A Narrative Review of the Prevalence, Types, and Contributing
Factors of Drug-Related Problems in Hospitals.
Tanvi Madane*, Dr. Rohini Chavan
Department of Pharmacy
Practice, PES’s Modern College of Pharmacy, Nigdi, Pune-411044, India.
*Correspondence: tanvimadane2002@gmail.com
DOI: https://doi.org/10.71431/IJRPAS.2026.5303
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Article
Information
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Abstract
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Review Article Received: 05/03/2026
Accepted:25/03/2026
Published:31/03/2026
Keywords
Adverse
drug reactions(ADR); drug-related problems(DRP); drug-drug interaction;
medication errors; polypharmacy
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Medication
is one of the most commonly used treatments used in modern healthcare; its
use is frequently linked to drug-related problems, such as medication errors,
adverse drug reactions, and inappropriate prescribing. Because concurrent conditions, clinical
complications, and poly pharmacy are common in hospital settings, these
issues can have a substantial impact on treatment outcomes and the safety of
patients. To categorize the most
widely used DRPs in clinical settings, determine which drug classes are most
commonly associated, and emphasize risk factors and successful interventions,
a systematic review was carried out.
PubMed, Scopus, Google Scholar, Web of Science, and the Cochrane
Library were used to conduct a thorough literature search for research
published between 2018 and 2025.Data on study characteristics, DRP types and
prevalence, risk factor, and interventions were extracted from relevant
articles on medication errors, adverse drug events, and drug-related hospital
admissions. The most common DRPs,
according to the review findings, were Drug choice problem (Inappropriate
drug selection, untreated indications), Dosing problem (incorrect dose
selection), adverse drug events, and drug-drug interactions. The main groups
of drugs involved were antimicrobial, cardiovascular agents, antidiabetic
drugs, and drugs that affect the central nervous system. Polypharmacy,
advanced age, several comorbidities, extended hospitalization, and clinical
complexity were all contributing factors.
Finally, DRPs continue to be a prevalent and avoidable issue in
patient care. Improving prescribing
procedures, encouraging interdisciplinary cooperation, and fortifying
clinical pharmacy services are all crucial to lowering DRPs, boosting patient
safety, and enhancing therapeutic results.
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INTRODUCTION
In pharmacology, a drug
is described as any chemical substance, excluding food, that produces
measurable physiological effects in living organisms [1]. Pharmacotherapy
remains the most widely used medical intervention and significantly improves
patient outcomes. Nevertheless, along with its therapeutic benefits, medication
use also carries the possibility of harm, making patient safety a priority [2,3]. Adverse drug use can
result in drug related problems (DRPs), which are described as "events or
circumstances involving medication that actually or possibly cause problems
with desired health outcomes." [4-6]. Medication Errors (MEs), which are defined as
"any avoidable occurrence that may cause or result in incorrect
application of medication or patient harm," are closely related to this. [7]. Though they can occur
at any
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Drug related problem
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Definition
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Drug dose too high
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Drug dose too high
occurs when the dosage of a drug is greater than required, resulting in
actual or potential harm to the patient. This can be due to prescribing
errors, lack of appropriate dose adjustment (e.g., in renal/hepatic
impairment), or drug interactions increasing drug levels." [25]
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Drug dose too low
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Drug dose too low occurs when a patient receives a dose of
medication that is less than what is required to produce the desired
therapeutic effect. This may be due to inappropriate dosage, frequency,
duration, drug interactions reducing effect, or patient-specific factors such
as weight or organ function."[25].
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Administration error
(including timing relative to meals)
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Errors in the method
or timing of drug administration, including incorrect route, technique, or
timing (e.g., before/after meals) that may alter absorption or efficacy.
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Drug interactions
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"A change in a drug's effect on the human body when the
medication is taken with a second drug" is the definition of a drug-drug
interaction [26].
