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Ahmed NA, Fouad EA, El-Asheer OM, Ghanem ASM. Pharmaceutical interventions for drug-related problems in the neonatal intensive care unit: incidence, types, and acceptability. Front Pharmacol 2024; 15:1391657. [PMID: 38873432 PMCID: PMC11169568 DOI: 10.3389/fphar.2024.1391657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background: Drug-related problems (DRPs) are widespread in hospitalized neonates, but studies on the prevalence of DRPs in this population are limited. The presence of clinical pharmacists on multidisciplinary teams helps prevent and reduce DRPs. Aim: This investigation aimed to identify and classify the incidence of DRPs in the neonatal intensive care unit (NICU), to determine the determining factors associated with DRPs and to document clinical pharmacists' interventions, outcomes, acceptance rates and clinical significance. Method: A prospective descriptive hospital study was conducted from August to November 2023 at the NICU of Children's University Hospital, Assiut University, Egypt. DRPs were classified using the Pharmaceutical Care Network of Europe (PCNE) classification V9.1. Results: Three hundred sixteen neonates were included in the study, with a mean gestational age of 34 ± 4 weeks and a mean birth weight of 2.03 ± 0.85 kg. A total of 1723 DRPs occurred among 283 neonates (89.6%), an average of 5.5 ± 5.1 DRPs per patient. The main types were treatment effectiveness (P1) (799, 46.4%), followed by others (P3) (469, 27.2%), and treatment safety (P2) (455, 26.4%). The leading causes were dose selection (C3) (1264, 61.9%) and "other domain" (C9) (543, 26.6%). Of the 2149 interventions introduced by pharmacists, 98.8% were accepted and 93% were accepted, and fully implemented. As a result, 92% of the DRPs were resolved. Both length of hospital stay and number of medications were significantly associated with DRPs. Conclusion: DRPs are common in the NICU; this study demonstrated the crucial role of clinical pharmacists in identifying and resolving DRPs.
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Affiliation(s)
- Norhan Attia Ahmed
- Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Ehab Ahmed Fouad
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Osama M. El-Asheer
- Department of Pediatrics, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt
| | - A. S. M. Ghanem
- Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
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Bedhomme S, Vaillant-Roussel H, Vorilhon P, Lafarge E, Pereton B, Prunet-Spano C, Pereira B, Vennat B, Savanovitch C. Pediatric pharmaceutical interventions in self-medication: a descriptive study in community pharmacies. BMC PRIMARY CARE 2023; 24:232. [PMID: 37932731 PMCID: PMC10626637 DOI: 10.1186/s12875-023-02180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/12/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The practice of self-medication is common but not without risk, especially for vulnerable populations such as the pediatric population. Community pharmacists have an important role of vigilance in dispensing drugs available without a medical prescription, with the possibility of carrying out a Pharmaceutical Intervention (PI) if necessary. The aim of our study was to characterize the Pediatric Pharmaceutical Interventions (PPIs) in self-medication carried out during a spontaneous request for a drug at the community pharmacy. METHODS We conducted a descriptive study in 139 pharmacies in the Auvergne-Rhône-Alpes region (France). Data were collected from students under the supervision of internship masters in the pharmacy, using the validated GIPAMED (GrId for PhArmaceutical Self-MEDication interventions) notification grid, the first week of each month, from February to May for five years (2017 to 2021). Collected data were entered on a secure university platform. RESULTS Of the 3,552 PIs collected, 8,3% (n = 286) were PPIs. Of these PPIs, 35% (n = 100) was generated by requests for optional prescription drugs contraindicated by the pathophysiological condition, 28.3% for drugs requiring a prescription and 20.6% for over the counter drugs not indicated by the symptomatology. Finally, 10% of requests required a referral for a medical consultation. Four Anatomical Therapeutic Chemical (ATC) classes accounted for more than 90% of the requests: respiratory system (39.5%), alimentary tract and metabolism (19.2%), nervous system (11.5%), and musculoskeletal system (10.8%). The most common drugs generating PPIs were: ibuprofen, oxomemazine and combination camphor/essential oils, mainly due to age-related or weight-related contraindication. Paracetamol also generated PPIs frequently, mainly due to problems with drug compliance and more precise infra-therapeutic doses. When these PPIs were dispensed, the pharmacist's proposed solutions were accepted in 94.8% (n = 271) of the cases. CONCLUSIONS The community pharmacist has an important role in providing information about medicines and their correct use to patients. Our research shows that this attention benefits vulnerable populations, such as children, even for drugs that are widely used (e.g. paracetamol and non-steroidal anti-inflammatory drugs) or active substances for which there are age-related or weight-related contraindications (e.g. antitussives, camphor combinations).
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Affiliation(s)
- Sabrina Bedhomme
- Faculty of Pharmacy, University of Clermont Auvergne, Clermont-Ferrand, France.
- Research Unit ACCePPT, University of Clermont Auvergne, Clermont-Ferrand, France.
