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Pediatric drug-related problems: a multicenter study in four French-speaking countries

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Abstract

Background Pediatric intensive care patients represent a population at high risk for drug-related problems. There are few studies that compare the activity of clinical pharmacists between countries. Objective To describe the drug-related problems identified and interventions by four pharmacists in a pediatric cardiac and intensive care unit. Setting Four pediatric centers in France, Quebec, Switzerland and Belgium. Method This was a six-month multicenter, descriptive and prospective study conducted from August 1, 2009 to January 31, 2010. Drug-related problems and clinical interventions were compiled from four pediatric centers in France, Quebec, Switzerland and Belgium. Data on patients, drugs, intervention, documentation, approval and estimated impact were compiled. Main outcome measure Number and type of drug-related problems encountered in a large pediatric inpatient population. Results A total of 996 interventions were recorded: 238 (24 %) in France, 278 (28 %) in Quebec, 351 (35 %) in Switzerland and 129 (13 %) in Belgium. These interventions targeted 270 patients (median 21 months old, 53 % male): 88 (33 %) in France, 56 (21 %) in Quebec, 57 (21 %) in Switzerland and 69 (26 %) in Belgium. The main drug-related problems were inappropriate administration technique (29 %), untreated indication (25 %) and supra-therapeutic dose (11 %). The pharmacists’ interventions were mostly optimizing the mode of administration (22 %), dose adjustment (20 %) and therapeutic monitoring (16 %). The two major drug classes that led to interventions were anti-infectives for systemic use (23 %) and digestive system and metabolism drugs (22 %). Interventions mainly involved residents and all clinical staff (21 %). Among the 878 (88 %) proposed interventions requiring physician approval, 860 (98 %) were accepted. Conclusion This descriptive study illustrates drug-related problems and the ability of clinical pharmacists to identify and resolve them in pediatric intensive care units in four French-speaking countries.

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References

  1. Sanghera N, Chan PY, Khaki ZF, Planner C, Lee KK, Cranswick NE, et al. Interventions of hospital pharmacists in improving drug therapy in children: a systematic literature review. Drug Saf. 2006;29(11):1031–47.

    Article  PubMed  Google Scholar 

  2. National Patient Safety Agency. Safety in doses. 2009 [updated 2009; cited 8 March 2012]; Available from: http://www.nrls.npsa.nhs.uk/resources/?EntryId45=61625.

  3. Wong IC, Ghaleb MA, Franklin BD, Barber N. Incidence and nature of dosing errors in paediatric medications: a systematic review. Drug Saf. 2004;27(9):661–70.

    Article  PubMed  Google Scholar 

  4. Ghaleb MA, Barber N, Dean Franklin B, Wong IC. What constitutes a prescribing error in paediatrics? Qual Saf Health Care. 2005;14(5):352–7.

    Article  PubMed  CAS  Google Scholar 

  5. Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC. Systematic review of medication errors in pediatric patients. Ann Pharmacother. 2006;40(10):1766–76.

    Article  PubMed  Google Scholar 

  6. Ghaleb MA, Barber N, Franklin BD, Wong IC. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010;95(2):113–8.

    Article  PubMed  Google Scholar 

  7. Krupicka MI, Bratton SL, Sonnenthal K, Goldstein B. Impact of a pediatric clinical pharmacist in the pediatric intensive care unit. Crit Care Med. 2002;30(4):919–21.

    Article  PubMed  Google Scholar 

  8. Kaushal R, Bates DW, Abramson EL, Soukup JR, Goldmann DA. Unit-based clinical pharmacists’ prevention of serious medication errors in pediatric inpatients. Am J Health Syst Pharm. 2008;65(13):1254–60.

    Article  PubMed  Google Scholar 

  9. Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285(16):2114–20.

    Article  PubMed  CAS  Google Scholar 

  10. Wang JK, Herzog NS, Kaushal R, Park C, Mochizuki C, Weingarten SR. Prevention of pediatric medication errors by hospital pharmacists and the potential benefit of computerized physician order entry. Pediatrics. 2007;119(1):e77–85.

