기타학회
| Prescription Intervention Activities by Pharmacists for Pediatric Patients in Korea | ||
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Department of Pharmacy, Asan Medical Center, South Korea
Introduction Despite the fatal consequences of medication prescribing errors in pediatric patients, these errors commonly occur. This is because the dosage and administration requirements vary widely according to their growth and developmental stages, as well as the frequent use of off-label medications. Although Clinical Decision Support Systems(CDSS) reduce these errors, their effectiveness may be limited in pediatric patients due to their complexity and insufficient drug information. Thus, specialized pharmacists play a crucial role. However, limited study exists on the activities of pediatric pharmacists in Korea. This study aimed to evaluate the status of pharmacist interventions for pediatric patients with electronic prescriptions.
Method A retrospective analysis was conducted on electronic medical records (EMR) of pediatric patients who received pharmacist interventions one or more times between May 1st and June 30th, 2022 from a single medical center. Baseline characteristics of the patients, such as age and medical department, were collected. Pharmacist who participated in rounds directly intervened with the physician and recorded the intervention details on EMR immediately afterwards. In cases where the pharmacist only conducted prescription review, the intervention details were electronically proposed for the physician to promptly review. The collected intervention details included the cause of interventions, classification of drugs, frequency of drugs intervened by pharmacists, severity of interventions (classified as potentially lethal, serious, significant, minor, or not significant), and the proportion of accepted pharmacist interventions.
Results The study included a total of 508 subjects, among whom there were 81 neonates (15.9%), 97 infants (19.1%), 112 toddlers (22.0%), 108 school-age children (21.3%), and 110 adolescents (21.7%). There were 163,693 electronic prescriptions, and a total of 3,102 pharmacist interventions, resulting in an overall intervention rate of 1.9%. The severity of interventions was categorized as follows: 'potentially lethal' (1 case, 0.032%), 'serious' (143 cases, 4.61%), 'significant' (2,913 cases, 93.91%), 'minor' (36 cases, 1.16%), and 'not significant' (9 cases, 0.29%). The most frequent causes of prescribing intervention were clinical pharmacokinetic consultations (1035 cases, 33.4%), parenteral nutrition interventions (1010 cases, 32.6%), and dosage and administration interventions (571 cases, 18.4%), respectively. The targeted medication classes for intervention were anti-infective agents (1278 cases, 41.2%), intravenous nutrition agents (1084 cases, 34.9%), central nervous system agents (193 cases, 6.2%), and cardiovascular agents (137 cases, 4.4%). Among the categories of therapeutic efficacy, the most commonly used anti-infective agent was glycopeptides, and the most frequently intervened drug was vancomycin. Of the total number of proposed interventions, acceptance of the interventions was 143,199 (87.5%).
Conclusion The study revealed numerous individualized prescription interventions tailored to the specific needs of each pediatric patient. Clinical pharmacokinetic consultations and interventions related to parenteral nutrition accounted for the majority of the interventions. The findings suggest that pediatric pharmacists in Korea, utilizing electronic prescription systems, are transitioning their prescription intervention activities from general dosage error interventions supported by CDSS to more specialized, patient-centered, and individualized interventions. |
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