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Adverse drug reaction
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According to the WHO,
an adverse drug reaction (ADR) is any unpleasant and unexpected reaction to a
medication that happens at dosages used for human prophylaxis, diagnosis, or
treatment, excluding failure to accomplish the intended purpose [27].
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Inappropriate
indications for diagnosis
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“Inappropriate indication occurs when a drug is prescribed for a
condition for which it is not clinically indicated or lacks evidence-based
justification. This includes prescribing drugs for conditions they are not
approved or recommended for.”
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Inappropriate
indications for patients
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“Inappropriate
indication for a patient occurs when a drug is prescribed despite the absence
of a proper, evidence-based medical need in that individual, which may result
in unnecessary exposure to adverse effects and increased treatment costs.”
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Incorrect Dosage form
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"Using a drug in a way that is inappropriate for the
patient's condition, capacity to use, or planned route results in suboptimal
therapy or a risk of harm." This is known as "incorrect dosage
form."
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\stage of the use of medications, including prescriptions,
transcription, dispensing, and administration, prescription and administration
errors are the most frequently reported [8]. Common examples of
DRPs
Table 1) include
inappropriate dosage (either excessive or subtherapeutic), irrational drug
selection, Drug-drug interactions (DDIs), Adverse drug reactions (ADRs), and
non-adherence linked to psychological,
behavioural, or social
causes [9-11].
To better understand and
categorise DRPs, several classification frameworks have been introduced. The
influential model proposed by Hepler and Strand identifies categories such as
untreated indications, adverse drug reactions, improper drug selection, subtherapeutic
and excessive dosages, drug interactions, failure to receive medication, and
drug use without a valid indication [12]. More structured systems, such as the
Pharmaceutical Care Network Europe (PCNE) classification and Cipolle’s
framework, extend this approach by examining causes, interventions, and
outcomes [13]. DRPs and medication errors pose a serious public health concern
on a global basis, as they increase morbidity, lengthen hospital stays, and
drive up medical expenses. Research indicates that 5–10% of hospital stays are
directly related to preventable medication-related incidents, and 10 to 20 per
cent of hospitalised patients have at least one ADR [14]. The likelihood of
errors is even higher in high-acuity settings such as intensive care units,
operating theatres, and emergency departments, where treatment complexity and
time-sensitive decisions are routine [15,16]. For example, a study conducted in England in
2021 reported ADRs in 12.6% of psychiatric inpatients, illustrating the
widespread impact of DRPs across specialities [17].
In India, the scenario
is similarly concerning. According to Professor Jha's estimations, the British
Medical Journal highlighted the fact that there are roughly 5.2 million medical
errors per year. Contributing factors include a shortage of trained healthcare
professionals and nursing staff, inadequate resource allocation, and limited
systems for monitoring clinical outcomes [18]. Several
patient-related and treatment-related risk factors further increase the likelihood
of DRPs. These include polypharmacy, comorbidities, age-associated
pharmacokinetic and pharmacodynamic alterations, and the complexity of
hospital-based therapeutic regimens [19,20]. Older adults are especially vulnerable due to
multiple chronic illnesses, polypharmacy, and heightened susceptibility to ADRs
and DDIs [21]. The impact of DRPs extends beyond clinical harm, often impairing
quality of life, diminishing adherence to prescribed regimens, and contributing
to recurrent hospital readmissions [22]. Clinical pharmacists have an essential role in
addressing this burden, as their active involvement in multidisciplinary teams
has been shown to reduce prescribing errors, enhance medication safety, and
optimise therapeutic results [23,24].
Considering the
significant and largely preventable nature of DRPs, especially within hospital
environments, a consolidated understanding is required to strengthen patient
safety and ensure rational drug therapy. Although many studies have explored
DRPs in specific departments or populations, there remains a need for a
comprehensive and updated overview. The present review, therefore, aims to
synthesise current evidence on DRPs in hospital settings, focusing on their
definitions, classifications, prevalence, risk factors, clinical consequences,
and strategies for effective detection and prevention.