| | - Hélène Vaillant-Roussel
- Research Unit ACCePPT, University of Clermont Auvergne, Clermont-Ferrand, France
- Department of General Practice, University of Clermont Auvergne, Clermont-Ferrand, France
- DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Vorilhon
- Research Unit ACCePPT, University of Clermont Auvergne, Clermont-Ferrand, France
- Department of General Practice, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Elodie Lafarge
- Faculty of Pharmacy, University of Clermont Auvergne, Clermont-Ferrand, France
- Research Unit ACCePPT, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Bénédicte Pereton
- Faculty of Pharmacy, University of Clermont Auvergne, Clermont-Ferrand, France
- Research Unit ACCePPT, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Céline Prunet-Spano
- Research Unit ACCePPT, University of Clermont Auvergne, Clermont-Ferrand, France
- ISPB (Institut des Sciences Pharmaceutiques et Biologiques), Claude Bernard Lyon 1 University, Lyon, France
| | - Bruno Pereira
- DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Brigitte Vennat
- Faculty of Pharmacy, University of Clermont Auvergne, Clermont-Ferrand, France
- Research Unit ACCePPT, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Chantal Savanovitch
- Faculty of Pharmacy, University of Clermont Auvergne, Clermont-Ferrand, France
- Research Unit ACCePPT, University of Clermont Auvergne, Clermont-Ferrand, France
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Evaluation of Community Pharmacists' Competences in Identifying and Resolve Drug-Related Problems in a Pediatric Prescription Using the Simulated Patient Method. PHARMACY 2022; 11:pharmacy11010006. [PMID: 36649016 PMCID: PMC9844477 DOI: 10.3390/pharmacy11010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Drug-related problems (DRPs) are a global issue that impacts the efficacy and safety of the therapy, and pediatric patients are considered to be more vulnerable to DRPs, thus requiring more attention. Community pharmacists (CPs) are in a position that allow them to identify and alleviate these DRPs. Objectives: This study evaluated the ability of CPs in identifying and resolving DRPs in a pediatric prescription. Methods: A cross-sectional study was carried out in 235 community pharmacies to evaluate the ability of CPs working in the Khartoum locality to identify DRPs in a pediatric prescription and how they intervene to resolve these problems. Fifth-final year B. Pharm. Students were selected and trained to act as simulated patients (SPs) for this study. The visits were performed by using a simulated prescription that contains three different types of DRPs. The information obtained from the visits was documented immediately by the SPs after leaving the pharmacy in a data collection form. Results: All planned SPs visits were completed. Of the 235 community pharmacies, only 50 (21.3%) CPs were able to identify at least one of the DRPs. The most common type of DRP identified was the wrong duration of the treatment 19%, followed by the wrong dose 4%. The interventions made by CPs to mitigate the identified DRPs included recalculation and correction of the dose according to weight, which was made by 10 CPs, and correction of the duration, which was done by 45 CPs. None of the CPs who identified the presented DRPs communicated with the physician or referred the SP to the prescriber. The average dispensing time of the CPs was 68.18 ± 36.1 s. Conclusions: The majority of the CPs in the Khartoum locality were unable to identify DRPs in a pediatric prescription. Correction of the dose and duration of treatment were from the attempts of CPs to resolve DRPs. However, no collaboration was observed between CPs and physicians. In general, the practice of CPs in Khartoum locality in this area requires substantial improvement.
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Effect of Pharmacist-Led Interventions on Physicians' Prescribing for Pediatric Outpatients. Healthcare (Basel) 2022; 10:healthcare10040751. [PMID: 35455928 PMCID: PMC9028064 DOI: 10.3390/healthcare10040751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Children are at high risk of drug-related problems, increased risk of treatment failures, and high treatment costs. We aimed to evaluate the effect of pharmacist-led interventions on physicians’ prescribing for pediatric outpatients. Methods: A prospective study with pre- and post-intervention measurement assessment was conducted to collect pediatric outpatients’ prescriptions during the pre-intervention period (January 2020) and post-intervention (August 2020) at a children’s hospital in Vietnam. Drug-related problems were identified and categorized according to Pharmaceutical Care Network Europe (PCNE), version 9.1. The intervention program was developed based on the results of pre-intervention observations. After the intervention, prescriptions were evaluated. Statistical tests were used to compare the proportions of drug-related problems before and after the intervention and to identify factors related to drug-related problems. Results: There were 2788 out of 4218 (66.1%) prescriptions with at least one drug-related problem before the intervention. Of these drug-related problems, the most common was inappropriate timing of administration and incorrect dosage (36.1% and 35.6%, respectively). After the intervention, the percentage of prescriptions with at least one drug-related problem was 45.5% (p < 0.001). Most of the drug-related problem types decreased significantly (p < 0.05). The binary logistic regression analysis results showed that in addition to pharmacists’ intervention, patients’ gender, primary disease, comorbidity status, and the total number of drugs prescribed were also factors related to drug-related problems. Conclusions: Drug-related problems in pediatric outpatients were quite common. Pharmacists’ intervention helped to improve the prevalence and types of drug-related problems.
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Tawhari MM, Tawhari MA, Noshily MA, Mathkur MH, Abutaleb MH. Hospital Pharmacists Interventions to Drug-Related Problems at Tertiary Critical Care Pediatric Settings in Jazan, Saudi Arabia. Hosp Pharm 2022; 57:146-153. [PMID: 35521004 PMCID: PMC9065537 DOI: 10.1177/0018578721990889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: While drug-related problems (DRPs) have been recognized as a major concern in pediatric wards, the role of hospital pharmacy in improving medication safety has been rarely studied. Objectives: To investigate the frequency, nature, and severity of DRPs and associated pharmacist interventions (PIs). Methods: This is a prospective study carried out using direct observation over a year (2019-2020) in 3 pediatric wards (pediatric emergency department (PED), pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU) in Jazan, Saudi Arabia. A validated data reporting form was developed to include comprehensive clinical data about the prescribed medications, characteristics of patients, and PIs upon DRPs. Clinical significance of DRPs was evaluated by an expert panel, which comprised a clinical pharmacist, a pediatrician, and an internist. Data analysis was conducted using SPSS V26. Results: The overall incidence of DRPs was 6.6%. The highest rate of DRPs 15.2% was detected in the pediatric ICU. Of the 596 DRPs detected, 10.2% were inappropriate drug choice, 5.2% were rated major DRPs, and one-third 33.2% were related to the digestive system and metabolism. Dosing problems were the most predominant DRPs across the included wards. A higher proportion of clinically major and moderate DRPs were detected in pediatric ED. Telephone-delivered interventions [OR: 1.72: 95%CI: 0.78-2.57: P = .001], too high dose [OR: 2.64: 95%CI: 1.33-4.56: P = .01], and major DRPs [OR: 3.21: 95%CI: 2.15-6.42: P = .04] were significant predictors for acceptance of PIs. Conclusion: DRPs are common in Saudi pediatric wards and many of these incidents were clinically major and moderate. Telephone-delivered interventions, too high dose, and major DRPs were major predictors for physician acceptance of PIs.
