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Observational study of drug-related problems and clinical pharmacists’ interventions in a French paediatric hospital
  1. Sophie Robert1,
  2. Sophie Ménétré1,
  3. Cyril Schweitzer2,3,
  4. Béatrice Demoré1,4
  1. 1Pharmacy, Nancy Regional University Hospital Center, Vandoeuvre-lès-Nancy, France
  2. 2Pôle enfants néonatologie, Nancy Regional University Hospital Center, Vandoeuvre-lès-Nancy, France
  3. 3EVAH EA 3450, Faculté de médecine, Université de Lorraine, Nancy, France
  4. 4APEMAC, Université de Lorraine, Nancy, France
  1. Correspondence to Dr Sophie Robert, Pharmacy, Nancy Regional University Hospital Center, Vandoeuvre-lès-Nancy 54511, France; 88.sophie.robert{at}gmail.com

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.

  • paediatrics
  • clinical pharmacy
  • quality in health care
  • side effects of drugs
  • hospital pharmacy competencies
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