MATERIALS AND METHODS
Using five online
databases—PubMed, Scopus, Google Scholar, Web of Science, and the Cochrane
Library—a systematic review of the literature was carried out on articles
published in English between 2018 and 2025 (see Figure 1: PRISMA Flow Diagram).
To identify and eliminate duplicate studies and those unrelated to the topic, a
screening of titles and abstracts was conducted following the initial search.
The following search
terms and Boolean operators were used: ("adverse drug events" OR
"adverse drug reactions" OR "medication errors" OR
"medication-related problems") AND ("hospital admissions"
OR "hospitalisation") AND ("incidence" OR
"prevalence").
Studies were included if
they involved hospitalised patients (patient population) and reported DRPs such
as adverse drug reactions, medication errors, or other medication-related
issues. Eligible study designs included observational (cross-sectional, cohort,
and case-control) and interventional studies. Studies were required to report
clinical or epidemiological outcomes, such as the incidence, prevalence, or
risk factors of medication-related problems. Case reports, editorials,
commentaries, non-hospital-based studies, and non-English publications were
excluded.
Data extracted from each
included study comprised the author and year of publication, total number of
patients, frequency of hospitalisation due to medication, type of
medication-related issue (e.g., ADRs), identified risk factors, and reported
interventions. To ensure consistency across studies, all DRPs were reclassified
according to the Pharmaceutical Care Network Europe (PCNE) DRP classification
system (version 9.1). Equivalent study terms were mapped to the nearest PCNE
category.
The quality and risk of
bias of the included studies were assessed using the Newcastle–Ottawa Scale
(NOS) for observational studies and the ROBINS-I tool for interventional
studies. Two reviewers independently performed the assessment, and
discrepancies were resolved through consensus.
Identification of studies via databases and
registers
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Records
identified from: Databases (n=100)
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Records
removed before screening:
Duplicate
Records removed (n=20)
Records
removed for other reasons (n=5)
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Records sought for
retrieval (n=50)
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Reports not
retrieved(n=0)
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Reports assessed for
eligibility (n=50)
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Reports excluded:
DRP was not mentioned
(n=17)
Major contributing
drugs was not mentioned (n= 13)
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Studies included in
review (n= 20)
Reports of included
Studies
(n= 20)
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Fig. 1: Schematic form
of identification and screening of the studies and literatures from the
databases
RESULT
Twenty studies [Table 2]
from eight countries published between 2018 and 2025 were included, with India
accounting for the largest share (45%).
When taken as a whole, these studies examined over 25,000 prescriptions
from different hospital settings, such as medical wards, intensive care units,
and neonatal intensive care units. DRPs
were reported to be prevalent in 14% to 77% of cases (mean 46.8%). Drug choice problem (Inappropriate drug
selection (44.1%), untreated indications (20.9%)), Dosing problem (incorrect
dose selection (32.8%)), ADE(28.6%), and DDIs(16.3%) were the most common DRP
types.
The most frequently
implicated drug class was antimicrobials (60–65%), followed by medications for
the CNS (20–25%), cardiovascular (30–35%), and antidiabetic (25–30%). Ceftriaxone, metronidazole,
piperacillin-tazobactam, linezolid, colistin, insulin, metformin, and calcium
channel blockers were among the frequently used medications. An estimated 25–35% of DRPs were associated
with improper use of antibiotics. The
most common risk factors were comorbidities like hypertension, diabetes, and
renal impairment (55–65%) and polypharmacy (40–70%).
The Drug use process
problems (prescription (45.1%), documentation (33.8%), and administration
(21.1%)) phases were the most common times that medication errors were
reported. 90% of studies reported
clinical pharmacist involvement, with up to 99% of DRPs resolved through dose
modification (27–33%), stopping inappropriate therapy (20–25%), or adding
necessary treatment (15–20%). The
majority of unresolved DRPs (5–10%) were associated with complex clinical
conditions.