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Affiliation(s)
- Mosa M. Tawhari
- Pharmaceutical Care Deprtment, King Fahad Central Hospital, Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia
| | - Mohammed A. Tawhari
- Pharmaceutical Care Deprtment, King Fahad Central Hospital, Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia
| | - Mohammed A. Noshily
- Pharmaceutical Care Deprtment, King Fahad Central Hospital, Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia
| | - Majed H. Mathkur
- Pharmaceutical Care Deprtment, King Fahad Central Hospital, Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia
| | - Mohammed H. Abutaleb
- Pharmaceutical Care Deprtment, King Fahad Central Hospital, Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia,Mohammed H. Abutaleb, Pharmaceutical Care Deprtment, King Fahad Central Hospital, Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia.
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Mi X, Zeng L, Zhang L. Systematic review of the prevalence and nature of drug‐related problems in paediatric patients. J Clin Pharm Ther 2022; 47:776-782. [PMID: 35098566 PMCID: PMC9306611 DOI: 10.1111/jcpt.13606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 01/18/2023]
Abstract
What is known and objective Methods Results What is new and conclusion
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Affiliation(s)
- Xue Mi
- College of Pharmacy Ningxia Medical University Yinchuan China
- Evidence‐Based Pharmacy Center West China Second University HospitalSichuan University Chengdu China
| | - Linan Zeng
- Evidence‐Based Pharmacy Center West China Second University HospitalSichuan University Chengdu China
| | - Lingli Zhang
- Evidence‐Based Pharmacy Center West China Second University HospitalSichuan University Chengdu China
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7
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Drug-handling problems and expectations of the ideal pediatric drug-reported by children and their parents. Eur J Pediatr 2022; 181:2161-2171. [PMID: 35199240 PMCID: PMC9056485 DOI: 10.1007/s00431-022-04419-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/14/2022] [Accepted: 02/10/2022] [Indexed: 11/05/2022]
Abstract
Experienced drug-handling problems and inadequately considered expectations for drug therapy have an unfavorable influence on therapy. We performed a questionnaire survey in (i) parents of 0-5-year-old children and (ii) 6-17-year olds and their parents. We assessed (A) experienced drug-handling problems and (B) expectations for drug therapy. (i) Forty-six parents and (ii) 103 children and their parents participated in the study. Experienced drug-handling problems were described by (i) 100% of parents and (ii) 62% of children and 70% of parents. Problems concerned with the preparation of the drug, dosing, compliance with the time interval, and acceptance. (i) Sixty-five percent of parents preferred a peroral route of drug administration, while (ii) 74% of children and 86% of parents did so. Preferred characteristics of peroral drug formulations, e.g., liquid versus solid drug formulations or flavor, were highly heterogeneous. Preferences of 6-17-year-old children and their parents matched in 43 to 66%. Conclusion: Most children and their parents had already experienced drug-handling problems. Preferences concerning the ideal pediatric drug were highly heterogeneous and in about half of cases, preferences of children and their parents differed. Thus, the children should be approached directly. If information is solely gained from parents, the children's needs might remain unmet. What is Known: • Pediatric drug administration is complex and therefore error-prone. • Experiences and expectations of children and their parents should be considered. What is New: •Most pediatric patients and their parents have already experienced drug-handling problems. • Expectations concerning the ideal pediatric drug are highly heterogeneous. Parents are often insufficiently aware of those expectations in their children.
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8
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Marufu TC, Bower R, Hendron E, Manning JC. Nursing interventions to reduce medication errors in paediatrics and neonates: Systematic review and meta-analysis. J Pediatr Nurs 2022; 62:e139-e147. [PMID: 34507851 DOI: 10.1016/j.pedn.2021.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication errors are a great concern to health care organisations as they are costly and pose a significant risk to patients. Children are three times more likely to be affected by medication errors than adults with medication administration error rates reported to be over 70%. OBJECTIVE To identify nursing interventions to reduce medication administration errors and perform a meta-analysis. METHODS Online databases; British Nursing Index (BNI), Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and MEDLINE were searched for relevant studies published between January 2000 to 2020. Studies with clear primary or secondary aims focusing on interventions to reduce medication administration errors in paediatrics, children and or neonates were included in the review. RESULTS 442 studies were screened and18 studies met the inclusion criteria. Seven interventions were identified from included studies; education programmes, medication information services, clinical pharmacist involvement, double checking, barriers to reduce interruptions during drug calculation and preparation, implementation of smart pumps and improvement strategies. Educational interventional aspects were the most common identified in 13 out of 18 included studies. Meta-analysis demonstrated an associated 64% reduction in medicine administration errors post intervention (pooled OR 0.36 (95% Confidence Interval (CI) 0.21-0.63) P = 0.0003). CONCLUSION Medication safety education is an important element of interventions to reduce administration errors. Medication errors are multifaceted that require a bundle interventional approach to address the complexities and dynamics relevant to the local context. It is imperative that causes of errors need to be identified prior to implementation of appropriate interventions.
