Assessment of drug-related problems in pediatric inpatients by clinical pharmacist-led medication review: An observational study

Yeliz Şahin; Çağatay Nuhoğlu; Betul Okuyan; Mesut Sancar

Assessment of drug-related problems in pediatric inpatients by clinical pharmacist-led medication review: An observational study

Abstract

It is well-known that problems related to pharmacotherapy affect pediatric patients' therapy outcomes. Evaluating pharmacotherapy by a clinical pharmacist in pediatric clinics could ameliorate drug-related problems (DRPs). This study aimed to identify and compare the prevalence and types of DRPs in pediatric patients in two study phases: the prospective phase while providing clinical pharmacist-led medication review service and the retrospective phase among subjects obtained by age-sex-diagnose–matching according to the prospective phase. This observational study consisted of two phases (the prospective part between June 2019 and February 2020 and the retrospective part between December 2018 and February 2019) and was conducted in a pediatric unit of a university hospital. Turkish version of Pharmaceutical Care Network Europe Foundation Classification V9.1 is used to identify DRPs. Lexicomp® and Micromedex® were the resources used to assess the potential drug-drug interactions. Medscape® and UpToDate® recommendations and evidence-based guidelines were applied in assessing compliance with approved pharmacotherapy of patients. Prevalence and types of DRPs and clinical pharmacist interventions were assessed. Among 174 patients, at least one DRP was seen in 78,16% of the patients, and 527 DRPs were identified. Some of the problems were related to drug-drug interaction (64,90%), therapeutic monitoring (11,39%), and dosing (11,01%). Anti-infectives, bronchodilators, and inhaled corticosteroids were the most frequently used drugs. There were significant differences in duration of hospitalization (p=0,025), number of drugs used (p=0,003), and total DRPs (p=0,019) between the study and control groups. The findings demonstrate the potential to detect DRPs through pharmacist involvement in direct patient care.

Keywords

References

[1] Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017; 6: 37–46. [CrossRef]
[2] Messerli M, Blozik E, Vriends N, Hersberger KE. Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy--a prospective randomised controlled trial. BMC Health Serv Res. 2016; 16: 145. [CrossRef]
[3] Fernandez E, Perez R, Hernandez A, Tejada P, Arteta M, Ramos JT. Factors and mechanisms for pharmacokinetic differences between pediatric population and adults. Pharmaceutics. 2011;3(1):53-72. [CrossRef]
[4] The Board of Pharmacy Specialties, Pediatric Pharmacy. https://www.bpsweb.org/bps-specialties/pediatric-pharmacy/ (accessed on 29 April 2022)
[5] Hon MY, Chua XY, Premakumar CM, Mohamed Shah N. Drug-related problems in a general paediatric ward of a tertiary care hospital in Malaysia. Int J Clin Pharm. 2020; 42(3): 948-955. [CrossRef]
[6] 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(3): 513-519. [CrossRef]
[7] Nguyen TH, Le VTT, Quach DN, Diep HG, Nguyen NK, Lam AN, Pham ST, Taxis K, Nguyen T, Nguyen PM. Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam. Healthcare (Basel). 2021; 9(3): 327. [CrossRef]
[8] Prot-Labarthe S, Di Paolo ER, Lavoie A, Quennery S, Bussières JF, Brion F, Bourdon O. Pediatric drug-related problems: a multicenter study in four French-speaking countries. Int J Clin Pharm. 2013; 35(2): 251-259. [CrossRef]

