Steve Tomlin Consultant Pharmacist – Children’s Services Evaluation of a service to resolve drug-related problems in children admitted to hospital Steve Tomlin Consultant Pharmacist – Children’s Services Evelina Children’s Hospital Pharmacy Department

Introduction A Drug-Related Problem is defined as “an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes”1 DRPs are common and a major cause for harm and costs in hospitals. DRPs is up to 25% in inpatients (adult).2 DRPs were reported to be associated with 3-16% of hospital admission (adult).3 92% were probably preventable.3 The size of DRPs in children in the UK is relatively unknown Pharmaceutical Care Network Europe 2008. http://www.pcne.org/ (accessed on 06/12/2008). Koh Y, Kutty FB, Li SC. Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag 2005; 1(1):39-48.  Zargarzadeh AH, Emami MH, Hosseini F. Drug-related hospital admissions in a generic pharmaceutical system 1. Clin Exp Pharmacol Physiol 2007; 34(5-6):494-8.

Aim and objective To identify the incidence and type of DRPs in children admitted to hospital or attending A&E in a large UK teaching hospital Trust. To investigate causes of DRPs in children. To evaluate the effectiveness and cost of a service providing pharmacy support to reduce the problem

Methodology Observational study including patients aged 0-18 years Admitted to medical, surgical, PICU, and NICU wards or attending the A&E department at the study hospital 3 month data collection DRPs validated by a panel: consultant paediatrician clinical pharmacist researcher Score the validated DRPs in terms of potential patient outcomes on a validated scale (Dean & Barber model)* * Dean BS, Barber ND. A validated, relaiable method of scoring the severity of medication errors. Am J Health Syst Pharm 1999;56 (1): 57-62

Statistical Plan Descriptive analysis was conducted on the study demographics and DRPs using SPSS. The incidence of the DRPs was calculated with 95% CI. It is defined as number of patients with at least one DRP per total patients reviewed and multiplied by 100. Logistic regression to explore risk factors for DRPs Data will be analysed with respect to how many DRPs were identified and actions taken by the pharmacist. This will be related to the time the pharmacist spent reviewing patients and issuing recommendations for resolving DRPs

Demographic Results Total A&E Medical NICU PICU Number of pt 110 273 Ward Total A&E Medical NICU PICU Number of pt 110 273 50 483 Patient with DRP (%) 14 (12.7) 93 (34.1) 24 (48) 30 (60) 161 (33.3) Gender; n(%) Female 42 (38.2) 104 (38.1) 23 (46) 193 (39.9) Male 68 (61.2) 169 (61.9) 26 (52) 27 (54) 290 (60.0) No. of DRP (%) 17 (7.2) 143 (60.3) 28 (11.8) 49 (20.7) 237 (100) Age in group 0-1y 27 113 35 225 1-3y 18 32 10 60 >3y-≤6y 24 31 2 57 7y-12y 29 41 1 71 >12y-≤18y 12 56 70

Overall DRP Incidence 33.3% (95% CI; 29.1-37.7) Average time spent on evaluation and intervention for 237 DRPs: 12.7 minutes (SE ±1.5, 95%CI; 9.7-15.7) Overall mean age 4.3 years (95%CI; 3.8-4.7)

Cause of DRP Cause of DRP Number of cases % Drug or Dose Selection 70 29.5 Drug Use Process 26 10.9 Information 34 14.3 Patient/Psychological 16 6.8 Logistics 73 30.8 Others 12 5.1

Type of Intervention Type of intervention Number of cases % No intervention 19 8.0 Intervention at prescriber level 109 45.9 Intervention at patient/carer level 21 8.9 Intervention at drug level 125 52.7 Other 26 10.9

Examples A&E – propranolol liquid strength A&E – 100mg Viagra for a 3 yrs & 2 month old Medical – morphine infusion led to HDU Medical – 4 x dose of clindamicin A&E – Pen V (blanching trunk and vomiting) PICU – Fentanyl mg vs mcg (x2!!!!) Medical = Valproate – parents understanding

Loads to do Comparison of data with other centres Real role and cost of the pharmacist in preventing DRPs Value of pharmacist in A&E? Align data with Reconciliation data PUBLISH in early 2011

Thanks & Questions ASIA RASHED ECH pharmacy staff Prof Ian Wong Dr J Jackman NPPG & Man Med ASIA RASHED