This study evaluated drug use patterns and patient care practices in outpatient departments of three district hospitals including Kabgayi, Nyanza, and Ruhango—in Rwanda’s Southern Province, using the World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD) Patient Care Indicators framework. Employing a cross-sectional research design, data were collected from 291 respondents out of a target sample of 388 (75% response rate) through systematic observation, prescription review, and exit interviews. The study measured key indicators including average consultation and dispensing times, completeness of dispensing, adequacy of labeling, patient knowledge of prescribed drugs, and satisfaction levels. Results revealed an average consultation time of 24.1 minutes and a dispensing time of 403 seconds, both exceeding WHO’s recommended minimums (10 minutes and 180 seconds respectively). These findings suggest strong patient–provider engagement and adequate counseling practices. However, only 81.5% of prescribed drugs were fully dispensed and 88.3% adequately labeled, indicating gaps in stock management and labeling compliance. Patient knowledge of prescribed medications (82.8%) and confidence in understanding medications (96.6%) were generally high, reflecting effective communication but highlighting the need for more standardized patient education approaches. Satisfaction with consultation (81.7%) and pharmacy experience (94.2%) demonstrated high service quality and strong adherence to patient-centered care principles. The study concludes that while drug use patterns in the Southern Province align substantially with WHO standards, challenges persist in ensuring complete drug availability, proper labeling, and consistent counseling. Strengthening pharmaceutical management systems, enhancing health worker training, and implementing digital dispensing tools could further improve efficiency, safety, and rational drug use. These findings provide critical insights for policymakers and health managers aiming to optimize medicine use, promote patient satisfaction, and reinforce healthcare quality in Rwanda’s district hospitals.