from 2020 to 2022. Drug names were used as search keywords. The changes in prescriptions number and irrationality rate over the past three years were analyzed. Drugs associated with irrational prescriptions were sampled and the reasons for their irrational use were analyzed. Results Approximately 1.9 million prescriptions were sampled for 2020-2021, and more than 4 million prescriptions were sampled for 2022. The proportion of Modern medicine (abbreviated medicine) prescriptions of oncology treatment gradually increased while the proportion of Traditional Chinese Medicine(TCM) prescriptions gradually decreased from 2020 to 2022. The irrationality rate of medicine prescriptions briefly decreased in 2021 before increasing again in 2022. The irrationality rate of TCM prescriptions gradually decreased, and the average irrationality rate of medicine prescriptions was higher than that of TCM. Notably, the rationality of several drugs didn’t improve over the past three years, which included fluorouracil (injection), lobaplatin，bleomycin，Goserelin Acetate Sustained-release Depot ，Pabolizumab，vaginal preparations of recombinant human interferon. Conclusion Prescription review can improve prescription rationality and systematically identify off-label drug use, becoming an important way to expand drug clinical use and improve drug regulatory policies. The use of TCM in oncology treatment is becoming more rational, while the rational use of medicine still needs to be improved. Doctors should regulate their prescribing behavior and strive to increase the rationality of prescriptions.