gms | German Medical Science

Background: Problems of drug therapy are of outstanding interest. Due to off-label use, lack of age-appropriate formulations and individual dose calculations, children and adolescents are particular prone to problems. Identifying Drug-related Problems (DRPs) enables risk quantification and determination of the potential impact of prevention strategies.

We systematically investigated DRPs in hospitalised paediatric patients in Germany prior to the implementation of an electronic prescribing system, in order to identify the incidence and nature of DRPs and to ascertain the potential impact of electronic prescribing systems on the safety of pharmacotherapy in paediatrics.

Materials and Methods: An observational study was carried out during a 3-month period on a general paediatric ward at the Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen. All patients aged 0 to <18 years admitted to the study ward were observed and assessed with respect to DRPs. The identification of these was based on intensive chart review and regular interviews of nurses. The definition of DRPs used was “A Drug-related Problem is an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes” [1]. All DRPs were classified according to a modified version of the PCNE Classification for Drug-related Problems (V5.01) and judged with regard to their severity and preventability.

Results: 232 patients fulfilled the inclusion criteria and thus were considered for analysis. The median age of patients was 8 years (IQR 2 – 14) and median duration of stay on the study ward was 2 days (IQR 2 – 4). 207 patients (89.2%) had at least one drug prescription with a median of 4 drugs (IQR 2 – 6) per patient; the maximum number of drugs prescribed per patient was 24.

In total, 617 DRPs were identified in 89.4% (n=185) of patient with at least one drug prescription. 66.2% (n=137) of patients had at least one severe or moderate DRP. Absolutely, 0.5% (n=3) of DRPs were classified as severe, 55.3% (n=341) as moderate and 44.2% (n=273) as minor. Most DRPs were preventable and occurred during the prescribing (35.8%, n=221) and documentation (29.0%, n=179) process. Drug Use, Dose Selection and Drug Selection were less frequent afflicted with problems. DRPs were predominantly associated with antiepileptics and corticosteroids for systematic use.

Conclusion: This study clearly shows that drug therapy in children and adolescents is a high risk process. Prescribing and documentation appear to be most problematic, thus electronic prescribing systems may increase the safety of pharmacotherapy. This has already been shown in adult inpatients; however, paediatric data are still scarce. Further research needs to be done.