Abstract
Background Although medications play a vital role in the cure, palliation, and inhibition of disease, they also expose patients to drug-related problems (DRPs). DRPs are common in hospitalized patients. Specifically, pediatrics population are easily affected by DRPs, as dynamic and kinetic behaviors of drugs in this population are usually different than in adults. Objectives To assess the prevalence of DRPs and associated factors in a pediatric setting in Ethiopia. Setting Pediatric ward of Zewditu Memorial Referral Hospital, Addis Abbeba, Ethiopia. Methods A cross-sectional study was conducted on 285 randomly selected patients. Data were obtained through review of physician medication orders and patient files. The prevalence and type of DRPs were studied and documented using the Pharmaceutical Care Network Europe Foundation classification system. The results were summarized using descriptive statistics including frequency, mean, and standard deviation. To identify the independent predicators of DRPs, logistic regression analysis was run and a P value ≤0.05 was considered as statistically significant. Main outcome measure DRPs, types of DRPs, drugs that are frequently involved in DRPs, and factors associated with DRPs. Main outcome measure Number of DRPs. Results Of the 1055 medication orders reviewed, a total of 106 DRPs were identified in 90 patients. This gives an overall rate of drug-related problems of 31.57%. The most frequently identified DRPs were dosing problems, with dose too low being 34.9% and dose too high being 7.5%. This was followed by drug–drug interactions (38.67%) and adverse drug reactions (8.49%). The number of prescribed drugs (AOR 2.3, 95% CI 1.3–4.3, P = 0.007) and total number of disease conditions (AOR 4.8, 95% CI 1.9, 12.1, P = 0.001) were potential risk factors for occurrence of DRPs. Conclusion The present study demonstrated that DRPs were common at the pediatric ward of Zewditu Memorial Referral Hospital and that it needs great attention. The most frequently identified DRPs were dosing problems, followed by drug–drug interactions and adverse drug reaction. Poly-pharmacy and number of disease conditions have been identified as important risk factors for occurrence of DRPs. The investigators recommend establishing a system for reporting DRPs in the pediatric ward of the hospital as it may facilitate appropriate measures for prospective interventions, such as training the healthcare team, as well as detail precautions to be followed by the practitioners. In addition to this, improving communication between the healthcare team members such as physicians, pharmacists, nurses, and other healthcare workers in the hospital is recommended.
Similar content being viewed by others
References
Baena MI, Faus MJ, Fajardo PC, Luque FM, Sierra F, Martinez-Olmos J, et al. Medicine-related problems resulting in emergency department visits. Eur J Clin Pharmacol. 2006;62(5):387–93.
Pharmaceutical Care Network Europe. The PCNE classification for drug-related problems V 6.2. [Last accessed on 2014 March 01; Last updated on 2010 Jan 14]. Available from: http://www.pcne.org/sig/drp/documents/PCNE%20classification%20V6-2.pdf.
Flaherty JH, Perry HM III, Lynchard GS, Morley JE. Polypharmacy and hospitalization among older home care patients. J Gerontol A Biol Sci Med Sci. 2000;55(10):M554–9.
Fijn R, Van den Bemt PMLA, Chow M, De Blaey CJ, De Jong-Van den Berg LTW, Brouwers JRBJ. Hospital prescribing errors: epidemiological assessment of predictors. Br J Clin Pharmacol. 2002;53(3):326–31.
Blix HS, Viktil KK, Moger TA, Reikvam Å. Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams. Pharm World Sci. 2006;28(3):152.
Ibrahim N, Wong IC, Patey S, Tomlin S, Sinha MD, Jani Y. Drug-related problem in children with chronic kidney disease. Pediatr Nephrol. 2013;28(1):25–31.
Rashed AN, Wong IC, Cranswick N, Hefele B, Tomlin S, Jackman J, et al. Adverse Drug Reactions in Children-International Surveillance and Evaluation (ADVISE): a multicentre cohort study. Drug Saf. 2012;35(6):481–94.
Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41(2):192–9.
Easton KL, Chapman CB, Brien J-AE. Frequency and characteristics of hospital admissions associated with drug-related problems in paediatrics. Br J Clin Pharmacol. 2004;57(5):611–5.
Oshikoya KA, Chukwura H, Njokanma OF, Senbanjo IO, Ojo I. Incidence and cost estimate of treating pediatric adverse drug reactions in Lagos, Nigeria. Sao Paulo Med J. 2011;129(3):153–64.
Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277(4):301–6.
Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997;277(4):307–11.
Winterstein AG, Sauer BC, Hepler CD, Poole C. Preventable drug-related hospital admissions. Ann Pharmacother. 2002;36(7–8):1238–48.
Lagnaoui R, Moore N, Fach J, Longy-Boursier M, Begaud B. Adverse drug reactions in a department of systemic diseases-oriented internal medicine: prevalence, incidence, direct costs and avoidability. Eur J Clin Pharmacol. 2000;56(2):181–6.
Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology—drug disposition, action, and therapy in infants and children. N Engl J Med. 2003;349(12):1157–67.
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356(9237):1255–9.
Pocket book of pediatric hospital care: Ethiopia. Guidelines for the management of common illnesses in hospitals. 2013.
Cipolle RJ, Strand L, Morley P. Pharmaceutical care practice: the clinician’s guide, second edition: the clinician’s guide. New York: McGraw-Hill; 2004.
Rashed AN, Wilton L, Lo CC, Kwong BY, Leung S, Wong IC. Epidemiology and potential risk factors of drug-related problems in Hong Kong paediatric wards. Br J Clin Pharmacol. 2014;77(5):873–9.
Rashed AN, Neubert A, Tomlin S, Jackman J, Alhamdan H, AlShaikh A, et al. Epidemiology and potential associated risk factors of drug-related problems in hospitalised children in the United Kingdom and Saudi Arabia. Eur J Clin Pharmacol. 2012;68(12):1657–66.
Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing. JAMA. 1997;277(4):312–7.
Moura CS, Acurcio FA, Belo NO. Drug–drug interactions associated with length of stay and cost of hospitalization. J Pharm Pharm Sci. 2009;12(3):266–72.
van den Bemt PM, Egberts AC, Lenderink AW, Verzijl JM, Simons KA, van der Pol WS, et al. Risk factors for the development of adverse drug events in hospitalized patients. Pharm World Sci. 2000;22(2):62–6.
Melander E, Nissen A, Henricson K, Merlo J, Mölstad S, Kampmann JP, et al. Utilisation of antibiotics in young children: opposite relationships to adult educational levels in Danish and Swedish counties. Eur J Clin Pharmacol. 2003;59(4):331–5.
Acknowledgements
We are very much thankful for the participants in this study as well as the University of Gondar for the financial support.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
None.
Conflicts of interest
The authors declare that they have no conflict of interests.
Rights and permissions
About this article
Cite this article
Birarra, M.K., Heye, T.B. & Shibeshi, W. Assessment of drug-related problems in pediatric ward of Zewditu Memorial Referral Hospital, Addis Ababa, Ethiopia. Int J Clin Pharm 39, 1039–1046 (2017). https://doi.org/10.1007/s11096-017-0504-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-017-0504-9