Table 2: List of literatures.
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Study N.
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Reference
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Country
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Drug related problem
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Problems on admission
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Major contributing Drugs
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Remark
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1
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[28]
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India
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Drug choice problem(14.54%), andDrug drug interaction(6.36%)
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The
prevalent comorbidities were ischemic heart
disease (21.81%), urinary
tract infections
(18.18%)andchronic kidney disease
(14.54%).
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37.27% received monotherapy for T2DM, with Human
Actrapid being the most common (70.73%).
Dual therapy (33.63%)
was dominated by Vildagliptin+Metformin (29.72%)and triple therapy (10%) most often involved
Metformin+Voglibose+Glimepiride (63.63%).
Beta blockers (36.36%) and calcium channel blockers (37.27%) were common,
with bisoprololaccounting for 23.63%.
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DRPs have a major influence on how T2DM and HTN
are managed, emphasizing the necessity of routine medication reviews and
focused interventions to maximize therapeutic results in these patients.
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2
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[29]
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India
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Dosing problem, suboptimal drug treatment
outcomes, and ambiguous issues
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NR
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Antihypertensives, proton pump inhibitors,
furosemide, anticoagulants
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DRPs are an emerging issue within the connes of
the health-care system
and should be
scrutinized to avoid
negative outcomes. A stage-wise
analysis of patients
who are at
risk will ensure
better patient care
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3
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[30]
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India
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Drugchoice problem by the prescriber 193 (59.5%),
drug-drug interactions (16.3%), Inappropriate drug formulations were
prescribed for 7 (2.1%), Dosing problem were observed in 3 (0.9%),
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NR
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Ceftriaxone+Heparin, Azithromycin+
ondensetron,Formeterol+ ondensetron , Ibuprofen+ Ciprofloxacin, Haloperidol+
Promethazine
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The current study emphasizes the importance of
reporting DRPs to patients in order to provide better health care and
advocates the significance of clinical pharmacists in pharmaceutical patient
care.
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4
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[31]
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Egypt
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Drug treatment effects not optimal 714 (41.4%),
Adversedrugevents455 (26.4%)
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NR
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Metronidazole, cefepime, linezolid, amikacin,
meropenem, cefotaxime, piperacillin-tazobactam, ampicillin-sulbactam,
caffeine, and dopamine
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This study showed how important clinical
pharmacists are in recognizing and addressing DRPs, which are prevalent in
the NICU.
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5
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[32]
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Turkey
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Adverse drug events (ADEs) (77.18%),Drug choice
problem(40.29%) and Dosing problem(54.36%),Drug introduction(35.43%)
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Respiratory system problems (60.9%) and sepsis
(72.2%), nephrotoxicity (48.57%), electrolyte disorders (17.14%),
drug-induced thrombocytopenia (17.14%), liver enzyme increase (8.57%) and
other causes (8.57%)
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Heparin, linezolid, and piperacillin-tazobactam
are a few medications that can cause thrombocytopenia. The main medication that causes
nephrotoxicity is colistin.
Hyperkalemia brought on by trimethoprim-sulfamethoxazole is an example
of an electrolyte imbalance.
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In this study, the importance of the clinical
pharmacist in the determination and analysis of DRPs was emphasized. Clinical
pharmacy services like the one described should be implemented widely to
increase patient safety.
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6
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[33]
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India
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Adverse drug events(n = 933, 8.9%), Drug interactions(20.1%) drug–disease
interactions (7.9%)
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Pedal edema (6.6%), sedation (5.3%) and gastritis
(5.2%)
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Antihypertensives (24, 35.8%), neurological drugs
(16, 23.8%) and antidiabetics (10, 14.9%).
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One out of 10 prescriptions of older outpatients
carries a DRP. New-onset metabolic and neurological disturbances should prompt
a thorough drug history. A multifaceted holistic approach can prevent
significant drug-related morbidity and requires future evaluation.