    Article  PubMed  Google Scholar 

  11. Fortescue EB, Kaushal R, Landrigan CP, McKenna KJ, Clapp MD, Federico F, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;111(4 Pt 1):722–9.

    Article  PubMed  Google Scholar 

  12. Mikeal RL, Brown TR, Lazarus HL, Vinson MC. Quality of pharmaceutical care in hospitals. Am J Hosp Pharm. 1975;32(6):567–74.

    PubMed  CAS  Google Scholar 

  13. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.

    PubMed  CAS  Google Scholar 

  14. Allenet B, Bedouch P, Rose FX, Escofier L, Roubille R, Charpiat B, et al. Validation of an instrument for the documentation of clinical pharmacists’ interventions. Pharm World Sci. 2006;28(4):181–8.

    Article  PubMed  Google Scholar 

  15. Canales PL, Dorson PG, Crismon ML. Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting. Am J Health Syst Pharm. 2001;58(14):1309–16.

    PubMed  CAS  Google Scholar 

  16. Gattis WA, Hasselblad V, Whellan DJ, O’Connor CM. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the pharmacist in heart failure assessment recommendation and monitoring (PHARM) study. Arch Intern Med. 1999;159(16):1939–45.

    Article  PubMed  CAS  Google Scholar 

  17. Kane SL, Weber RJ, Dasta JF. The impact of critical care pharmacists on enhancing patient outcomes. Intensive Care Med. 2003;29(5):691–8.

    PubMed  Google Scholar 

  18. Varma S, McElnay JC, Hughes CM, Passmore AP, Varma M. Pharmaceutical care of patients with congestive heart failure: interventions and outcomes. Pharmacotherapy. 1999;19(7):860–9.

    Article  PubMed  CAS  Google Scholar 

  19. McMullin ST, Hennenfent JA, Ritchie DJ, Huey WY, Lonergan TP, Schaiff RA, et al. A prospective, randomized trial to assess the cost impact of pharmacist-initiated interventions. Arch Intern Med. 1999;159(19):2306–9.

    Article  PubMed  CAS  Google Scholar 

  20. Schumock GT, Butler MG, Meek PD, Vermeulen LC, Arondekar BV, Bauman JL. Evidence of the economic benefit of clinical pharmacy services: 1996–2000. Pharmacotherapy. 2003;23(1):113–32.

    Article  PubMed  Google Scholar 

  21. Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics. 1987;79(5):718–22.

    PubMed  CAS  Google Scholar 

  22. European Association of Hospital Pharmacists EAHP Survey 2005. [updated 2005; cited 8 March 2012]; Available from: http://www.eahp.eu/EAHP-survey/2005-Survey.

  23. Kausch C, Tan Sean P, Boelle P, Paye F, Beaussier M, Parc R, et al. Impact économique et intégration d’un pharmacien clinicien dans un service de chirurgie digestive. J Pharm Clin. 2005;24(2):90–7.

    Google Scholar 

  24. Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of ward-based clinical pharmacy services in Belgium—description of the impact on a geriatric unit. Ann Pharmacother. 2006;40(4):720–8.

    Article  PubMed  Google Scholar 

  25. Lampert ML, Kraehenbuehl S, Hug BL. Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital. Pharm World Sci. 2008;30(6):768–76.

    Article  PubMed  Google Scholar 

  26. Canadian Society of Hospital Pharmacists. 2005/2006 Annual Report. Hospital Pharmacy in Canada. Ethics in Hospital Pharmacy. 2007 [updated 2007; cited 8 March 2012]; Available from: http://www.lillyhospitalsurvey.ca.

  27. Prot-Labarthe S, Lavoie A, Bourdon O, Lebel D, Bussieres JF, Faye A, et al. Pilot study about pharmaceutical care implantation in a general paediatric unit in a French hospital. France-Quebec collaboration and comparison. Arch Pediatr. 2007;14(4):345–53.

    Article  PubMed  CAS  Google Scholar 

  28. Prot-Labarthe S, Therrien R, Demanche C, Larocque D, Bussières J. Pharmaceutical care in an inpatient pediatric hematopoietic stem cell transplant service (accepté pour publication). J Oncol Pharm Pract. 2008;14(3):147–52.

