Peer-reviewed article
Drug-related problems and their predictors in pediatric community-acquired infections: the role of pharmacist-led interventions in Pakistan.
Ali S, Zehra A, Anjum F, Shah SSAM, Abro F et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined medication errors in hospitalized children with infections in Pakistan and tested whether pharmacists could reduce them. Researchers reviewed over 3,800 medication orders for 400 children and found that more than half contained errors, most commonly incorrect doses. A trained pharmacist identified and corrected these errors, with doctors accepting 98.7% of recommendations and resolving 81% of problems. The intervention saved money and prevented potential harm to children.
Key points
- 5.03 drug-related problems per patient were identified, with 52.3% of medication orders containing errors
- Dose selection errors were the most common problem (58.13%), followed by wrong drug form (15.01%) and wrong drug selection (13.08%)
- 9% of errors had potential to cause serious harm to children
- Pharmacist interventions had 98.7% acceptance rate by physicians and resolved 81.1% of drug-related problems
- Direct cost saving was PKR 363,184 (USD 1,290) over 10 months with 142% return on investment
Limitations
The study was conducted in a single tertiary care hospital in Karachi, so findings may not represent all pediatric settings in Pakistan or other low-income countries. The study did not measure whether the prevented errors actually avoided patient harm or adverse events.
Abstract
Purpose Drug-Related Problems (DRPs) are a leading cause of preventable harm to hospitalized children, yet the data from low- and middle-income countries (LMICs) are limited. This study aimed to determine the prevalence, severity and determinants of DRPs in children with community-acquired infections (CAIs) using standard classification, and to quantify clinical and economic impact of pharmacist-led interventions. Methods A prospective interventional study conducted (June 2024-March 2025), in pediatric ward of tertiary care public hospital, Karachi, Pakistan. Children aged 2months-14 years with CAIs were enrolled. A trained pharmacist reviewed medication orders daily, identifying DRPs (classified by PCNE V9.1 and severity by NCC MERP criteria). Interventions were proposed to physicians and acceptance rates recorded. Direct cost savings were calculated and DRP predictors were identified using logistic regression. Results A total of 3,842 medication orders were reviewed for 400 patients, identifying 2,010 DRPs (5.03 DRPs/patient). Primary causes were dose-selection (C3-58.13%), drug-form (C2-15.01%), and drug-selection (C1-13.08%). Severity assessment classified 9.0% of errors as having potential to cause serious harm. Pharmacist interventions had 98.7% acceptance and 81.1% DRPs were resolved. Number of medications (AOR 1.32), fever (AOR 2.84) and length of stay >7days (AOR 1.76) were identified as predictors of DRPs; past immunization was protective (AOR 0.51). Direct cost saving was PKR 363,184 (USD1,290) over 10 months (23:1 cost ratio). Cost per DRP prevented was PKR 241 (USD 0.86), with 142% return on investment. Conclusion DRPs affected 52.3 per 100 medication orders in hospitalized children with CAIs, with dose selection DRPs predominant and 9% having serious harm potential. Pharmacist-led interventions demonstrated a 98.7% acceptance rate and 81.1% resolution of DRPs, and were associated with substantial cost savings, providing evidence for integrating clinical pharmacy services in LMICs.