1. 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

2. 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 (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.

3. 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

4. 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

5. 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

6. 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

7. 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; )
Overall mean age
4.3 years (95%CI; )

14. 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

15. 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

17. 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

18. 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

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