(988) Beyond the Prescription: Exploring Medication Therapy Problems in Critically Ill Children

Introduction: Medication therapy problems (MTPs) are common within critically ill children and can increase mortality, lengths of stay, & costs. Pediatric & neonatal patients face unique challenges due to complex dosing, preparation, & administration drugs typically dispensed in adult strengths. This scoping review aimed to summarize published literature regarding MTPs in pediatric (PICU) & neonatal intensive care units (NICU) to aid practitioners and educators improve medication safety & medication-related outcomes in critically ill children.

Methods: PubMed & Embase were searched for studies using terms related to MTPs and critically ill patients. Studies of ICU survivors and drug-related admission were excluded along with non-English & non-original research. The Arksey & O’Malley framework was utilized, and reporting followed the PRISMA extension for scoping reviews.

Results: From 456 screened citations, 15 studies of PICU (n=4), NICU (n=8), or mixed (n=3) ICUs published from 2012-2023 were included representing 5 WHO regions. Most studies were conducted in Brazil with no studies from the United States. Six studies utilized the PCNE framework to classify MTPs while 7 did not use a predefined framework. Significant heterogeneity existed with respect to the type & number of reported MTPs. Drug dosing MTPs were commonly the most frequently reported constituting >50% of MTPs in 7 studies. Importantly, few studies mentioned specific drugs responsible for MTPs, however, parenteral nutrition & antimicrobials were among the most common. Only 4 studies assessed clinical significance of MTPs, noting the majority were moderate severity.

Conclusions: The findings reveal significant heterogeneity in MTP classification & reporting, with few studies using standardized frameworks. Dosing MTPs emerged as a common issue, underscoring the challenges of medication administration in pediatric populations. While few studies assessed the clinical significance of MTPs, those that did reported mostly moderate severity. These results emphasize the need for a standard approach to identifying, classifying, & reporting MTPs in PICU/NICUs, as well as the development and implementation of effective strategies to prevent & manage these problems, particularly in high-risk areas such as drug dosing and administration.