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European Journal of Pediatrics

, Volume 177, Issue 8, pp 1139–1148 | Cite as

A systematic review of clinical pharmacist interventions in paediatric hospital patients

  • Aaron DrovandiEmail author
  • Kelvin Robertson
  • Matthew Tucker
  • Niechole Robinson
  • Stephen Perks
  • Therése Kairuz
Review

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

Keywords

Clinical pharmacist Prescribing errors Medication reconciliation Patient safety Medication dosing 

Abbreviations

DRP

Drug-related problem

ED

Emergency department

JBI

Joanna Briggs Institute

NICU

Neonatal intensive care unit

PICU

Paediatric intensive care unit

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCT

Randomised controlled trial

Notes

Acknowledgements

The authors would like to thank the following colleagues for their assistance with the review: M Stelmaschuk, J Hart-Davies, S Maltby, L Pell, K MacFarlane, S Leotta, J Ede, A Bond, and Townsville hospital librarian Bronia Renison. Literature search by Louisa D’Arrietta, Townsville Hospital Librarian, 10/10/2017. The Townsville Hospital, QLD, Australia.

Authors’ contributions

All authors were responsible for the development of the initial research plan and were involved in quality assessment of eligible articles. AD carried out an independent literature search and was responsible for drafting of the manuscript. KR and MT were responsible for assessing article eligibility and revising of the manuscript drafts. NR and SP assisted in drafting of earlier versions of the manuscript. TK assisted in the literature search, drafting of earlier versions of the manuscript, and review of the final manuscript version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent is not applicable in this study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.College of Medicine and DentistryJames Cook UniversityTownsvilleAustralia
  2. 2.Pharmacy DepartmentTownsville Hospital & Health ServicesTownsvilleAustralia
  3. 3.School of Biomedical Sciences and Pharmacy, Faculty of Health and MedicineThe University of NewcastleCallaghanAustralia

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