The magnitude of drug-related problems, typology, and predictors among patients admitted to the pediatric intensive care unit: impact of pharmacist-led interventions in Northwest Ethiopia

Background: Drug-related problems (DRPs) are a significant concern in hospitalized patients. In Ethiopia, DRPs occur at a rate of 9.2 per 100 admissions and 9.4 per 1,000 patient days; however, pediatric-specific data are limited. Objective: This study assessed the magnitude, types, and predictors of DRPs and evaluated the acceptability of pharmacist-led interventions in pediatric intensive care units (PICUs) in Northwest Ethiopia. Design: A multicenter prospective interventional study. Methods: All pediatric patients admitted to the PICU during the study period were consecutively enrolled. The study was conducted from January 1, 2025 to March 31, 2025 across four specialized hospitals, resulting in a total of 394 participants. DRPs were identified through medical record reviews, caregiver interviews, and direct bedside assessment by a clinical pharmacist. Each DRP was classified according to the Pharmaceutical Care Network Europe (PCNE) classification system version 8.01. Binary logistic regression was performed to identify independent predictors of DRPs. Results: Of the patients, 251 (63.7%) experienced at least one DRP, with 522 DRPs identified (mean 1.3 ± 0.8 per patient). The dominant domains were treatment effectiveness (54.6%) and treatment safety (30.3%), and 97.7% were deemed preventable. Drug and dose selection were the main causes (46.0% and 43.8%, respectively). Independent predictors included age 29 days-1 year (AOR = 2.2, 95% CI: 1.0-4.8), polypharmacy (⩾5 medications; AOR = 1.7, 95% CI: 1.0-2.8), multiple prescribers (AOR = 1.8, 95% CI: 1.1-2.9), prolonged ICU stay (⩾10 days; AOR = 2.4, 95%CI: 1.2-4.7), circulatory system disease (AOR = 3.5, 95% CI: 1.4-9.0), the use of anti-infectives (AOR = 5.0, 95% CI: 2.0-13.7), and antiepileptics medications (AOR = 2.1, 95% CI: 1.0-4.3) were independent predictors of DRPs. Conclusion: DRPs were common in PICU but predominantly preventable. Despite a modest mean number of DRPs per patient, the type and causes identified indicate opportunities for optimizing medication use. Younger age, polypharmacy, multiple prescribers, prolonged PICU stays, circulatory system disease, and specific drug classes were independent predictors. The high acceptance and effectiveness of pharmacist-led interventions underscore their crucial role in improving medication safety and optimizing pharmacotherapy in resource-limited intensive care settings.