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Affiliation(s)
- Takawira C Marufu
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Rachel Bower
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Elizabeth Hendron
- Library Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joseph C Manning
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
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Wilkes S, Zaal RJ, Abdulla A, Hunfeld NGM. A cost-benefit analysis of hospital-wide medication reviews: a period prevalence study. Int J Clin Pharm 2021; 44:138-145. [PMID: 34498214 PMCID: PMC8866269 DOI: 10.1007/s11096-021-01323-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Background For specific medical specialties it has been shown that clinical pharmacists can have a beneficial effect on the reduction of drug-related problems by performing medication reviews. However, little is known on the cost–benefit ratio of hospital-wide implementation of medication reviews. Aim To investigate the effect of conducting hospital-wide medication reviews on the detection and resolution of drug-related problems, and to calculate the cost–benefit ratio of the intervention. Method In this observational prospective period prevalence study, medication reviews were conducted during five consecutive working days in a Dutch university hospital. Patients admitted for more than 24 h were included. The cost–benefit ratio of conducting the medication reviews was calculated by dividing the total costs by the total savings. Results In 622 medication reviews, 709 potential drug-related problems (1.1 per patient) were detected. The most common advice was to stop medication (38.6%). Patients with a potentially drug-related problem were significantly older, had a higher median number of prescriptions, and the median number of days from admission to the time of medication reviews was longer. Conducting medication reviews showed a positive cost–benefit ratio of 9.7. Conclusions Hospital-wide medication reviews by clinical pharmacists have a positive cost–benefit ratio and contribute to the detection and the resolution of drug related problems (DRPs), mainly by reducing overtreatment.
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Affiliation(s)
- Sarah Wilkes
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Rianne J Zaal
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alan Abdulla
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole G M Hunfeld
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Maffre I, Leguelinel-Blache G, Soulairol I. A systematic review of clinical pharmacy services in pediatric inpatients. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Feyissa Mechessa D, Dessalegn D, Melaku T. Drug-related problem and its predictors among pediatric patients with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia: Prospective observational study. SAGE Open Med 2020; 8:2050312120970734. [PMID: 33240498 PMCID: PMC7675898 DOI: 10.1177/2050312120970734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Drug-related problem is any event involving drug therapy that may interfere in a patient's desired clinical outcome. It has been pointed out that hospitalized pediatric patients are particularly prone to drug-related problems. Thus, this study aimed to assess drug-related problems and its predictors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia. Methodology A prospective observational study was conducted among pediatric patients with infectious diseases admitted to the Jimma University Medical Center. Drug-related problems were classified based on Cipolle, Morley, and Strand's drug-related problems classification method. The patient's specific data were collected using a structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug-related problems occurrence, multiple stepwise backward logistic regression analysis was done. Statistical significance was considered at a p-value < 0.05. Results Of the total 304 participants, 226 (74.3%) of them had at least one drug-related problem during their hospital stay. A total of 356 drug-related problems were identified among 226 patients. Anti-infective medication was the major class of drug involved in drug-related problems. Noncompliance (28.65%) and dose too low (27.53%) were the most common type of drug-related problems identified. Presence of disease comorbidity (adjusted odds ratio = 3.39, 95% confidence interval = 1.89-6.08), polypharmacy (adjusted odds ratio = 3.16, 95% confidence interval = 1.61-6.20), and more than 6 days stay in hospital (adjusted odds ratio = 3.37, 95% confidence interval = 1.71-6.64) were independent predictors for the occurrence of drug-related problems.. Conclusion Drug-related problems were high among pediatric patients with infectious disease in the study setting. The presence of comorbidity, polypharmacy, and prolonged hospital stay were predictors of drug-related problems in this finding. Therefore, to prevent these problems, the collaboration of clinical pharmacists, pediatricians, and other health care professionals is needed during the provision of pharmaceutical care.
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Affiliation(s)
- Desalegn Feyissa Mechessa
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Dula Dessalegn
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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12
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Robert S, Ménétré S, Schweitzer C, Demoré B. Observational study of drug-related problems and clinical pharmacists' interventions in a French paediatric hospital. Eur J Hosp Pharm 2020; 28:e85-e91. [PMID: 33115799 DOI: 10.1136/ejhpharm-2020-002319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Paediatric inpatients are a high-risk population for drug-related problems, yet there is a lack of data concerning drug-related problems and pharmaceutical interventions in paediatric hospitals in France. The objective of this study was to describe drug-related problems, pharmaceutical interventions and the acceptance rate of physicians based on the characteristics of both medication order and pharmaceutical interventions. METHODS A 12-month, monocentric, observational and prospective study was conducted from 1 June 2016 to 31 May 2017 in a French university paediatric hospital. Prescription analysis was performed at the central pharmacy. The data were collected by querying the drug prescription database of the e-prescription software. Data on drugs, prescribers, drug-related problems and interventions were recorded. The primary outcome was the measurement of the number of drug-related problems in paediatric hospitalised patients (medical and surgical wards). Secondary outcomes were classification of drug-related problems and pharmaceutical interventions. Physician acceptance of pharmaceutical interventions was additionally assessed. RESULTS The main types of drug-related problems were supratherapeutic dosage (33.8%), improper administration (22.9%) and subtherapeutic dosage (16.8%). A total of 1742 pharmaceutical interventions were recorded. The rate of pharmaceutical interventions was 2.48 per 100 drug prescriptions. Acceptance rate of physicians was 51.7%. Some 530 different drugs were involved. The drugs most frequently involved in pharmaceutical interventions were drugs for the nervous system (31.3%) and anti-infectives (20.2%). Pharmaceutical interventions related to dose adjustment accounted for half of the interventions ahead of drug choice interventions (35.4%). CONCLUSIONS This study illustrates the frequency of drug-related problems in paediatric inpatients and the ability of pharmacists to identify them in their daily work. However, it also highlights the difficulty in obtaining physician acceptance (or even clear refusal) of pharmaceutical interventions with a review of the prescription at the central pharmacy.
