Skip to main content
SpringerLink
Log in

A systematic review of clinical pharmacy services in pediatric inpatients

  • Review Article
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Background

Adverse drug events associated with medication errors (MEs) are three times higher in children than in adults. To reduce MEs in children, studies have reported the advantage of clinical pharmacist implementations, but a thorough overview of dedicated activities has not yet been clearly described.

Objectives

The objective of this systematic review was to establish an international overview of clinical pharmacy services (CPS) practiced by pharmacists for pediatric inpatients.

Methods

Two databases were searched for original articles published from January 2000 to 2019. Additionally, a manual hand search was conducted. Studies dealing with CPS performed by pharmacists for pediatric inpatients were included. General and geographical data, method, design, and population characteristics of studies were extracted. The primary outcome was to quantify and describe pediatric CPS. Secondary outcomes were to quantify the presence of an age range analysis and impact evaluation. Six validated checklists were used to assess the quality of studies included.

Results

After a full-text review, 42 studies were included. Among the 15 CPS reported, pharmaceutical interventions for prescriptions, medication reconciliation, interactions with medical and paramedical teams, ward round participation, and patient therapeutic education were the most frequently detailed. Only eight studies considered age interpretation. The principal limitation was the heterogeneity of studies.

Conclusion

This work provides a basis for harmonizing the deployment of pediatric CPS in hospital to improve patient safety. Because pharmacists’ time resources are limited, CPS should be prioritized according to hospital population, service organization, and needs evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Miller RR. History of clinical pharmacy and clinical pharmacology. J Clin Pharmacol. 1981;21:195–7.

    Article  CAS  PubMed  Google Scholar 

  2. Kaboli PJ, Hoth AB, McClimon BJ, et al. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166:955.

    Article  PubMed  Google Scholar 

  3. Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285:2114–20.

    Article  CAS  PubMed  Google Scholar 

  4. Choonara I, Conroy S. Unlicensed and off-label drug use in children: implications for safety. Drug Saf. 2002;25:1–5.

    Article  PubMed  Google Scholar 

  5. Lago P, Bizzarri G, Scalzotto F, et al. Use of FMEA analysis to reduce risk of errors in prescribing and administering drugs in paediatric wards: a quality improvement report. BMJ Open. 2012;2:e001249.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fortescue EB, Kaushal R, Landrigan CP, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;111:722–9.

    Article  PubMed  Google Scholar 

  7. Bhatt-Mehta V, Buck ML, Chung AM, et al. Recommendations for meeting the pediatric patient’s need for a clinical pharmacist: a joint opinion of the Pediatrics Practice and Research Network of the American College of Clinical Pharmacy and the Pediatric Pharmacy Advocacy Group. Pharmacother J Hum Pharmacol Drug Ther. 2013;33:243–51.

    Article  Google Scholar 

  8. Rinke ML, Bundy DG, Velasquez CA, et al. Interventions to reduce pediatric medication errors: a systematic review. Pediatrics. 2014;134:338–60.

    Article  PubMed  Google Scholar 

  9. Levine SR, Cohen MR, Blanchard NR, et al. Guidelines for preventing medication errors in pediatrics. J Pediatr Pharmacol Ther. 2001;6:426–42.

    Google Scholar 

  10. Wong I. Ways to reduce drug dose calculation errors in children. J Health Serv Res Policy. 2010;15:68–70.

    Article  PubMed  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Munn Z, Moola S, Lisy K, et al. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and incidence data. Int J Evid Based Heal. 2015;13:147–53.

    Article  Google Scholar 

  13. Moola S, Munn Z, Tufanaru C, et al. Chapter 7: systematic reviews of etiology and risk. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute; 2017. https://reviewersmanual.joannabriggs.org/. Accessed 30 May 2019.

  14. Tufanaru C, Munn Z, Aromataris E, et al. Chapter 3: systematic reviews of effectiveness. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute; 2017. https://reviewersmanual.joannabriggs.org/. Accessed 28 May 2019.

