This descriptive study illustrates drug-related problems and the ability of clinical pharmacists to identify and resolve them in pediatric intensive care units in four French-speaking countries.

IntroductionRational prescribing for children is an issue for all countries and has been inadequately studied. Inappropriate prescriptions, including drug omissions, are one of the main causes of medication errors in this population. Our aim is to develop a screening tool to identify omissions and inappropriate prescriptions in pediatrics based on French and international guidelines.MethodsA selection of diseases was included in the tool using data from social security and hospital statistics. A literature review was done to obtain criteria which could be included in the tool called POPI. A 2-round-Delphi consensus technique was used to establish the content validity of POPI; panelists were asked to rate their level of agreement with each proposition on a 9-point Likert scale and add suggestions if necessary.Results108 explicit criteria (80 inappropriate prescriptions and 28 omissions) were obtained and submitted to a 16-member expert panel (8 pharmacists, 8 pediatricians hospital-based −50%- or working in community −50%-). Criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology and miscellaneous). Each criterion was accompanied by a concise explanation as to why the practice is potentially inappropriate in pediatrics (including references). Two round of Delphi process were completed via an online questionnaire. 104 out of the 108 criteria submitted to experts were selected after 2 Delphi rounds (79 inappropriate prescriptions and 25 omissions).Discussion ConclusionPOPI is the first screening-tool develop to detect inappropriate prescriptions and omissions in pediatrics based on explicit criteria. Inter-user reliability study is necessary before using the tool, and prospective study to assess the effectiveness of POPI is also necessary.

A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription.

Discussion and conclusion This study highlights international consensus on prescription practice in pediatrics. The use of this tool in everyday practice could reduce the risk of inappropriate prescription. The impact of the diffusion of POPI tool will be assessed in a prospective multicentric study. 9 (2-9) 94.4 9 (3-9) 92.9 Rectal administration of paracetamol as a first-line treatment 8 (1-9) 78.9 8.5 (1-9) 85.7 The combined use of two NSAIDs 9 (1-9) 94.4 9 (7-9) 100 Opiates to treat migraine attacks 9 (3-9) 89.5 9 (8-9) 100 Omission of prescription Failure to give sugar solution to newborn babies and infants under four months old two minutes prior to venipuncture 9 (2-9) 88.9 9 (8-9) 100 Failure to give an osmotic laxative to patients being treated with morphine for a period of more than 48 hours 8 (2-9) 82.4 9 (8-9) 100 Urinary infections Inappropriate prescription Antibiotic prophylaxis following an initial infection without complications (except in the case of uropathy) 9 (1-9) 94.7 9 (9-9) 100 Antibiotic prophylaxis in the case of asymptomatic bacterial infection (except in the case of uropathy) 9 (1-9) 94.7 9 (8-9) 100 Vitamin supplements and antibiotic prophylaxis Inappropriate prescription Fluoride supplements prior to six months of age 9 (1-9) 94.7 9 (9-9) 92.9 Mosquitos Inappropriate prescription Citronella (lemon grass) essential oil 9 (1-9) 82.4 8.5 (1-9) 85.7 Anti-insect bracelets to protect against mosquitos and ticks 9 (1-9) 83.3 9 (1-9) 85.7 Ultrasonic pest control devices, vitamin B1, homeopathy, electric bug zappers, sticky tapes without insecticide 9 (1-9) 88.2 9 (1-9) 85.7 Omission of prescription Mosquito nets and clothes treated with pyrethroids 9 (1-9) 83.3 9 (1-9) 85.7 Digestive nausea, vomiting or gastroesophageal reflux problems Inappropriate prescription Metoclopramide 9 (3-9) 94.4 9 (3-9) 92.9 Domperidone 8 (2-9) 77.8 8.5 (3-9) 85.7 Oral administration of an intravenous proton pump inhibitor (notably by nasogastric tube) 9 (1-9) 94.7 9 (8-9) 100 Gastric antisecretory drugs to treat gastroesophageal reflux, dyspepsia, the crying of newborn babies (in the absence of any other signs or symptoms), as well as faintness in infants 9 (1-9) 94.7 9 (6-9) 92.9 9 (5-9) 94.4 9 (7-9) 100 Antibiotic treatment for a sore throat, without a positive rapid diagnostic test result, in children less than three years old 9 (1-9) 88.9 9 (5-9) 92.9 Antibiotics for-nasopharyngitis-congestive otitis-sore throat before three years of age-laryngitis-as a first-line treatment for acute otitis media showing few symptoms, before two years of age 9 (3-9) 82.4 9 (5-9) 92.9 Antibiotics to treat otitis media with effusion (OME), except in the case of hearing loss or if OME lasts for more than three months 9 (1-9) 84.2 9 (7-9) 100 Corticosteroids to treat acute suppurative otitis media, nasopharyngitis, or strep throat 9 (1-9) 94.7 9 (8-9) 92.9 Nasal or oral decongestant (oxymetazoline, pseudoephedrine, naphazoline, ephedrine, tuaminoheptane, phenylephrine) 9 (4-9) 82.4 9 (5-9) 92.9 H1-antagonists with sedative or atr...