[9] Tripathi S, Crabtree HM, Fryer KR, Graner KK, Arteaga GM. Impact of clinical pharmacist on the pediatric ıntensive care practice: An 11-year tertiary center experience. J Pediatr Pharmacol Ther. 2015; 20(4): 290-298. [CrossRef]
[10] Yismaw MB, Adam H, Engidawork E. Identification and resolution of drug-related problems among childhood cancer patients in Ethiopia. J Oncol. 2020; 2020: 6785835. [CrossRef]
[11] Liu XX, Wang HX, Hu YY, Zhu XT, Tan X, Yang Y, Hang YF, Zhu JG. Drug-related problems identified by clinical pharmacists in nephrology department of a tertiary hospital in China-a single center study. Ann Palliat Med. 2021; 10(8): 8701-8708. [CrossRef]
[12] Özdemir N, Kara E, Büyükçam A, Aykaç K, Çeliker A, Demirkan K, Kara A. Evaluation of medication errors in pediatric patients using antibiotics. Turk J Pediatr. 2021; 63(6): 970-977. [CrossRef]
[13] Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation - Making it safe and sound. First ed., The King’s Fund, UK, 2013.
[14] Batchelor HK, Marriott JF. Formulations for children: Problems and solutions. Br J Clin Pharmacol. 2015;79(3):405-418. [CrossRef]
[15] Kaufmann J, Laschat M, Wappler F. Medication errors in pediatric emergencies: a systematic analysis. Dtsch Arztebl Int. 2012;109(38):609-616. [CrossRef]
[16] Benavides S, Nahata MC, Pediatric Pharmacotherapy, first ed., American College of Clinical Pharmacy, Lenexa, Kansas, United States of America 2013, p: 48-52.
[17] Van den Bemt PM, Egberts TC, de Jong-van den Berg LT, Brouwers JR. Drug-related problems in hospitalised patients. Drug Saf. 2000 Apr;22(4):321-333. [CrossRef]
[18] Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37-46. [CrossRef]
[19] Kara E, Kelleci Çakır B, Sancar M, Demirkan K. Impact of clinical pharmacist-led ınterventions in Turkey. Turk J Pharm Sci. 2021; 18(4): 517-526. [CrossRef]
[20] Birarra MK, Heye TB, Shibeshi W. Assessment of drug-related problems in pediatric ward of Zewditu Memorial Referral Hospital, Addis Ababa, Ethiopia. Int J Clin Pharm. 2017; 39(5): 1039-1046. [CrossRef]
[21] Bizuneh GK, Adamu BA, Bizuayehu GT, Adane SD. A prospective observational study of drug therapy problems in pediatric ward of a referral hospital, northeastern Ethiopia. Int J Pediatr. 2020; 2020: 4323189. [CrossRef]
[22] Ibrahim N, Wong IC, Tomlin S, Sinha MD, Rees L, Jani Y. Epidemiology of medication-related problems in children with kidney disease. Pediatr Nephrol. 2015; 30(4): 623-633. [CrossRef]
[23] Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014; 2014(6): CD001266. [CrossRef]
[24] Dempsey PP, Businger AC, Whaley LE, Gagne JJ, Linder JA. Primary care clinicians' perceptions about antibiotic prescribing for acute bronchitis: A qualitative study. BMC Fam Pract. 2014; 15: 194. [CrossRef]
[25] Lugo RA, Salyer JW, Dean JM. Albuterol in acute bronchiolitis--continued therapy despite poor response? Pharmacotherapy. 1998; 18(1): 198-202.
[26] Hsia Y, Lee BR, Versporten A, Yang Y, Bielicki J, Jackson C, Newland J, Goossens H, Magrini N, Sharland M; GARPEC and Global-PPS networks. Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): An analysis of paediatric survey data from 56 countries. Lancet Glob Health. 2019; 7(7): e861-e871. Erratum in: Lancet Glob Health. 2021 Jun;9(6):e758. [CrossRef]
[27] Fernández-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Pérez-Sanz C, Duran-García E, Sanjurjo-Saez M. Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child. 2012; 97(6): 564-568. [CrossRef]
[28] 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(2): 83-91. [CrossRef]
[29] Griese-Mammen N, Hersberger KE, Messerli M, Leikola S, Horvat N, van Mil JWF, Kos M. PCNE definition of medication review: reaching agreement. Int J Clin Pharm. 2018; 40(5): 1199-1208. [CrossRef]
[30] Pharmaceutical Care Network Europe. PCNE Classification V 9.1. 2020. https://www.pcne.org/working-groups/2/drug-related-problem-classification. (accessed on 06 December 2021).
[31] Bakaki PM, Horace A, Dawson N, Winterstein A, Waldron J, Staley J, Pestana Knight EM, Meropol SB, Liu R, Johnson H, Golchin N, Feinstein JA, Bolen SD, Kleinman LC. Defining pediatric polypharmacy: A scoping review. PLoS One. 2018; 13(11): e0208047. [CrossRef]