  15. Drovandi A, Robertson K, Tucker M, et al. A systematic review of clinical pharmacist interventions in paediatric hospital patients. Eur J Pediatr. 2018;177:1139–48.

    Article  PubMed  Google Scholar 

  16. Prot-Labarthe S, Lavoie A, Bourdon O, et al. Étude pilote sur la mise en place des soins pharmaceutiques dans le service de pédiatrie générale d’un hôpital français Collaboration et comparaison franco-québécoise. Arch Pédiatrie. 2007;14:345–53.

    Article  CAS  Google Scholar 

  17. Nguyen V, Sarik DA, Dejos MC, et al. Development of an interprofessional pharmacist-nurse navigation pediatric discharge program. J Pediatr Pharmacol Ther. 2018;23:320–8.

    PubMed  PubMed Central  Google Scholar 

  18. Ramadaniati HU, Lee YP, Hughes JD. The difference in pharmacists’ interventions across the diverse settings in a children’s hospital. PLoS ONE. 2014. https://doi.org/10.1371/journal.pone.0110168.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zobell JT, Schwab E, Collingridge DS, et al. Impact of pharmacy services on cystic fibrosis medication adherence. Pediatr Pulmonol. 2017;52:1006–12.

    Article  PubMed  Google Scholar 

  20. Zhang C, Zhang L, Huang L, et al. Clinical pharmacists on medical care of pediatric inpatients: a single-center randomized controlled trial. PLoS ONE. 2012;7:e30856.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Cunningham KJ. Analysis of clinical interventions and the impact of pediatric pharmacists on medication error prevention in a teaching hospital. J Pediatr Pharmacol Ther. 2012;17:365–73.

    PubMed  PubMed Central  Google Scholar 

  22. Virani A, Crown N. The impact of a clinical pharmacist on patient and economic outcomes in a child and adolescent mental health unit. Can J Hosp Pharm. 2003;56:158–62.

    Google Scholar 

  23. Moffett BS, Mott AR, Nelson DP, et al. Medication dosing and renal insufficiency in a pediatric cardiac intensive care unit: impact of pharmacist consultation. Pediatr Cardiol. 2008;29:744–8.

    Article  PubMed  Google Scholar 

  24. Prot-Labarthe S, Di Paolo ER, Lavoie A, et al. Pediatric drug-related problems: a multicenter study in four French-speaking countries. Int J Clin Pharm. 2013;35:251–9.

    Article  PubMed  Google Scholar 

  25. Carthon CE, Hall RC, Maxwell PR, et al. Impact of a pharmacist-led vaccine recommendation program for pediatric kidney transplant candidates. Pediatr Transplant. 2017;21:e12989.

    Article  Google Scholar 

  26. Abrogoua D, Békégnran C, Gro B, et al. Assessment of a clinical pharmacy activity in a pediatric inpatient department in Cote D′ivoire. J Basic Clin Pharm. 2017;8:15.

    Article  CAS  Google Scholar 

  27. Fernández-Llamazares CM, Pozas M, Feal B, et al. Profile of prescribing errors detected by clinical pharmacists in paediatric hospitals in Spain. Int J Clin Pharm. 2013;35:638–46.

    Article  PubMed  Google Scholar 

  28. Echarri-Martínez L, Fernández-Llamazares CM, Manrique-Rodríguez S, et al. Pharmaceutical care in paediatric intensive care unit: activities and interdisciplinary learning in a Spanish hospital. Eur J Hosp Pharm. 2012;19:416–22.

    Article  Google Scholar 

  29. Abu Farha R, Abu Hammour K, Al-Jamei S, et al. The prevalence and clinical seriousness of medication discrepancies identified upon hospital admission of pediatric patients. BMC Health Serv Res. 2018;18(1):966.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Huynh C, Wong ICK, Tomlin S, et al. An evaluation of paediatric medicines reconciliation at hospital discharge into the community: paediatric medicines reconciliation discharge. Int J Pharm Pract. 2016;24:196–202.

