Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review

Abstract

BackgroundProblems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. While previous reviews have provided an estimate of prevalence in this population, these predate recent developments in the delivery of paediatric care. Hence, there is a need for an updated, focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK, in order to support the development and targeting of interventions to improve medication safety.MethodsNine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to April 2019. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children. Quality appraisal of the studies was also conducted.ResultsIn all, 26 studies were included. There were no studies which specifically reported prevalence of adverse drug events. Two adverse drug reaction studies reported a median prevalence of 25.6% of patients (IQR 21.8–29.9); 79.2% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors (median prevalence 6.5%; IQR 4.7–13.3); of which, the median rate of dose prescribing errors was 11.1% (IQR 2.9–13). Ten studies reported on administration errors with a median prevalence of 16.3% (IQR 6.4–23). Administration technique errors represented 53% (IQR 52.7–67.4) of these errors. Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 23% (Range 20.1–46) of prescribed medication; 70.3% (Range 50–78) were classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors.ConclusionsChildren are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm,, there is a need for a deeper theoretical understanding of paediatric medication systems to enable more effective interventions to be developed to improve patient safety.

Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions

“…Our study found a great proportion of admissions with DRPs, a 45.1% of the cases. Most of the evidence available at a hospital level have focused on specific medical fields [51][52][53] , being limited to ambulatory patients in numerous occasions [54][55][56] . There are, however, some studies focusing on medical specialties, which found a DRP prevalence ranging from 15 to 81% 26,27,[60][61][62] .…”

Model Based Evaluation of Hypersensitivity Adverse Drug Reactions to Antimicrobial Agents in Children

“…Application of pharmacometrics methods in clinical practice give the ability to analyze pharmacokinetics profile and define the optimal doses of drugs in special populations such as children, in whom drugs are not usually studied during clinical trials (Sutherland et al, 2019). It is also possible to quantify doseresponse relationships in these populations (Lala, 2012).…”

Verbesserung der Arzneimitteltherapiesicherheit durch ein klinikinternes Meldesystem – Analyse der Meldungen über 15 Jahre einer Kinderklinik

“…Während Verordnungsprobleme nur gut 10 % der Meldungen in der vorliegenden Analyse ausmachten, publizierten Hart et al, dass eine medizinisch inkorrekte Verordnung in ihrer Untersuchung mehr als ein Drittel der Berichte ausmachten [15]. Auch andere Studien zeigen, dass die Inzidenz von Verordnungsfehlern direkt hinter Anwendungsfehlern rangiert [13,21,27].…”