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A systematic review of clinical pharmacist interventions in paediatric hospital patients

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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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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

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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.

Author information

Authors and Affiliations

  1. College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD, 4814, Australia

    Aaron Drovandi

  2. Pharmacy Department, Townsville Hospital & Health Services, Townsville, Australia

    Kelvin Robertson, Matthew Tucker, Niechole Robinson & Stephen Perks

  3. School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia

    Therése Kairuz

Authors
  1. Aaron Drovandi
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  2. Kelvin Robertson
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  3. Matthew Tucker
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  4. Niechole Robinson
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  5. Stephen Perks
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  6. Therése Kairuz
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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.

Corresponding author

Correspondence to Aaron Drovandi.

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The authors declare that they have no conflict of interest.

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Informed consent is not applicable in this study.

Additional information

Communicated by Piet Leroy

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Drovandi, A., Robertson, K., Tucker, M. et al. A systematic review of clinical pharmacist interventions in paediatric hospital patients. Eur J Pediatr 177, 1139–1148 (2018). https://doi.org/10.1007/s00431-018-3187-x

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  • DOI: https://doi.org/10.1007/s00431-018-3187-x

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