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7
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[34]
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India
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Drug Choice problem(Inappropriate choice 63
(14.82%),Similar range of activity 51 (12%),antibiotic administered with no
indication 58 (13.65%)), Dosing problem(Regimen insufficient 103 (24.24%),
Regimen excessive 150 (35.29%))
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NR
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Metronidazole [n = 110 (25.8%)] was used
inappropriately which was followed by Cefuroxime + sulbactam [n = 63
(14.82%)]
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An antibiotic stewardship program in which the
Clinical pharmacist is an integral part along with well-framed institutional
antibiotic guidelines must be implemented to assure appropriate antibiotic
use.
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8
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[35]
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India
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There were 559 DRP causes found in all. Of thesewere Drug choice problem(drug
selection157(28.2%),drug use process [n = 127 (22.7%),no or insufficient drug
therapy in spite of existing indication[n = 90 (16.1%)]), Dosing
problem(dosage selection [n = 141 (25.0%)]) as causes of DRPs.
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Neonatal sepsis plus RDS 74 (17.3%), RDS plus RDS
plus unconjugated hyperbilirubinemia 67 (15.7%), RDS plus 58 (13.6%), RDS
plus pneumonia 53 (12.4%), RDS 43 (10.0%), RDS plus chronic heart disease 34
(7.9%), Unconjugated hyperbilirubinemia 31 (7.2%), Neonatal sepsis plus
convulsion 28 (6.5%), pneumonia 18 (4.2), convulsion 12 (2.8%), Chronic heart
disease
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The most commonly prescribed drug class was
antimicrobial agents [n = 1200(55.2%)], followed by respiratory agents [n =
378(17.4%)], with the primary medications in each class being gentamicin [n =
215(17.9%)] and caffeine [n = 127 (33.5%)].
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Neonates admitted to the NICU frequently have
DRPs. Clinical pharmacists can be very
helpful in detecting, preventing, and treating DRPs in newborns.
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9
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[36]
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India
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Adverse drug-event, followed by Drug choice
problem(untreated indication anddrug selection,indication for drug-treatment
not noticed),effect of treatment not optimal,
Dosing problem(dose selection,pharmacokinetic problem requiring dose
adjustment and drug dose too high)
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NR
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Levofloxacin, simvastatin, paroxetine,
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The participation of clinical pharmacists into
multidisciplinary teams promotes the detection and solution of DRP.
Polypharmacy, obesity, renal impairment and allergy are associated with a
higher risk of DRP during admission.
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10
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[37]
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Ethiopia
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Half (60/121) of these drug-related issues were
caused by treatment-effectiveness issues, with Drug choice problems(31/121,
26.3%), Dosing problem(19/121, 16.1%), and other unspecified but connected
issues (19/121, 16.1%) following.
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NR
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NR
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Drug-therapy-related issues were very common, and
the medical ward had a high rate of acceptance of interventions that had
significant effects on the economy, clinical practice, and organization.
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11
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[38]
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Indonesia
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Drug dose problem (No effect of drug treatment
8.68%, Effect of drug treatment not optimal 35.76%, Untreated symptoms or
indication 22.22%,Unnecessary drug-treatment 17.36%, Inappropriate drug
according to guidelines/formulary 2.95%, Inappropriate drug (within
guidelines but otherwise contra-indicated) 3.22%, No indication for the drug 13.17%,
Inappropriate duplication of a therapeutic group or active ingredient
5.64%, No or incomplete drug treatment
despite an existing indication 20.16%,Too many drugs prescribed for an
indication 1.34%), Adverse drug event (possibly) occurring 15.62%, , Drug
drug interaction 13.44%, Dosing problem (Inappropriate drug form (for this
patient) 0.53%, Drug dose too low 1.34%, Drug dose too high 1.88%, Dosage
regimen not frequent enough 4.03%, Dosage regimen too frequent 0.53%,
Duration of treatment too short 10.21%), Drug use process problem
(Inappropriate timing of administration or dosing intervals 11.29%, Drug
under-administered 3.49%, Drug not administered at all 2.15%, Wrong drug
administered 0.26%,No or inappropriate outcome monitoring (incl. TDM) 0.26% )
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NR
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Antibiotic 23.1%, NSAID 12.5%, Steroids 7.6%,
Antihyperglycemic6.6%, Gastroenterology drugs 6.3%, Antihypertension 5.6%,
Antipyretics 5.3%, Antihistamines 3.6%, Antiemetics 2.6%, Antiepilepsy 2%,
Antihyperlipidemic2%, Others12.2%, Untreated indication 10.6%,Total 100
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The incidence of DRP in a patient is influenced
by age, length of stay, and the number of medications taken; the incidence of
DRP in a patient is influenced by gender in addition to age and medication.