    Article  PubMed  Google Scholar 

  31. Tripathi S, Crabtree HM, Fryer KR, et al. Impact of clinical pharmacist on the pediatric intensive care practice: an 11-year tertiary center experience. J Pediatr Pharmacol Ther JPPT Off J PPAG. 2015;20:290–8.

    Google Scholar 

  32. Fernández-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, et al. Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child. 2012;97:564–8.

    Article  PubMed  Google Scholar 

  33. Stone BL, Boehme S, Mundorff MB, et al. Hospital admission medication reconciliation in medically complex children: an observational study. Arch Dis Child. 2010;95(4):250–5.

    PubMed  Google Scholar 

  34. Coffey M, Mack L, Streitenberger K, et al. Prevalence and clinical significance of medication discrepancies at pediatric hospital admission. Acad Pediatr. 2009;9:360-365.e1.

    Article  PubMed  Google Scholar 

  35. Wang JK, Herzog NS, Kaushal R, et al. Prevention of pediatric medication errors by hospital pharmacists and the potential benefit of computerized physician order entry. Pediatrics. 2007;119:e77-85.

    Article  PubMed  Google Scholar 

  36. Kaushal R, Bates DW, Abramson EL, et al. Unit-based clinical pharmacists’ prevention of serious medication errors in pediatric inpatients. Am J Health Syst Pharm. 2008;65:1254–60.

    Article  PubMed  Google Scholar 

  37. Nguyen-Ha P-T, Howrie D, Crowley K, et al. A quality assessment of a collaborative model of a pediatric antimicrobial stewardship program. Pediatrics. 2016;137:e20150316–e20150316.

    Article  PubMed  Google Scholar 

  38. Rogers J, Pai V, Merandi J, et al. Impact of a pharmacy student–driven medication delivery service at hospital discharge. Am J Health Syst Pharm. 2017;74:S24–9.

    Article  PubMed  Google Scholar 

  39. Shah D, Manzi S. Pharmacist outpatient prescription review in the emergency department. Pediatr Emerg Care. 2018;34:497–500.

    Article  PubMed  Google Scholar 

  40. Marconi GP, Claudius I. Impact of an emergency department pharmacy on medication omission and delay. Pediatr Emerg Care. 2012;28:30–3.

    Article  PubMed  Google Scholar 

  41. Lehnbom EC, Li L, Prgomet M, et al. Little things matter: a time and motion study of pharmacists’ activities in a paediatric hospital. Stud Health Technol Inform. 2016;227:80–6.

    PubMed  Google Scholar 

  42. Provine AD, Simmons EM, Bhagat PH. Establishment and evaluation of pharmacist-managed admission medication history and reconciliation process for pediatric patients. J Pediatr Pharmacol Ther. 2014;19:98–102.

    PubMed  PubMed Central  Google Scholar 

  43. Maat B, Au YS, Bollen CW, et al. Clinical pharmacy interventions in paediatric electronic prescriptions. Arch Dis Child. 2013;98:222–7.

    Article  PubMed  Google Scholar 

  44. Dersch-Mills D, Hugel K, Nystrom M. Completeness of information sources used to prepare best possible medication histories for pediatric patients. Can J Hosp Pharm. 2011;64:10–5.

    PubMed  PubMed Central  Google Scholar 

  45. Lake N, Nawer H, Wagner D. Piloting medication histories in a pediatric postanesthesia care unit. J Perianesth Nurs. 2019;34(1):117–23.

    Article  PubMed  Google Scholar 

  46. Angoulvant F, Rouault A, Prot-Labarthe S, et al. Randomized controlled trial of parent therapeutic education on antibiotics to improve parent satisfaction and attitudes in a pediatric emergency department. PLoS ONE. 2013;8:e75590.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Malfará M, Pernassi M, Aragon D, et al. Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit. Int J Clin Pharm. 2018;40:513–9.

