Epidemiology of Preventable Drug-Related Problems (DRPs) Among Hospitalized Children at KAMC-Jeddah: a Single-Institution Observation Study

Figures & data

Table 1 Patients’ Characteristics (Total Number of Patients Experienced DRPs, N=235)

		ED n=49	Surgical n=62	Medical n=76	PICU n=22	NICU n=26	Total N=235
Age	0–1 month	1	3	3	5	12	24, 10.2%
	>1 month to ≤2 years	28	17	35	16	13	109, 46.4%
	>2 years to ≤6 years	8	23	17	0	0	48, 20.4%
	>6 years to ≤12 years	8	16	18	5	0	47, 20%
	>12 years to 15 years	1	3	3	0	0	7, 3%
Median age and IQR		1.5 years (IQR 10 months to 5 years)	4 years (IQR 14 days to 14 years)	2 years (IQR 11 months to 7 years)	9 months (IQR 5 months to 6 years)	2 years (IQR 2 days to 2 years)	1.5 year (IQR 6 months to 6 years)
Gender
Male		30	35	42	13	17	137, 58.3%
Female		19	27	34	9	9	98, 41.7%
Number of prescribed drugs per patient
<5 (total of 187 drugs)		25	16	15	0	9	65, 27.7%
5–10 (total of 896 drugs)		22	41	54	14	19	150, 63.8%
>10 (total 157 drugs)		0	5	7	8	0	20, 8.5%

Abbreviations: ED, emergency department; PICU, pediatric intensive care unit; NICU, neonatal intensive care unit; IQR, interquartile range; n, number of included patients with DRPs per study area; N, total number of patients with DRPs.

Figure 1 A total of 23 disease systems were recorded in 235 patients with DRPs.

Table 2 Frequency of Detected Preventable DRPs (280) Identified in 235 Patients Based on Age and Gender per Study Area Provided in Percentage (%, N/N)

Frequency of Preventable DRPs per Age and Gender		ED n=48	Surgical n=77	Medical N=92	PICU n=30	NICU n=33	Total N=280 (%, n^b/N^a)
Age	0–1 month	1	4	4	2	14	25, 8.9%
	>1month to ≤2years	31	19	44	21	19	134, 47.9%
	>2years to ≤6years	7	30	19	0	0	56, 20%
	>6years to ≤12 years	6	22	20	7	0	55, 19.6%
	>12 years to 15 years	3	2	5	0	0	10, 3.6%
Gender	Frequency in Male	26	47	49	18	25	165, 58.9%
	Frequency in Female	22	30	43	12	8	115, 41%

Notes: ^a% calculated of total number of preventable DRPs identified in each ward; ^bFrequency of identified preventable DRPs, as one child can contribute to more than one preventable DRP.

Abbreviations: DRPs, preventable drug-related problems; ED, emergency department; PICU, pediatric intensive care unit; NICU, neonatal intensive care unit; n, number of included patients with preventable DRPs per study area; N, total number of patients with preventable DRPs.

Table 3 Anatomical Therapeutic Chemical (ATC) 1st Level Classification for the Reported Preventable DRPs

ATC	Frequency (%, n^b/N^a)
A	25%, 70/280
B	25%, 70/280
C	1%, 3/280
H	1.8%, 5/280
J	32.9%, 92/280
L	0.7%, 2/280
M	3.9%, 11/280
N	6.8%, 19/280
R	2.9%, 8/280

Notes: ^a% calculated of total number of preventable DRPs identified in each ward; ^bFrequency of identified drug class in the preventable DRPs, as one child can contribute to more than one preventable DRP; ATC anatomical groups (9 identified groups involved in the preventable DRPs).

Abbreviations: ATC, anatomical therapeutic chemical; DRPs, preventable drug-related problems; A, alimentary tract and metabolism; B, blood and blood forming organs; C, cardiovascular system; H, systemic hormonal preparations, excluding sex hormones and insulin; J, anti-infective for systemic use; L, antineoplastic and immune-modulating agents; M, musculoskeletal system; N, nervous system; R, respiratory system; n, number of identified cases.

Table 4 Frequency of Identified Preventable DRPs’ Category per Study Area Classified According to PCNE Classification (V.7)

DRPs Category, Total (%, n*/N)	Classification	ED n=48	Surgical n=77	Medical n=92	PICU n=30	NICU n=33	DRP Incidence (%, n^b/N^a)
1-Dosing problems (74.6%, n=209/280)	Dose too low	39	38	67	15	5	58.6%, 164/280
	Dose too high	3	16	14	5	7	16.1%, 45/280
2-Drug choice problems (22.9%, n=64/280)	Duplication of drug	0	0	1	0	0	0.4%, 1/280
	No clear indication for the drug	1	7	4	1	11	8.6%, 24/280
	Contraindications	0	2	0	1	3	2.1%, 6/280
	Inappropriate drug	4	11	4	5	7	11.1%, 31/280
	Drug interaction	0	0	0	2	0	0.7%, 2/280
3-Drug use problems (2.5%, n=7/280)	Treatment duration too long	1	1	1	0	0	1.1%, 3/280
	Inappropriate drug monitoring	0	0	0	1	0	0.3%, 1/280
	Drug omission	0	2	1	0	0	1.1%, 3/280

Notes: ^a% calculated of total number of preventable DRPs identified in each ward; ^bFrequency of identified preventable DRPs, as one child can contribute to more than one preventable DRP.

Abbreviations: PCNE, Pharmaceutical Care Network Europe; DRPs, preventable drug-related problems; ED, emergency department; PICU, pediatric intensive care unit; NICU, neonatal intensive care unit; n, number of included patients with preventable DRPs per study area; N, total number of patients with preventable DRPs.

Table 5 Risk Factors Associated with Preventable DRPs (Location, Type of Admission, and Number of Medications)

Risk Factors		OR	95% CI	P-Value
Location	ED	1.27	0.75–2.16	0.337
	Surgical	3.31	1.95–5.62	0.00001*
	Medical	2.97	1.87–4.74	0.00001*
	PICU	4.44	1.87–10.52	0.00001*
	NICU	1	–	–
Type of admission	Transferred	1	–	–
	ED	1.8	1.45–4.42	0.036*
	Scheduled	2.89	1.83–4.70	0.005*
Number of medications		1.2	0.78–1.72	0.00005*

Notes: Binary logistic regression used to summarize the association between DRP and location, type of admission, and number of medications. *Significant at 0.05.

Abbreviations: DRPs, preventable drug-related problems; ED, emergency department; PICU, pediatric intensive care unit; NICU, neonatal intensive care unit; OR, odds ratio; 95% CI, 95% confidence interval.

Table 6 Variables Associated with Preventable DRPs (Location, Type of Admission, and Number of Medications)

(A) Chi-square test to summarize the association between DRP and location, type of admission, and gender
Variable	Chi-square	P-Value
Location	33.508	0.00001*
Type of admission	14.186	0.001*
Gender	0.608	0.436
(B) T-test for independent variables to summarize the association between DRP and age, weight, and number of medications
Variable	T statistic	P-Value
Age	0.862	0.389
Weight	0.989	0.323
Number of medications	8.755	0.00005*

Notes: Binary logistic regression used to summarize the association between DRP and age, weight, and number of medications. *Significant at 0.05.