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12
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[40]
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Thailand
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Dosing problem(Dosages that are too high
(22.31%), too low (26.93%))and require additional medication therapy
(27.09%), Drug choice problem(Ineffective medication (8.05%), unnecessary
medication therapy (12.35%)), Drug
use process problem(2.15 percent non-adherence), Adverse drug events(1.12%)
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Dyspnea and high blood pressure, neurotoxicity,
hyperglycemia
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Electrolytic calorie and water balance agents 179
items (13.82%), cardiovascular medications 171 items (13.20%), and
antiinfective agents 307 items (23.71%)
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The most frequent DRPs were the requirement for
extra medication therapy and antimicrobial agent dosage modifications. The ward's clinical pharmacists are
proficient in both preventing and addressing DRPs.
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13
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[41]
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India
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Drug use process problem(Errors in prescription
[92 (45.1%)], documentation [69 (33.82%)], and administration [43 (21.08%)]
)were the next most common.
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NR
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Sodium chloride [11 (5.47%)], glimepiride [10
(4.97%)], insulin [19 (9.45%)], magnesium sulfate [9 (4.48%)], and potassium
chloride were implicated in 26 (12.94%) of MEs. Twenty-eight percent (58) of the errors
were related to medications used in the cardiovascular system. Blood and organs that form blood [30 (14.92%)],
medications under the nervous system [33 (16.42%)], and IV fluids [5 (2.49%)]
were the least frequently used HAMs in error.
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Even though error prevention has advanced
significantly, the objective of making HAM errors "never" occur has
not been met. Therefore, a clinical
pharmacist's active monitoring could help the medical staff advance patient
care.
|
|
14
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[42]
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Iran
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Drug-drug interactions (36.26%) and Drug choice
problem(126 prescriptions, 29.86%)
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Pneumonia (35.6%), gastroenteritis problems
(10.8%), and trauma (9.6%). diabetes mellitus (DM), glucose-6-phosphate
dehydrogenase (G6PD) deficiency, and central nervous system (CNS) disorders
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Antibiotics (53.47%), anticonvulsants (18.56%),
and proton pump inhibitors (PPIs) (20.06%).
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The incidence of DRPs is high among patients
admitted to PICUs. It is crucial to
think about the best possible dosage modification, especially for young
patients with compromised kidney function.
|
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15
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[43]
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India
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Drug choice problem(Duplication of a therapeutic
group or active ingredient (1.5%), no clear indication for drug use
(4.6%),noprescription but clear indication (3.8%)), Dosing
problem(inappropriate drug form (6.1%), Drug drug interaction(4.1%)
|
Foot or ankle swelling, hypotension (3.3%),
hypoglycemia (3.2%), mild rash or itching (1.5%), extreme sleepiness (1.4%),
and skin rashes (1.0%)
|
Insulin + Emeril accounted for the majority of
drug interactions (226; 11.8%), followed by Emeril + PCM + Diclofenac (111;
5.8%).
|
Clinical pharmacists play a vital role in
reducing issues related to drugs. More
focus should be placed on patient counseling and follow-up in particular.
|
|
16
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[44]
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India
|
Out of a total of 24,572 medication orders, 2,624
had prescription errors
|
The central nervous system (27), gastrointestinal
(10), cardiovascular (9), musculoskeletal (9), endocrinological involvement
(4), infections (12), renal (12), respiratory involvement (37), and poisoning
(15) come next.
