Clinical Pharmacists on Medical Care of Pediatric Inpatients: A Single-Center Randomized Controlled Trial

Objective To explore the best interventions and working patterns of clinical pharmacists in pediatrics and to determine the effectiveness of clinical pharmacists in pediatrics. Methods We conducted a randomized controlled trial of 160 pediatric patients with nerve system disease, respiratory system disease or digestive system disease, who were randomly allocated into two groups, with 80 in each group. Interventions by clinical pharmacists in the experimental group included answering questions of physicians and nurses, giving advice on treating patients, checking prescriptions and patient counseling at discharge. In the control group, patients were treated without clinical pharmacist interventions. Results Of the 109 interventions provided by clinical pharmacists during 4 months, 47 were consultations for physicians and nurses, 31 were suggestions of treatment, with 30 accepted by physicians (96.77%) and 31 were medical errors found in 641 prescriptions. Five adverse drug reactions were submitted to the adverse drug reaction monitoring network, with three in the experimental group and two in the control group. The average length of stay (LOS) for patients with respiratory system diseases in the experimental group was 6.45 days, in comparison with 10.83 days in the control group, which was statistically different (p value<0.05); Average drug compliance rate in the experimental group was 81.41%, in comparison with 70.17% of the control group, which was statistically different (p value<0.05). Cost of drugs and hospitalization and rate of readmission in two weeks after discharge in the two groups were not statistically different. Conclusion Participation by clinical pharmacists in the pharmacotherapy of pediatric patients can reduce LOS of patients with respiratory system disease and improve compliance rate through discharge education, showing no significant effects on prevention of ADR, reduction of cost of drugs and hospitalization and readmission rate in two weeks. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-10001081

[1]  M. Alexander.  To Err is Human. , 2006, Journal of infusion nursing : the official publication of the Infusion Nurses Society.

[2]  Effect of pharmacist counseling on drug information recall. , 1982, American journal of hospital pharmacy.

[3]  S. Bratton,et al.  Impact of a pediatric clinical pharmacist in the pediatric intensive care unit , 2002, Critical care medicine.

[4]  D. Bates,et al.  Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. , 1999, JAMA.

[5]  Michelle Condren,et al.  Clinical Activities of an Academic Pediatric Pharmacy Team , 2004, The Annals of pharmacotherapy.

[6]  D. S. Newton,et al.  Influence on medication therapy of increased patient services by pharmacists in a pediatric hospital. , 1975, American journal of hospital pharmacy.

[7]  E. Davies,et al.  Drug Errors: What Role do Nurses and Pharmacists have in Minimizing the Risk? , 2003, Journal of child health care : for professionals working with children in the hospital and community.

[8]  Adil S. Virani,et al.  The Impact of a Clinical Pharmacist on Patient and Economic Outcomes in a Child and Adolescent Mental Health Unit , 2003 .

[9]  M. Mackay,et al.  Pharmacist monitoring of parenteral nutrition: clinical and cost effectiveness. , 1979, American journal of hospital pharmacy.

[10]  M. Couper,et al.  Promoting safety of medicines for children , 2007 .

[11]  J Crooks,et al.  Deviation from prescribed drug treatment after discharge from hospital. , 1976, British medical journal.

[12]  P. Shah,et al.  Pharmaceutical Care in Medical Progressive Care Patients , 1998, The Annals of pharmacotherapy.

[13]  W. Shannon,et al.  A Randomized, Prospective Evaluation of an Interventional Program to Discontinue Intravenous Antibiotics at Two Tertiary Care Teaching Institutions , 1997, Pharmacotherapy.

[14]  B. Roberts,et al.  Pharmacist influence on economic and morbidity outcomes in a tertiary care teaching hospital. , 1997, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[15]  G. Burckart,et al.  Standardized versus pharmacist-monitored individualized parenteral nutrition in low-birth-weight infants. , 1981, American journal of hospital pharmacy.

[16]  F. Cammarata,et al.  Effect of pharmacists on health care outcomes in hospitalized patients. , 1993, American journal of hospital pharmacy.

[17]  J. Gums,et al.  A Randomized, Prospective Study Measuring Outcomes after Antibiotic Therapy Intervention by a Multidisciplinary Consult Team , 1999, Pharmacotherapy.

[18]  Linda T. Kohn.  Academic health centers: leading change in the 21st century. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[19]  Maurizio Bonati,et al.  Survey of unlicensed and off label drug use in paediatric wards in European countries , 2000, BMJ : British Medical Journal.

[20]  G. Koren,et al.  Use of Clinical Pharmacists to Prevent Medication Errors in Children , 1991, The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians.

[21]  D. Bates,et al.  Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. , 2003, Pediatrics.

[22]  C. Destache,et al.  Impact of a Clinical Pharmacokinetic Service on Patients Treated with Aminoglycosides for Gram-Negative Infections , 1989, DICP : the annals of pharmacotherapy.

[23]  M. Pathy,et al.  Drug counselling in the elderly and predicting compliance. , 1984, The Practitioner.

[24]  B. Franklin,et al.  Incidence and Nature of Dosing Errors in Paediatric Medications , 2004, Drug safety.

[25]  S L Williford,et al.  Impact of pharmacist counseling on medication knowledge and compliance. , 1995, Military medicine.

[26]  J C Russo,et al.  Medication error prevention by clinical pharmacists in two children's hospitals. , 1987, Pediatrics.

[27]  G. Haig,et al.  Effect of pharmacist participation on a medical team on costs, charges, and length of stay. , 1991, American journal of hospital pharmacy.

[28]  H. Chrystyn,et al.  An investigation of hospital generated pharmaceutical care when patients are discharged home from hospital. , 2003, British journal of clinical pharmacology.

[29]  H. Chrystyn,et al.  The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. , 2002, British journal of clinical pharmacology.

[30]  P Impicciatore,et al.  Incidence of adverse drug reactions in paediatric in/out-patients: a systematic review and meta-analysis of prospective studies. , 2001, British journal of clinical pharmacology.

[31]  N. Col,et al.  The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. , 1990, Archives of internal medicine.

[32]  J. McElnay,et al.  Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland , 2004, Pharmacy World and Science.

[33]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[34]  Emmanuel,et al.  Drug consultation: its significance to the discharged hospital patient and its relevance as a role for the pharmacist. , 1972, American journal of hospital pharmacy.

[35]  D. Strong,et al.  Focus and impact of pharmacists' interventions. , 1993, The Canadian Journal of Hospital Pharmacy.

[36]  A. Haines,et al.  A pharmacy discharge plan for hospitalized elderly patients--a randomized controlled trial. , 2001, Age and ageing.

[37]  C. Hepler,et al.  Economic consequences of two drug-use control systems in a teaching hospital. , 1988, American journal of hospital pharmacy.

[38]  H. L. Lipton,et al.  The impact of clinical pharmacists' consultations on geriatric patients' compliance and medical care use: a randomized controlled trial. , 1994, The Gerontologist.

[39]  Michael J. Peters,et al.  Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. , 2003, Archives of internal medicine.

[40]  I. Wong,et al.  Interventions of Hospital Pharmacists in Improving Drug Therapy in Children , 2006, Drug safety.