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Affiliation(s)
- Sophie Robert
- Pharmacy, Nancy Regional University Hospital Center, Vandoeuvre-lès-Nancy, France
| | - Sophie Ménétré
- Pharmacy, Nancy Regional University Hospital Center, Vandoeuvre-lès-Nancy, France
| | - Cyril Schweitzer
- Pôle enfants néonatologie, Nancy Regional University Hospital Center, Vandoeuvre-lès-Nancy, France.,EVAH EA 3450, Faculté de médecine, Université de Lorraine, Nancy, France
| | - Béatrice Demoré
- Pharmacy, Nancy Regional University Hospital Center, Vandoeuvre-lès-Nancy, France.,APEMAC, Université de Lorraine, Nancy, France
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Naseralallah LM, Hussain TA, Jaam M, Pawluk SA. Impact of pharmacist interventions on medication errors in hospitalized pediatric patients: a systematic review and meta-analysis. Int J Clin Pharm 2020; 42:979-994. [PMID: 32328958 DOI: 10.1007/s11096-020-01034-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
Background Medication errors are avoidable events that may occur at any stage of the medication use process. Implementing a clinical pharmacist is one strategy that is believed to reduce the number of medication errors. Pediatric patients, who are more vulnerable to medication errors due to several contributing factors, may benefit from the interventions of a pharmacist. Aim of the review To qualitatively and quantitatively evaluate the impact of clinical pharmacist interventions on medication error rates for hospitalized pediatric patients. Methods PubMed, EMBASE, Cochrane Controlled Trials Register and Google Scholar search engines were searched from database inception to February 2020. Study selection, data extraction and quality assessment was conducted by two independent reviewers. Observational and interventional studies were included. Data extraction was done manually and the Crowe Critical Appraisal Tool was used to critically appraise eligible articles. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Results 19 studies were systematically reviewed and 6 studies (29,291 patients) were included in the meta-analysis. Pharmacist interventions involved delivering educational sessions, reviewing prescriptions, attending rounds and implementing a unit-based clinical pharmacist. The systematic review indicated that the most common trigger for pharmacist interventions was inappropriate dosing. Pharmacist involvement was associated with significant reductions in the overall rate of medication errors occurrence (OR 0.27; 95% CI 0.15 to 0.49). Conclusion Pharmacist interventions are effective for reducing medication error rates in hospitalized pediatric patients.
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Affiliation(s)
| | | | - Myriam Jaam
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Shane Ashley Pawluk
- Department of Pharmacy, Clinical Pharmacy, Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada. .,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
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A Prospective Observational Study of Drug Therapy Problems in Pediatric Ward of a Referral Hospital, Northeastern Ethiopia. Int J Pediatr 2020; 2020:4323189. [PMID: 32256614 PMCID: PMC7115047 DOI: 10.1155/2020/4323189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/21/2019] [Accepted: 01/23/2020] [Indexed: 12/01/2022] Open
Abstract
Background A drug therapy problem is any undesirable event experienced by a patient during drug therapy that interferes with achieving the desired goals of therapy. It has been pointed out that hospitalized pediatric patients are particularly prone to drug-related problems. Identifying drug therapy problems enables risk quantification and determination of the potential impact of prevention strategies. The purpose of this study was to assess the drug therapy problems in a pediatric ward of Dessie Referral Hospital, northeast of Ethiopia, and to identify associated factors for drug therapy problems. Methods A prospective observational study design was carried out to assess drug therapy problems in a pediatric ward of Dessie Referral Hospital from February 1, 2018, to May 30, 2018. Ethical approval was obtained, and informed consent was signed by each study participant's parent before the commencement of the study. All patients admitted to the ward during the study period were included in the study. Data was collected by trained pharmacy staffs through medical record reviews of patients using a prepared standard checklist and semistructured questionnaire. The collected data were cleared and checked every day for completeness and consistency before processing. Data were entered, and descriptive statistical analysis was done using SPSS Version 20 Software. A P value of less than 0.05 was considered significant. Results The participants' mean age was 2.32 years with the standard deviation (SD) of 0.76 years. Among 81 patients, 71 (87.7%) of them had at least one drug therapy problem per patient which indicates that the prevalence of the drug therapy problem was substantially high. Needs additional drug was the most predominantly encountered drug therapy problem accounted (30 (25.2%)). On the other hand, ineffective drug was the least (3 (2.5%)) drug therapy problem. Antibiotics (47 (39.5%)) followed by fluid and electrolyte (25 (21%)) were classes of drugs mostly involved in the drug therapy problem. The main risk factors reported to the occurrence of the drug therapy problems were prescribing and dose calculation errors. Conclusion The present study revealed that majority of the patients had at least one DTP per patient; this indicates that prevalence of DTP was very high in the study area. Needs additional drug therapy followed by noncompliance was the major cause of the occurrence of DTP. Antibiotics were the main class of drugs involved in the drug therapy problem, and among the risk factors assessed, prescribing and dose calculation errors showed statistical significance.
