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Epidemiology and potential associated risk factors of drug-related problems in hospitalised children in the United Kingdom and Saudi Arabia

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Aim

Drug-related problems (DRP) are “an event or circumstance involving drug therapy that actually or potentially interferes with the desired health outcome”. The extent and characteristics of DRPs in children in the UK and the Kingdom of Saudi Arabia (KSA) are unknown. Our aim was to determine the epidemiology of and identify risk factors for DRPs in hospitalised children.

Methods

A prospective cohort study was carried out in children aged 0–18 years, admitted to the medical ward, paediatric intensive care unit (PICU) and neonatal intensive care unit (NICU) during a 3-month period in two hospitals. Patients’ charts, medical records and laboratory data were reviewed daily to identify DRPs; their preventability and severity were assessed. Logistic regression was used to analyse the potential risk factors associated with DRP incidence.

Results

Seven hundred and thirty-seven children (median age 2.3 years, interquartile range 6 months to 8 years, 58.1% male) were included. Three hundred and thirty-three patients suffered from 478 DRPs. Overall DRP incidence was 45.2% (95% CI, 41.5–48.8); KSA (51.1%; 95% CI, 45.8–56.3), UK (39.4%; 95% CI, 34.4–44.6). Incidence was highest in the PICU (59.7%; 95% CI, 47.0–71.5). Dosing problems were the most frequently reported DRPs (n = 258, 54%). 80.3% of DRP (n = 384) cases were preventable; 72.2% (n = 345) of DRPs were assessed as minor; 27% (n = 129) as moderate. Number of prescriptions and type of admission (transferred) were potential risk factors for DRP occurrence in children.

Conclusions

Drug-related problems were common in the hospitalised children in this study; the most frequent were dosing problems and drug choice problems; the majority of them were preventable. Polypharmacy and transferred admission (another hospital or ward) were potential risk factors. To improve prescribing practices and minimise the risk of DRPs in hospitalised children, paediatric pharmacology and pharmacotherapy are important in medical education.

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Acknowledgements

The authors wish to thank Karen Topping, Jennifer Marianczak, Nikash Gudka, and Emma Kirk at the UK site, and Dr Ahmed Alsaati and Dr Aisha Alazmi at the KSA site for their help with the data collection. Asia Rashed was funded by the Yamani Cultural and Charitable Foundation, London, UK.

Funding

The study in the UK was funded by the Neonatal and Paediatric Pharmacists Group (NPPG) Man-Med award 2009.

Conflicts of interest

IW has received funding from the “Global Research in Paediatrics—Network of Excellence (GRiP)” (Seventh Framework Programme: FP7/2007-2013, Grant Agreement no. 261060) for paediatric pharmacoepidemiology research. Other authors declared that they have no financial interests that may be relevant to the submitted work.

Ethics approval

The study was approved by local NHS Ethics Committee in the UK and by the Research Committee at Kind Abdulaziz Medical City, National Guard Health Affairs, Jeddah, KSA.

Author contributions

ICKW created the idea of the study. AN revised the methodology and supervised the study and the analysis. ANR was responsible for the management and analysis of the data from all sites. ST, HA and AA were responsible for study implementation and data collection at their sites. AS, JJ, ST, MA and ANR were responsible for data assessment. ANR produced the first draft of the manuscript and all authors approved the final draft. LW contributed to the interpretation of results, reviewing and proof-reading the manuscript. ICKW is the guarantor of the study.

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Authors and Affiliations

  1. Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, 29–39 Brunswick Square, London, WC1N 1AX, UK

    Asia N. Rashed, Antje Neubert, Lynda Wilton & Ian C. K. Wong

  2. Department of Paediatric and Adolescent Medicine, FAU Erlangen-Nuremberg, Loschgestrasse 15, 91054, Erlangen, Germany

    Antje Neubert

  3. Evelina Children’s Hospital, Guy’s & St. Thomas’ NHS Foundation Trust, London, SE1 7EH, UK

    Stephen Tomlin & John Jackman

  4. National Guard Health Affairs, Kind Abdul-Aziz Medical City-Jeddah, P.O. Box 9515, Jeddah, 21432, Saudi Arabia

    Hani Alhamdan, Adnan AlShaikh, Ahmed Attar & Mohammed Aseeri

  5. Department of Pharmacology and Pharmacy (DPP), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong

    Ian C. K. Wong

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  1. Asia N. Rashed
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Corresponding author

Correspondence to Ian C. K. Wong.

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Rashed, A.N., Neubert, A., Tomlin, S. et al. Epidemiology and potential associated risk factors of drug-related problems in hospitalised children in the United Kingdom and Saudi Arabia. Eur J Clin Pharmacol 68, 1657–1666 (2012). https://doi.org/10.1007/s00228-012-1302-x

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