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Drug-Related Problems and the Impact of Clinical Pharmacist Interventions in a Paediatric and Neonatal Intensive Care Setting: A Six-Month Prospective Observational Study at a Tertiary Care Teaching Hospital
1 2 3 4 Department of Pharmacy Practice, Hanagal Shri Kumareshwar College of Pharmacy, B.V.V.S, Bagalkote, Karnataka, India.
Published Online: May-August 2026
Pages: 01-06
Background: Children, and critically ill neonates in particular, rank among the patients most vulnerable to drug-related problems (DRPs), owing to weight-based dosing, immature organ function, frequent off-label prescribing and a comparatively thin evidence base. A ward-based clinical pharmacist is well placed to detect and resolve such problems before they translate into harm. Objective: To characterise the type, severity and predictors of DRPs in a combined paediatric and neonatal intensive care setting, and to evaluate the nature and prescriber acceptance of clinical pharmacist interventions. Materials and Methods: A six-month prospective observational study was conducted in the paediatric ward and neonatal intensive care unit (NICU) of a tertiary care teaching hospital. Consecutive inpatients (n = 110) were followed from admission to discharge. Medication orders were screened for DRPs using CIMS and IBM Micromedex together with standard references; interactions were graded by severity, and pharmacist recommendations and their acceptance were documented. Associations were tested using the Pearson chi-square test, with p < 0.05 taken as significant. Results: Among 110 children (71 male, 39 female), 167 DRPs were identified. Drug–drug interactions predominated (127; 76.0 %), followed by adverse drug reactions (20; 12.0 %) and improper drug selection (7; 4.2 %). Of the 127 interactions, 78 (61.4 %) were major and 3 (2.4 %) contraindicated. DRPs clustered strongly in children receiving five or more concurrent medications (χ² = 19.6; p < 0.001). Pharmacists made 73 recommendations, most commonly cessation of an offending drug (32) and drug substitution (18); 72 were accepted, and 47 produced a documented change in therapy. Conclusion: DRPs, dominated by potentially serious drug interactions, were common among hospitalised children and were closely linked to polypharmacy. A ward-based clinical pharmacist identified and resolved a substantial share of these problems with high prescriber acceptance, supporting the integration of clinical pharmacy services into routine paediatric and neonatal care.