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Modesto ACF, Ribeiro AM, Pereira JL, Silva LT, Provin MP, Ferreira PSLAI, Amaral RG, Ferreira TXAM. Evaluation of a method for drug-related problems identification and classification in hospital setting: applicability and reliability. Int J Clin Pharm 2019; 42:193-200. [PMID: 31865595 DOI: 10.1007/s11096-019-00957-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022]
Abstract
Background Prescription evaluation by pharmacists has potential to improve pharmacotherapy management. It requires the use of robust methods to identify drug-related problems (DRP), which are important issues in pharmacotherapy. Objective To evaluate the applicability and reliability of Grupo de Investigação em Cuidados Farmacêuticos (GIGUF) method for prescription analysis, identification and classification of drug-related problems in inpatients prescriptions. Setting Department of Medical Clinic of a tertiary and teaching Brazilian hospital. Method An observational and retrospective study of identification and classification of drug-related problems. GIGUF method was used to evaluate prescriptions of hematological patients hospitalized between August and October 2015. The problems were categorized using GICUF-method classification. Three pharmacists performed inter-rater agreement analysis of the method using Kappa. Differences in prevalence of DRP was calculated by age, sex, pharmacotherapy complexity, length of stay and number of drugs. Main outcome measure (a) frequency and characteristics and (b) inter-rater agreement in identification and classification of the drug-related problems. Results A total of 211 problems were identified and 'inadequate dosing' was the most common problem. There was an association between the occurence of a drug-reklated problem and complexity of pharmacotherapy (p = 0.001) and number of drugs used (p = 0.010). The overall inter-rater agreement was moderate (k = 0.44 IC 95% 0.34-0.55) and the problem 'not suitable drug' (k = 0.55 IC 95% 0.44-0.66) had greater inter-rater agreement. Conclusion The method "Evaluation Drug Use Process" was useful for prescription analysis since it made the identification and classification of DRPs possible. The method demonstrated a moderate inter-rater agreement, and can contribute to pharmacotherapy management by hospital pharmacists.
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Affiliation(s)
- Ana Carolina Figueiredo Modesto
- Hospital of Clinics, Federal University of Goiás - UFG/EBSERH, First Avenue, East University District, Goiânia, Goiás, 74605-020, Brazil.
| | - Allyne Marques Ribeiro
- Multiprofessional Health Residence, Federal University of Goiás - UFG/EBSERH, Hospital, First Avenue, East University District, Goiânia, Goiás, 74605-020, Brazil
| | - Jhonata Lima Pereira
- Multiprofessional Health Residence, Federal University of Goiás - UFG/EBSERH, Hospital, First Avenue, East University District, Goiânia, Goiás, 74605-020, Brazil
| | - Lunara Teles Silva
- School of Pharmacy, Federal University of Goiás - UFG, Street 240, Corner with Fifth Avenue, East University District, Goiânia, Goiás, 74605-170, Brazil
| | - Mércia Pandolfo Provin
- School of Pharmacy, Federal University of Goiás - UFG, Street 240, Corner with Fifth Avenue, East University District, Goiânia, Goiás, 74605-170, Brazil
| | | | - Rita Goreti Amaral
- School of Pharmacy, Federal University of Goiás - UFG, Street 240, Corner with Fifth Avenue, East University District, Goiânia, Goiás, 74605-170, Brazil
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Leopoldino RD, Santos MT, Costa TX, Martins RR, Oliveira AG. Drug related problems in the neonatal intensive care unit: incidence, characterization and clinical relevance. BMC Pediatr 2019; 19:134. [PMID: 31027487 PMCID: PMC6485091 DOI: 10.1186/s12887-019-1499-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Any event involving drug therapy that may interfere in a patient's desired clinical outcome is called a drug related problem (DRP). DRP are very common in intensive therapy, however, little is known about DRP in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to determine the incidence of DRPs in NICU patients and to characterize DRPs according to type, cause and corresponding pharmaceutical conducts. METHODS Prospective observational study conducted in the NICU at a teaching hospital in Brazil from January 2014 to November 2016. The data were collected from the records of the clinical pharmacy service, excluding neonates admitted for less than 24 h and those who had no drugs prescribed. DRPs were classified according to the Pharmaceutical Care Network Europe system and evaluated for relevance-safety. RESULTS Six hundred neonates were included in the study, with mean gestational age of 31.9 ± 4.1 weeks and mean birth weight of 1779 ± 885 g. The incidence of DRPs in the NICU was 6.8% patient-days (95%CI 6.2-7.3%) and affected 59.8% of neonates (95% CI 55.8-63.8%). Sub-optimal effect (52.8%) and inappropriate dose selection (39.75%) were the most common problem and cause, respectively. Anti-infectives was the medication class most involved in DRPs. More than one-third of neonates were exposed to DRP of significant or high safety-relevance. Most of the pharmaceutical interventions were related with drug prescription, with over 90% acceptance by attending physicians. CONCLUSION DRP are common in NICU, predominating problems of sub-optimal treatment, mainly due to inappropriate dose selection.
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Affiliation(s)
- Ramon Duarte Leopoldino
- Department of Pharmacy, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil.
| | - Marco Tavares Santos
- Maternity School Januário Cicco, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha, 259. Petrópolis, Natal, RN, 59012-310, Brazil
| | - Tatiana Xavier Costa
- Maternity School Januário Cicco, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha, 259. Petrópolis, Natal, RN, 59012-310, Brazil
| | - Rand Randall Martins
- Department of Pharmacy, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
| | - António Gouveia Oliveira
- Department of Pharmacy, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
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Jafarian K, Allameh Z, Memarzadeh M, Saffaei A, Peymani P, Sabzghabaee AM. The Responsibility of Clinical Pharmacists for the Safety of Medication Use in Hospitalized Children: A Middle Eastern Experience. J Res Pharm Pract 2019; 8:83-91. [PMID: 31367643 PMCID: PMC6636415 DOI: 10.4103/jrpp.jrpp_19_66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: We aimed to detect and report the frequency of occurrence of drug-related problems (DRPs) in a Middle Eastern University Children's Hospital (Isfahan, Iran) and classify them in terms of their nature and cause to clarify the responsibility of clinical pharmacists for the safe utilization of medications in hospitalized children. Methods: In this cross-sectional study which was carried out in Imam Hossein Children's University Hospital affiliated with Isfahan University of Medical Sciences (Isfahan, Iran) from September 2017 to May 2018, DRPs during the hospitalization of pediatric patients in three medical wards, the pediatric intensive care unit, and two neonatal intensive care units were detected and identified concurrently with the treatment process using Pharmaceutical Care Network of Europe data gathering form for DRPs v. 8.01. All cases were verified and validated in a professional focus group before documentation. Findings: We detected 427 DRPs in 201 out of 250 randomly included hospitalized children in which 86% of them were directly reported by the hospital's clinical pharmacist. The highest frequency of DRPs (47.3%) was observed in the age range of 1 month–2 years. Safety of treatment was the most frequently reported as the nature of the problem (43.5%), followed by effectiveness issues (36.8%). The most frequent cause of DRPs was dose selection issues (34.2%), followed by drug-type selection (25.5%), and unavailability of appropriate dosage forms (13.6%). Ninety-eight interventions were proposed by the clinical pharmacist, in which 59.2% of them were accepted. Conclusion: This study confirms the necessity for the active role of clinical pharmacists before, during, and after drug therapy in hospitalized pediatric patients for the safety and proper utilization of drugs in this vulnerable population.