    Article  PubMed  Google Scholar 

  48. Bahnasawy SM, El Wakeel LM, Beblawy NE, et al. Clinical pharmacist-provided services in iron-overloaded beta-thalassaemia major children: a new insight into patient care. Basic Clin Pharmacol Toxicol. 2017;120:354–9.

    Article  CAS  PubMed  Google Scholar 

  49. Okumura LM, da Silva DM, Comarella L. Relation between safe use of medicines and clinical pharmacy services at pediatric intensive care units. Rev Paul Pediatr Engl Ed. 2016;34:397–402.

    Google Scholar 

  50. Prot-Labarthe S, Therrien R, Demanche C, et al. Pharmaceutical care in an inpatient pediatric hematopoietic stem cell transplant service. J Oncol Pharm Pract Off Publ Int Soc Oncol Pharm Pract. 2008;14:147–52.

    Article  Google Scholar 

  51. Krupicka MI, Bratton SL, Sonnenthal K, et al. Impact of a pediatric clinical pharmacist in the pediatric intensive care unit. Crit Care Med. 2002;30:919–21.

    Article  PubMed  Google Scholar 

  52. Christiansen SR, Morgan JA, Hilmas E, et al. Impact of a prescription review program on the accuracy and safety of discharge prescriptions in a pediatric hospital setting. J Pediatr Pharmacol Ther JPPT Off J PPAG. 2008;13:226–32.

    Google Scholar 

  53. Huynh C, Tomlin S, Jani Y, et al. An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital. Arch Dis Child. 2016;101:67–71.

    Article  PubMed  Google Scholar 

  54. Terry DRP, Solanki GA, Sinclair AG, et al. Clinical significance of medication reconciliation in children admitted to a UK pediatric hospital: observational study of neurosurgical patients. Pediatr Drugs. 2010;12:331–7.

    Article  Google Scholar 

  55. Cies JJ, Varlotta L. Clinical pharmacist impact on care, length of stay, and cost in pediatric cystic fibrosis (CF) patients: pharmacist impact in pediatric CF. Pediatr Pulmonol. 2013;48:1190–4.

    Article  PubMed  Google Scholar 

  56. Alagha HZ, Badary OA, Ibrahim HM, et al. Reducing prescribing errors in the paediatric intensive care unit: an experience from Egypt: prescribing errors in a PICU. Acta Paediatr. 2011;100:e169–74.

    Article  PubMed  Google Scholar 

  57. Nguyen M-NR, Mosel C, Grzeskowiak LE. Interventions to reduce medication errors in neonatal care: a systematic review. Ther Adv Drug Saf. 2018;9:123–55.

    Article  PubMed  Google Scholar 

  58. Horace A, Ahmed F. Polypharmacy in pediatric patients and opportunities for pharmacists’; involvement. Integr Pharm Res Pract. 2015;4:113.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Huynh C, Wong ICK, Tomlin S, et al. Medication discrepancies at transitions in pediatrics: a review of the literature. Pediatr Drugs. 2013;15:203–15.

    Article  Google Scholar 

  60. Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057–69.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Bédard P, Tardif L, Ferland A, et al. A medication reconciliation form and its impact on the medical record in a paediatric hospital: medication reconciliation in a paediatric hospital. J Eval Clin Pract. 2011;17:222–7.

    Article  PubMed  Google Scholar 

  62. American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians, Transitions Clinical Report Authoring Group. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128:182–200.

  63. Kaushal R, Goldmann DA, Keohane CA, et al. Adverse drug events in pediatric outpatients. Ambul Pediatr. 2007;7:383–9.

    Article  PubMed  Google Scholar 

  64. Varnell CD, Rich KL, Nichols M, et al. Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients. Pediatr Transplant. 2017;21:e13027.