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89 (0.4%; 95% CI 0.3–0.4), cardiovascular 82
(0.3%; 95% CI 0.3–0.4), antihypertensives 55 (0.2%; 95% CI 0.2–0.3), general
care and nutrition 1,367 (5.6%; 95% CI 5.3–5.8).
|
10.7% of MPEs occurred in the tertiary care
hospital's medical intensive care unit, with 3.52% of those errors being
considered severe.
|
|
17
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[45]
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United Arab Emirates
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Drug choice problem(61%, n = 503), dosing
problem(22%, n = 225)
|
NR
|
Antimicrobial agents
|
The study highlights the importance of CP in the
intensivecare unit, addressing DRPs and improving patient care in
general. It also draws attention to
how pharmacist interventions may enhance patient survival results. This emphasizes how crucial it is to
introduce CP services in ICUs throughout the United Arab Emirates.
|
|
18
|
[46]
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Thailand
|
Dosing problem(excessive dosage (27.7%)), Drug
choice problem(ineffective medication (17.2%), need for further medication
(15.3%), needless medication (14.6%),) adverse drug event (9.7%), andDrug use
process problem(1.2%).
|
Sepsis or septic shock, Hemodynamic unstable,
Hemorrhagic or hypovolemic shock, Postcardiac arrest, Status epilepticus,
Drug overdose
|
Intravenous phenytoin, amiodarone, propofol,
midazolam, vancomycin, acyclovir, ganciclovir, amikacin, ophthalmic
lubricants, proton-pump inhibitors (PPIs), trimethoprim and sulfamethoxazole,
meropenem, levofloxacin, fluconazole, and colistin
|
In the tertiary university hospital's medical
intensive care unit, the most common drug-related issue found during
medication care interventions is an excessive dosage..
|
|
19
|
[47]
|
China
|
Drug Choice problem(124; 44.1%), Dosing
problemC3(92;32.7%)
|
Cerebrovascular disease, hypertension, diabetes,
infectious diseases, and atrial fibrillation
|
Traditional Chinese Medicine (85.2%),
antihyperlipidemic drugs (86.4%), antiplatelet drugs (81.9%),
antihypertensive drugs (71.0%), and drugs for the digestive system (46.2%)
|
Clinical pharmacists can successfully minimize
and prevent DRPs to maximize medication therapy. DRPs are a common occurrence
in the neurology unit in China, and they are the main reason for drug and
dose selection.
|
|
20
|
[48]
|
Ethiopia
|
Drug use process problem(17.22%), Drug choice
problem92 (27.79%), and Dosing problem(16.92%)
|
NR
|
Diclofenac 31 (14.42%), ceftriaxone 61 (27.37%),
and cimetidine 32 (14.88%)
|
It was discovered that a significant number of
patients admitted to the study settings' medical wards had drug therapy
issues. In order to address the DTPs
in this area, clinical pharmacy services ought to be implemented in hospital.
|
Note: NR = Not reported.
Blank cells were completed using these standardized abbreviation to improve
data clarity. DRP categories were standardized according to the Pharmaceutical
Care Network Europe (PCNE) Classification V9.1. Original study terminology was
harmonized for consistency.
DISCUSSION
DRPs continue to be a
major and complex issue in hospital settings for a variety of patient
populations, including critically ill patients, adults, and neonates, according
to an analysis of 20 recent studies. Unsuitable drug or dose selection, ADRs,
left untreated indications, DDIs, polypharmacy, and failure to adhere are among
the most frequently reported DRPs.These results demonstrate the universal applicability
and similarity of DRP patterns across geographic locations and hospital
departments.