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Affiliation(s)
- Khatereh Jafarian
- Pharmacy Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Allameh
- Department of Pharmaceutical Care, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Memarzadeh
- Department of Pediatric Surgery, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Saffaei
- Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Peymani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammad Sabzghabaee
- Department of Pharmaceutical Care, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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A systematic review of clinical pharmacist interventions in paediatric hospital patients. Eur J Pediatr 2018; 177:1139-1148. [PMID: 29915870 DOI: 10.1007/s00431-018-3187-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
Clinical pharmacists provide beneficial services to adult patients, though their benefits for paediatric hospital patients are less defined. Five databases were searched using the MeSH terms 'clinical pharmacist', 'paediatric/paediatric', 'hospital', and 'intervention' for studies with paediatric patients conducted in hospital settings, and described pharmacist-initiated interventions, published between January 2000 and October 2017. The search strategy after full-text review identified 12 articles matching the eligibility criteria. Quality appraisal checklists from the Joanna Briggs Institute were used to appraise the eligible articles. Clinical pharmacist services had a positive impact on paediatric patient care. Medication errors intercepted by pharmacists included over- and under-dosing, missed doses, medication history gaps, allergies, and near-misses. Interventions to address these errors were positively received, and implemented by physicians, with an average acceptance rate of over 95%. Clinical pharmacist-initiated education resulted in improved medication understanding and adherence, improved patient satisfaction, and control of chronic medical conditions.Conclusion: This review found that clinical pharmacists in paediatric wards may reduce drug-related problems and improve patient outcomes. The benefits of pharmacist involvement appear greatest when directly involved in ward rounds, due to being able to more rapidly identify medication errors during the prescribing phase, and provide real-time advice and recommendations to prescribers. What is Known: • Complex paediatric conditions can require multiple pharmaceutical treatments, utilised in a safe manner to ensure good patient outcomes • The benefits of pharmacist interventions when using these treatments are well-documented in adult patients, though less so in paediatric patients What is New: • Pharmacists are adept at identifying and managing medication errors for paediatric patients, including incorrect doses, missed doses, and gaps in medication history • Interventions recommended by pharmacists are generally well-accepted by prescribing physicians, especially when recommendations can be made during the prescribing phase of treatment.
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19
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Malfará M, Pernassi M, Aragon D, Carlotti A. Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit. Int J Clin Pharm 2018; 40:513-519. [PMID: 29603074 DOI: 10.1007/s11096-018-0632-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
Background Problems related to pharmacotherapy are common in patients admitted to the paediatric intensive care unit (PICU) and are associated with increased healthcare costs. Data on the impact of clinical pharmacist interventions to prevent pharmacotherapy-related problems and to minimize costs in the PICU are limited. Objectives To evaluate the number and type of clinical pharmacist interventions in the PICU and to determine cost savings associated with them. Setting a ten bed PICU of a tertiary-care university hospital in Brazil. Method This was a prospective, observational study conducted over 1-year. The Failure Mode and Effects Analysis (FMEA) tool was applied at the beginning of the study to assess drug-related risks in the PICU and to guide clinical pharmacist interventions. Main outcome measure Number and type of clinical pharmacist interventions and healthcare-related costs. Results One hundred sixty-two children were followed-up by the clinical pharmacist and 1586 prescriptions were evaluated; pharmacotherapy-related problems were identified in 12.4% of them. Sixteen of 75 failure modes identified by FMEA were potentially reduced by the clinical pharmacist interventions. There were 197 interventions with a cost saving of R$ 15,118.73 (US$ 4828.00). Clinical pharmacist interventions were related to drug interaction and therapeutic monitoring (34.5%), drug selection (22.3%), dosing and frequency (16.8%), prescription (13.2%) and administration (13.2%). Ninety-seven per cent of the clinical pharmacist interventions were accepted by the medical team. The interventions with larger cost savings were related to administration (39%). Conclusion The clinical pharmacist interventions minimized the risks of pharmacotherapy-related problems and contributed to the reduction of costs associated with medical prescription.
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Affiliation(s)
- Márcia Malfará
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Maria Pernassi
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Davi Aragon
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Ana Carlotti
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
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Okumura LM, da Silva DM, Comarella L. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 27578187 PMCID: PMC5176057 DOI: 10.1016/j.rppede.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Clinical Pharmacy Services (CPS) are considered standard of care and is endorsed
by the Joint Commission International, the American Academy of Pediatrics, and the
American College of Clinical Pharmacy. In Brazil, single experiences have been
discreetly arising and the importance of these services to children and
adolescents care has led to interesting results, but certainly are under reported.
