54 Epidemiology of preventable drug-related problems (DRPs) in hospitalized children: single institution observational study

Abstract

Background Drug-related problems (DRPs) ‘are the unwanted effects of a drug that potentially lead to harmful outcome’, which receive substantial attention. Prescribing a drug for children is considered a challenging process for all healthcare providers and possesses an economic burden to the healthcare system. Hospitalized pediatric patients, in particular, represent a population at risk for DRPs. The epidemiology of preventable DRPs in children in Saudi Arabia remains scarce, which poses distinct challenges to all healthcare professionals. We aimed to characterize preventable DRPs in hospitalized children at KAMC-Jeddah. Methods This prospective observational study included children (aged 15 years or younger) admitted to pediatric units (excluding cancer units) at King Abdulaziz Medical City (KAMC)-Jeddah, which is located in Jeddah, the largest city in Makkah Province in the Kingdom of Saudi Arabia. The hospital is a 751-bed referral center. Five diverse pediatric wards were included (general, surgical, emergency department [ED], neonatal intensive care unit [NICU], and pediatric intensive care unit [PICU]). We excluded patients admitted to pediatric cancer units, patients with no medications, if admission was less than 24 hours, and patients aged more than 15 years. The study was done over a 3-month period to determine the incidence of preventable DRPs and investigate the possible associated factors (sex, age, admission location, type of admission, and number of medications). Results A total of 319 DRPs were identified in 235 patients, in which 280 (87.8%) of 319 DRPs were deemed to be preventable. The majority of preventable DRPs were related to dose selection (219 [78%] of 280). None of the preventable DRPs were life-threatening or fatal. The majority were assessed as moderate in severity (264 [94.3%] of 280). There was no significant difference between DRP incidence with age (mean 3.5, p=0.389), sex (p=0.436), and weight (mean 13.47, p=0.323). Younger children (aged 2 years or younger) admitted to the PICU were more likely to have a DRP (odds ratio 4.44, p=0.000). Scheduled admissions were 2.89 times more likely to be exposed to DRP compared with transferred admissions (p=0.005). Additionally, DRP incidence increased proportionally to the number of medications. Conclusion Our results show a high incidence of preventable DRPs, which were found to be related to dosing and drug choice problems. These results may be used for designing the epidemiology study in the pediatric population aiming to establish appropriate prevention strategies towards improvement and safe medicine use in this vulnerable patient population.