Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial

Frontiers in Pharmacology

Pharmacology

Merve Kaşıkcı¹  Nadir Yalçın²  Kutay Demirkan²  Karel Allegaert³  Şule Yiğit⁴  Hasan Tolga Çelik⁴ 

[1] Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye;Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye;Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium;Department of Development and Regeneration, Leuven, Belgium;Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, Netherlands;Division of Neonatology, Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye;

关键词: clinical pharmacist (CP);    drug-related problems (DRPs);    medication errors;    adverse drug reactions;    drug-drug interactions (DDIs);    pharmaceutical care;    pharmacotherapy optimization;   

DOI  :  10.3389/fphar.2023.1242779

 received in 2023-06-19, accepted in 2023-08-07,  发布年份 2023

来源: Frontiers

【 摘 要 】

Introduction: Drug-related problems (DRPs) incidence is higher in neonatal intensive care units (NICUs), compared to other pediatric wards due to aspects like off-label medications, pharmacokinetic/dynamic variability, or organ dysfunction/immaturity. This study aimed to determine whether and to what extent a clinical pharmacist intervention improves medication safety and prevents DRPs [medication errors (MEs), adverse drug reactions (ADRs), drug-drug interactions (DDIs)].Methods: A prospective, randomized, double blind, controlled study in NICU-admitted neonates was conducted. NICU patients were randomly assigned to the intervention (clinical pharmacist-led) (IG) or control group (standard care such as clinical diagnosis, pharmacotherapy) (CG). The clinical pharmacist was involved in the IG to identify-prevent-intervene MEs, or identify and monitor ADRs and DDIs. The primary outcome was the number of neonates who developed at least one DRP compared with those seen across IG and CG. Secondary outcomes included length of hospital stay, total number of drugs or DRP type.Results: Neonates were randomly assigned to CG (n = 52) or IG (n = 48). In total, 45%, 42%, and 16% of patients had at least 1 MEs, ADRs, and clinically significant DDIs, respectively. The number of patients with at least 1 ME was 28 (53%) and 17 (35%) in the CG and IG (p>0.05). The median (range) number of ME was higher in CG [1 (0–7)] than in IG [0 (0–4)] (p = 0.003). Applying regression analysis, the CG had 2.849 times more MEs than the IG (p<0.001). Furthermore, the number of patients (CG to IG) with at least one detected ADR or clinical DDI was 19 (36%) to 23 (47%) (p>0.05) and 4 (7%) to 12 (25%), respectively (p = 0.028).Conclusion: Clinical pharmacist availability to systematically and standardized identify, prevent and resolve DRPs among NICU patients is effective. Daily detailed clinical pharmacist observations and interventions enables prevention and monitoring of DRPs.Clinical Trial Registration ClinicalTrials.gov, identifier NCT04899960.

【 授权许可】

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Copyright © 2023 Yalçın, Kaşıkcı, Çelik, Allegaert, Demirkan and Yiğit.