    Article  Google Scholar 

  65. El-Rachidi S, Larochelle JM, Morgan JA. Pharmacists and pediatric medication adherence: bridging the gap. Hosp Pharm. 2017;52:124–31.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Sleath B, Bush PJ, Pradel FG. Communicating with children about medicines: a pharmacist’s perspective. Am J Health-Syst Pharm AJHP Off J Am Soc Health-Syst Pharm. 2003;60:604–7.

    Article  Google Scholar 

  67. Saseen JJ, Ripley TL, Bondi D, et al. ACCP clinical pharmacist competencies. Pharmacother J Hum Pharmacol Drug Ther. 2017;37:630–6.

    Article  Google Scholar 

  68. Bellomo R, Bagshaw SM. Evidence-based medicine: classifying the evidence from clinical trials–the need to consider other dimensions. Crit Care Lond Engl. 2006;10:232.

    Article  Google Scholar 

  69. Chan C, Woo R, Seto W, et al. Medication reconciliation in pediatric cardiology performed by a pharmacy technician: a prospective cohort comparison study. Can J Hosp Pharm. 2015;68:8–15.

    PubMed  PubMed Central  Google Scholar 

  70. McDonald D, Mansukhani R, Kokotajlo S, et al. Effect of nursing education on optimization of medication reconciliation in the pediatric emergency department. J Pediatr Pharmacol Ther. 2018;23:203–8.

    PubMed  PubMed Central  Google Scholar 

  71. Small L, Schuman A, Reiter PD. Training program for pharmacists in pediatric emergencies. Am J Health Syst Pharm. 2008;65:649–54.

    Article  PubMed  Google Scholar 

  72. Kennedy MJ, Phan H, Benavides S, et al. The role of the pediatric pharmacist in personalized medicine and clinical pharmacogenomics for children: pediatric pharmacogenomics working group. J Pediatr Pharmacol Ther JPPT Off J PPAG. 2011;16:118–22.

    Google Scholar 

  73. Lampkin SJ, Gildon B, Benavides S, et al. Considerations for providing ambulatory pharmacy services for pediatric patients. J Pediatr Pharmacol Ther. 2018;23:4–17.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The author thanks Dr Clarisse Roux (pharmacist in Nîmes University Hospital) for her review of the manuscript and the critical contributions of Dr Philippe Cestac (pharmacist in Toulouse University Hospital) and Dr Gaëlle de Barry (pharmacist in Montpellier University Hospital).

Author information

Authors and Affiliations

  1. Department of Pharmacy, CHU Nimes, Nîmes University Hospital, University of Montpellier, Place du Professeur Robert Debré, 30029, NIMES Cedex 09, France

    Irène Maffre, Géraldine Leguelinel-Blache & Ian Soulairol

  2. UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France

    Géraldine Leguelinel-Blache

  3. ICGM, CNRS, ENSCM, University of Montpellier, Montpellier, France

    Ian Soulairol

Authors
  1. Irène Maffre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Géraldine Leguelinel-Blache
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian Soulairol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Irène Maffre.

Ethics declarations

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Irène Maffre, Géraldine Leguelinel-Blache, and Ian Soulairol have no conflicts of interest that are directly relevant to the content of this article.

Availability of data and material

Not applicable.

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Author contributions

Irène Maffre wrote the initial manuscript and revised the manuscript, conducted the article inclusion process, collected the data, performed the statistical and results analyses, co-performed quality analysis of included studies and co-wrote the methodology of the review. Ian Soulairol critically reviewed the manuscript, co-wrote the methodology of the protocol, co-performed quality analysis of included studies, supervised and planned the review, and verified the statistical analysis. Géraldine Leguelinel-Blache critically reviewed the manuscript, supervised the methodology of the protocol, and planned the study. All authors read and approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maffre, I., Leguelinel-Blache, G. & Soulairol, I. A systematic review of clinical pharmacy services in pediatric inpatients. Drugs Ther Perspect 37, 363–375 (2021). https://doi.org/10.1007/s40267-021-00845-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-021-00845-y

Search

Navigation