Pharmaceutical Challenges for Drug-Related Problems in Neonatal Intensive Care Unit: An Observational Study

Abstract

Introduction: Neonates are very sensitive and vulnerable individuals. They require multiple medications during their stay in the Neonatal Intensive Care Unit (NICU), which can lead to pharmacological errors and Drug-related Problems (DRPs), like drug-drug interactions and adverse drug effects. Aim: To assess DRPs in the NICU to improve the quality of pharmaceutical care. Materials and Methods: This prospective observational study was conducted from June 2023 to August 2023 in a tertiary-level, well-equipped NICU at JNU Hospital, Jaipur, Rajasthan, India. All 61 neonates admitted to the NICU were included, except for those who were admitted for less than 24 hours and had not been prescribed any medications. All DRPs were documented using the Pharmaceutical Care Network Europe (PCNE V9.1). The problems related to DRPs, their causes, planned interventions, acceptance of interventions, and outcomes were assessed. The final analysis was conducted with the Statistical Package for Social Sciences (SPSS) software version 25.0. A p-value <0.05 was considered statistically significant. Results: A total of 61 newborns were enrolled, of which 34 (55.74%) were males. DRPs were present in 47 (77.05%) of the total 61 patients. The total number of DRPs identified was 98. The most common problems were ‘unnecessary drug treatment’ 63 (64.29%) cases and ‘effect of drug treatment not optimal’ 28 (28.57%) cases. The most common cause of DRPs was ‘dose selection’ 105 (62.87%) cases. The intervention was accepted in 96 (97.96%) of the DRPs, and the problem was totally resolved in 70.41% of the cases. However, the problem remained unsolved in 17.35% of DRPs, primarily due to the ‘lack of cooperation from the prescriber’ in 9.18% of cases. Conclusion: Unnecessary and ineffective treatments, along with inappropriate doses, are the major problems and causes of DRPs. The need for clinical pharmacologists in NICUs, along with planned interventions and their acceptance, could help address these issues and ultimately lead to improved quality of care.

Keywords

• adverse drug effect
• drug overdose
• medical errors
• quality improvement