Antimicrobials,
cardiovascular agents, antidiabetics, and CNS medications were among the drug
classes most commonly linked to DRPs.For instance, serious side effects like
hypoglycemia, thrombocytopenia, and nephrotoxicity have been linked to
medications like insulin, glimepiride, linezolid, piperacillin–tazobactam,
metronidazole, and calcium channel blockers [28-32]. Therapeutic risks were
further increased by the misuse of combination therapies, such as
cefuroxime-sulbactam, metformin-based fixed-dose combinations, and insufficient
PPI prescriptions [28, 33-34].
Inadequate care, even
when clear treatment indications were present, was a recurring contributor to
DRPs, particularly among neonates with sepsis and respiratory distress syndrome
(RDS) [32,35]. Inappropriate antibiotic use was another critical concern, as it
increases the risk of antimicrobial resistance and healthcare costs, with
common issues including prescriptions without indication and overlapping
spectrum combinations [31,35-36].
The occurrence of DRPs
was further driven by multiple system-level and patient-related factors such as
advanced age, polypharmacy, prolonged hospitalisation, comorbidities, low birth
weight, lack of vaccination, cesarean delivery, smoking, alcohol use, and male
sex [28-29,32-33,35-39]. These findings underscore that DRPs extend
beyond medication errors alone, reflecting the interplay of medical complexity
and sociodemographic determinants. Establishing comprehensive risk assessment
frameworks is therefore vital to guide targeted interventions and improve
patient safety. Interestingly, all of the studies reported a high success rate
for the intervention. Some studies found
that up to 99% of DRPs were resolved by interventions like dose modification,
drug termination, addition of needed therapy, and formulation modifications [35,38,40]. But because of complicated clinical
circumstances, a portion of DRPs remained unresolved, underscoring the
shortcomings of reactive approaches and the necessity of proactive ones like
therapeutic drug monitoring and medication reconciliation.
MEs were also identified
as a significant contributor to DRPs, particularly during the prescribing,
documentation, and administration stages.
These errors were linked to a number of factors, including duty shifts,
peak workload, staff fatigue, and interruptions during care transitions [41]. These systemic flaws are especially
noticeable in hospitals with limited resources, where documentation procedures
and pharmacovigilance practices may be lacking.
The studies also support
the critical role that interprofessional collaboration and clinical pharmacists
play in detecting and fixing DRPs [32,37,42]. It has been demonstrated that incorporating
computerised decision support systems, routine monitoring, and structured
medication reviews improves results.
Avoidable DRPs can also be reduced by enhancing access to updated treatment
protocols and putting in place educational interventions for prescribers.
CONCLUSION
This systematic review
demonstrates that DRPs continue to be a recurring and avoidable issue in a
variety of hospital settings. Although
DDIs, ADRs, and improper prescribing were the most common, polypharmacy,
comorbidities, and deficiencies in clinical assessment were frequently the root
causes. Significantly, research
indicates that proactive strategies like pharmacist-led interventions,
medication reconciliation, and therapeutic drug monitoring can resolve up to
99% of identified DRPs, proving their clinical value.
To detect and prevent
DRPs in real time, healthcare systems should prioritise integrating clinical
pharmacists into multidisciplinary teams, strengthening pharmacovigilance
infrastructure, and implementing digital decision-support tools. Future studies should also concentrate on
measuring the financial cost of DRPs and assessing the long-term effects of
intervention models in low- and middle-income environments. Improving medication safety, maximising
treatment results, and attaining safer, more sustainable healthcare delivery
will all depend on strengthening these tactics.
ACKNOWLEDGEMENT
I express my sincere
gratitude to PES's Modern College of Pharmacy Nigdi, Pune, for lending me the
resources and facilities required to conduct this study. I really appreciate
the Department of Pharm D for their assistance and expertise.
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