Details

Primary Language

English

Subjects

Clinical Pharmacy and Pharmacy Practice

Journal Section

Research Article

Authors

Yeliz Şahin ^*
0000-0002-3709-6072
Türkiye

Çağatay Nuhoğlu
Türkiye

Betul Okuyan
0000-0002-4023-2565
Türkiye

Mesut Sancar
Türkiye

Publication Date

June 28, 2025

Submission Date

February 7, 2022

Acceptance Date

May 13, 2022

Published in Issue

Year 2022 Volume: 26 Number: 4

IZ

https://izlik.org/JA89KN38LL

Cite

RIS / Bibtex

APA

Şahin, Y., Nuhoğlu, Ç., Okuyan, B., & Sancar, M. (2025). Assessment of drug-related problems in pediatric inpatients by clinical pharmacist-led medication review: An observational study. Journal of Research in Pharmacy, 26(4), 1007-1015. https://izlik.org/JA89KN38LL

AMA

1.Şahin Y, Nuhoğlu Ç, Okuyan B, Sancar M. Assessment of drug-related problems in pediatric inpatients by clinical pharmacist-led medication review: An observational study. J. Res. Pharm. 2025;26(4):1007-1015. https://izlik.org/JA89KN38LL

Chicago

Şahin, Yeliz, Çağatay Nuhoğlu, Betul Okuyan, and Mesut Sancar. 2025. “Assessment of Drug-Related Problems in Pediatric Inpatients by Clinical Pharmacist-Led Medication Review: An Observational Study”. Journal of Research in Pharmacy 26 (4): 1007-15. https://izlik.org/JA89KN38LL.

EndNote

Şahin Y, Nuhoğlu Ç, Okuyan B, Sancar M (June 1, 2025) Assessment of drug-related problems in pediatric inpatients by clinical pharmacist-led medication review: An observational study. Journal of Research in Pharmacy 26 4 1007–1015.

IEEE

[1]Y. Şahin, Ç. Nuhoğlu, B. Okuyan, and M. Sancar, “Assessment of drug-related problems in pediatric inpatients by clinical pharmacist-led medication review: An observational study”, J. Res. Pharm., vol. 26, no. 4, pp. 1007–1015, June 2025, [Online]. Available: https://izlik.org/JA89KN38LL

ISNAD

Şahin, Yeliz - Nuhoğlu, Çağatay - Okuyan, Betul - Sancar, Mesut. “Assessment of Drug-Related Problems in Pediatric Inpatients by Clinical Pharmacist-Led Medication Review: An Observational Study”. Journal of Research in Pharmacy 26/4 (June 1, 2025): 1007-1015. https://izlik.org/JA89KN38LL.

JAMA

1.Şahin Y, Nuhoğlu Ç, Okuyan B, Sancar M. Assessment of drug-related problems in pediatric inpatients by clinical pharmacist-led medication review: An observational study. J. Res. Pharm. 2025;26:1007–1015.

MLA

Şahin, Yeliz, et al. “Assessment of Drug-Related Problems in Pediatric Inpatients by Clinical Pharmacist-Led Medication Review: An Observational Study”. Journal of Research in Pharmacy, vol. 26, no. 4, June 2025, pp. 1007-15, https://izlik.org/JA89KN38LL.

Vancouver

1.Yeliz Şahin, Çağatay Nuhoğlu, Betul Okuyan, Mesut Sancar. Assessment of drug-related problems in pediatric inpatients by clinical pharmacist-led medication review: An observational study. J. Res. Pharm. [Internet]. 2025 Jun. 1;26(4):1007-15. Available from: https://izlik.org/JA89KN38LL