This short report aims to discuss the effect of implementing a bedside CPS at a
Brazilian Pediatric Intensive Care Unit (PICU). Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital,
from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were
included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems
(DRPs) which were solved within clinicians (89% acceptance of all interventions).
The most common interventions performed to improve drug therapy included:
preventing incompatible intravenous solutions (21%) and a composite of inadequate
doses (17% due to low, high and non-optimized doses). Among the top ten
medications associated with DRPs, five were antimicrobials. By analyzing the
correlation between DRPs and PICU length of stay, we found that 74% of all
variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a
multifaceted collaboration with other health care professionals, who should
attempt to use active and evidence-based strategies to reduce morbidity related to
medications.
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21
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Okumura LM, Silva DMD, Comarella L. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units. REVISTA PAULISTA DE PEDIATRIA 2016; 34:397-402. [PMID: 27578187 DOI: 10.1016/j.rpped.2016.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Clinical Pharmacy Services (CPS) are considered standard of care and they are endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU). METHODS This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. RESULTS Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs) which were solved within clinicians (89% acceptance of all interventions). The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21%) and a composite of inadequate doses (17% due to low, high and non-optimized doses). Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. CONCLUSIONS Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications.
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Krzyzaniak N, Bajorek B. A global perspective of the roles of the pharmacist in the NICU. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:107-120. [DOI: 10.1111/ijpp.12284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
To describe pharmacist practice and roles performed in the neonatal intensive care unit (NICU) worldwide and to map these findings along the medicines management pathway (MMP).
Method
Quasi-systematic review.
Search Strategy
Google Scholar, Medline/PubMed and Embase were searched utilising the selected MeSH terms.
Results
Thirty sources of information were reviewed. Overall, pharmacist practice in the NICU involves a wide-range of roles, with the most commonly reported involving patient medication chart review, therapeutic drug monitoring and the provision of medication information. Studies highlight that pharmacist contribution to total parenteral nutrition (TPN) regimens and patient medication chart review is beneficial to patient outcomes. Roles beyond the regular scope of practice included involvement in immunisation programmes and research. Most of the data were collected from the USA (13 of 30), followed by the UK (6 of 30) and reports from other countries. The American, British, South African and Australian articles have reported very similar roles, with a pharmacist firmly integrated into the overall structure of the NICU team.
Conclusion
The literature identifies that there is insufficient evidence to describe what roles are currently performed in NICUs worldwide. This is due to the lack of recently published articles leading to a large gap in knowledge in understanding what contemporary pharmaceutical services in the NICU comprise. Further research is required to address these gaps in knowledge, and identify the impact of the pharmacist's role on neonatal patient outcomes as well as to determine how to better resource NICUs to access pharmacy services.
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Affiliation(s)
- Natalia Krzyzaniak
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Australia
| | - Beata Bajorek
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Australia
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23
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Bannan DF, Tully MP. Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review. J Clin Pharm Ther 2016; 41:246-55. [DOI: 10.1111/jcpt.12398] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 04/08/2016] [Indexed: 11/26/2022]
Affiliation(s)
- D. F. Bannan
- Manchester Pharmacy School; University of Manchester; Manchester UK
- Faculty of Pharmacy; King Abdulaziz University; Jeddah KSA
| | - M. P. Tully
- Manchester Pharmacy School; University of Manchester; Manchester UK
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Pichala PT, Kumar BM, Zachariah S, Thomas D, Saunchez L, Gerardo AU. An interventional study on intensive care unit drug therapy assessment in a rural district hospital in India. J Basic Clin Pharm 2014; 4:64-7. [PMID: 24808673 PMCID: PMC3979274 DOI: 10.4103/0976-0105.118801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Intensive care unit is a potential area for drug-related problems. As many of the patients treated are complex patients, clinical pharmacy intervention could find drug therapy problems. Materials and Methods: Drug information liaisons daily attended ward rounds with intensivists and screened the patient for drug therapy assessment using the American Society for Health-System Pharmacists clinical skills competition DTA format. This was a prospective study done for 6 months from August 2012 to January 2013. Simple statistics were used to tabulate the drug-related problems assessed. Results: A total of 72 patients were screened for drug therapy problems, for which 947 drug doses were prescribed in the study period. The total number of prescriptions was 148. The average number of drugs per prescription was 6.39 and the average number of drugs per patient was 13.15. A total of 243 problems were identified; on an average, 1.67 problems were present per prescription. The total number of drug interactions identified was N = 192 (78.2%); majority of them (61.4%) were of type C (not serious). So, 55.73% of them were monitored and not stopped or substituted. The second type of problem was a correlation between drug therapy and medical problem (7.4%). Appropriate drug selection and drug regimen was the third problem, and the adverse drug reactions and therapeutic duplications accounted for approximately 2% of the drug-related problems identified. Conclusion: Drug interactions constituted the major problem of ICUs, but not many were serious or significant. Consensus in assessment of drug-related problems and convincing intensivists with good quality evidences are required for better acceptance of interventions.
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Affiliation(s)
- Priyanka Tejashwani Pichala
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research, Andhra Pradesh, India
| | - Bharani Mukkillapati Kumar
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research, Andhra Pradesh, India
| | - Seeba Zachariah
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research, Andhra Pradesh, India
| | - Dixon Thomas
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research, Andhra Pradesh, India
| | - Laura Saunchez
- Intensive Care Unit, Rural Development Trust Hospital, Andhra Pradesh, India
| | - Alvarez-Uria Gerardo
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
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Basger BJ, Moles RJ, Chen TF. Application of drug-related problem (DRP) classification systems: a review of the literature. Eur J Clin Pharmacol 2014; 70:799-815. [PMID: 24789053 DOI: 10.1007/s00228-014-1686-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
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