    Article  PubMed  Google Scholar 

  29. Flack K, Darsey E, Naughton M. Pharmacy interventions in a multidisciplinary pediatric intensive care unit. J Pediatr Pharm Pract. 1997;3:162–7.

    Google Scholar 

  30. Moffett BS, Mott AR, Nelson DP, Gurwitch KD. Medication dosing and renal insufficiency in a pediatric cardiac intensive care unit: impact of pharmacist consultation. Pediatr Cardiol. 2008;29(4):744–8.

    Article  PubMed  Google Scholar 

  31. Struck P, Pedersen K, Moodley P, Rasmussen M. A pilot study of pharmacist-initiated interventions in drug therapy in an Australian paediatric hospital. EJHP Sci. 2007;13(4):105–12.

    Google Scholar 

  32. Prot-Labarthe S, Bussieres JF, Brion F, Bourdon O. Comparison of hospital pharmacy practice in France and Canada: can different practice perspectives complement each other? Pharm World Sci. 2007;29(5):526–33.

    Article  PubMed  Google Scholar 

  33. Jani YH, Ghaleb MA, Marks SD, Cope J, Barber N, Wong IC. Electronic prescribing reduced prescribing errors in a pediatric renal outpatient clinic. J Pediatr. 2008;152(2):214–8.

    Article  PubMed  Google Scholar 

  34. Chisholm MA, Pittman DG, Longley JM, Mullis SR. Implementation of pharmaceutical care in acute medical cardiovascular patients. Hosp Pharm. 1995;30(7):572–574, 7–8.

    Google Scholar 

  35. Krahenbuhl JM, Kremer B, Guignard B, Bugnon O. Practical evaluation of the drug-related problem management process in Swiss community pharmacies. Pharm World Sci. 2008;30(6):777–86.

    Google Scholar 

  36. Barber ND, Batty R, Ridout DA. Predicting the rate of physician-accepted interventions by hospital pharmacists in the United Kingdom. Am J Health Syst Pharm. 1997;54(4):397–405.

    PubMed  CAS  Google Scholar 

  37. Boardman H, Fitzpatrick R. Self reported clinical pharmacist interventions under-estimate their input to patient care. Pharm World Sci. 2001;23(2):55–9.

    Article  PubMed  CAS  Google Scholar 

  38. Pullinger W, Franklin BD. Pharmacists’ documentation in patients’ hospital health records: issues and educational implications. Int J Pharm Pract. 2010;18(2):108–15.

    PubMed  Google Scholar 

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Acknowledgments

We thank the pediatric intensive care units and cardiology care teams at the various centers for their hospitality and availability, and Ariane Blanc for helping creating the database for data collection.

Funding

The program received a grant from Réseau Mère-Enfant de la Francophonie (RMEF, Francophone Mother Child Network).

Conflicts of interest

None.

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Authors and Affiliations

  1. Pharmacy Department, APHP, Hôpital Robert Debré, 48, boulevard Sérurier, 75019, Paris, France

    Sonia Prot-Labarthe, Françoise Brion & Olivier Bourdon

  2. Université Paris Descartes, Paris, France

    Françoise Brion & Olivier Bourdon

  3. Pharmacy Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Ermindo R. Di Paolo

  4. Pharmacy Department, CHU Sainte Justine, Montréal, QC, Canada

    Annie Lavoie & Jean-François Bussières

  5. Pharmacy Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium

    Stefanie Quennery

  6. Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada

    Annie Lavoie & Jean-François Bussières

Authors
  1. Sonia Prot-Labarthe
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  2. Ermindo R. Di Paolo
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  3. Annie Lavoie
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  4. Stefanie Quennery
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  5. Jean-François Bussières
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  6. Françoise Brion
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  7. Olivier Bourdon
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Corresponding author

Correspondence to Olivier Bourdon.

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Prot-Labarthe, S., Di Paolo, E.R., Lavoie, A. et al. Pediatric drug-related problems: a multicenter study in four French-speaking countries. Int J Clin Pharm 35, 251–259 (2013). https://doi.org/10.1007/s11096-012-9740-1

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  • DOI: https://doi.org/10.1007/s11096-012-9740-1

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