Clinical pharmacists’ interventions for preventing adverse events in critically ill neonates in Qatar: an economic impact analysis

ABSTRACT

Objective

This study aimed to assess the overall economic impact of clinical pharmacist interventions in the neonatal ICU (NICU) in Qatar.

Methods

A retrospective review of neonates’ records was performed over a 3-month duration in the NICU of Qatar to determine the total economic benefit of clinical pharmacist interventions. The total benefit of interventions was calculated by considering the cost avoidance due to preventable adverse drug events (ADEs) and the cost savings associated with the revised resource use due to interventions. Sensitivity analyses were conducted to ensure the robustness and generalizability of the results.

Results

A total of 513 interventions were analyzed, involving 150 neonates. Most of the drug-related problems were related to therapy dosing, followed by drug choice appropriateness, the addition of prophylactic treatment, and administration frequency. The overall annual benefit was estimated at QAR 4,178,352 (1,147,584), which consisted of cost avoidance of QAR 1,050,680 (USD 288,648) and an overall cost saving of QAR −6091 (USD −1673).

Conclusions

While the clinical pharmacist interventions led to increased resource utilisation and associated costs, when considering the avoided costs of ADEs, the overall clinical pharmacist practices in the NICU setting were economically beneficial.

KEYWORDS:

• Adverse drug event
• Neonates
• cost savings
• economics
• intervention
• pharmacist

Acknowledgment

We want to thank all the clinical pharmacists who contributed to the documentation of the interventions. Open Access funding provided by the Medical Research Center: MRC-01-19-110.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

DA-B and DA contributed to the study conception and design, led data validation, data analysis and interpretation, and revised the manuscript. OY contributed to analysis and writing the first draft of manuscript. MR, MA, OA, RK, MA, PA, WE, and FA contributed to the data collection. MA, PA, and WE facilitated the planning and carrying out of the study. All authors contributed to the final version of the manuscript.

Additional information

Funding

Medical Research Center, Hamad Medical Corporation , Doha, Qatar supported this work; [grant number MRC-01-19-110]. The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.

Notes on contributors

Ola Yakti

Ola Yakti is a dedicated clinical pharmacist working at Hamad Medical Corporation, a governmental healthcare organization in Doha, Qatar. She possesses a solid educational background and diverse clinical training experiences. Ola earned her Doctor of Pharmacy (PharmD) degree and Bachelor of Science in Pharmacy (BSc (Pharm)) degree from Qatar University, College of Pharmacy, both accredited by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) in 2021 and 2020, respectively. Throughout her academic journey, Ola excelled in various clinical training sites, including the Drug Information Center, Intensive Care Unit (ICU), Home Health Care Services, Internal Medicine, Women's Health, Oncology, Infectious Diseases, and Cardiology. Before assuming her role as a clinical pharmacist, Ola served as a research assistant at Qatar University, contributing significantly to multiple projects and gaining valuable insights into the fields of pharmaceutical and health research. In her capacity as a research assistant, she had the opportunity to work on multiple projects, and she successfully published some of them. Currently, Ola actively contributes to ongoing projects and is engaged in interprofessional education sessions and continuing professional pharmacy development, demonstrating her commitment to lifelong learning.

Daoud Al-Badriyeh

Dr. Daoud Al-Badriyeh completed an honors degree in pharmacy at the University of Sydney (Sydney, Australia) and then received his PhD in pharmacoeconomics from Monash University (Melbourne, Australia). Dr. Daoud also completed specialized training in healthcare analytics, patient safety and medical errors, and medical statistics. Currently, Dr. Daoud is a Professor of Pharmacoeconomics and Outcomes Research at the College of Pharmacy of Qatar University, Qatar. Dr. Daoud has hundreds of publications and conference presentations. He supervised over a dozen postgraduate students so far and has accumulated research funds in millions of dollars. Dr. Daoud’s research focuses on pharmacoeconomics, health economics, decision-analytic simulation, comparative effectiveness research, and the economic impact of hospital services. Underlying populations of interest vary, from neonatal intensive care illnesses, cardiovascular disease, cancer, diabetes, mental health, and infectious diseases to healthcare services research concerning genotype testing, clinical and technology interventions, and stewardship programs. Dr. Daoud is also the Founder and current President of the Qatar Chapter of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR, USA).

Mohammed Rijims

Dr. Mohammed Rijims is an empathetic, solution-oriented health care professional with an exceptional blend of clinical expertise, ingenuity, and compassion. Dr. Mohammed earned his Masters in Clinical Pharmacy Practice from Annamalai University in India in 2005. Presently, he is engaged in the pursuit of his Ph.D. in Clinical Pharmacy. He has demonstrated exceptional performance in various positions, such as clinical pharmacist, community pharmacist, and clinical pharmacist specialist in the neonatal intensive care unit at Women's Wellness and Research Centre, Hamad Medical Corporation-Qatar. At present, he holds this position. Approximately fifteen research initiatives and publications had been his work. He holds the positions of adjunct clinical lecturer and preceptor for the pharmacy residency program at Hamad Medical Corporation in Doha, and Qatar University's Pharm D program.

Mohammed Abdelaal

Mohammed Abdelaal is a pharmacist holding a master’s degree in Pharmacoeconomics and Outcome Research from Qatar University with more than 14 years’ experience in the pharmaceutical field. With a passion for patient safety, he passed the Qualified Person Responsible for Pharmacovigilance (QPPV) Advanced Training Program on Good Pharmacovigilance Practice (GPV), Pharmacoepidemiology & Biostatistics. This is in addition to multiple tailored programs organized by WHO in relation to bioequivalence and medicines quality assessment. His experience covers clinical practice aspects through working in community pharmacies in Egypt and Saudi Arabia during the period from 2009 – 2012, as well as drugs registration files assessment in CTD, Nees and eCTD format, covering all aspects of quality, safety and efficacy, from both industrial and governmental perspectives, with extensive knowledge of ICH and GCC policies and guidelines through working in national drug authority of both Egypt & Qatar, and a private pharmaceutical company in Egypt. Mohammed joined the Ministry of Public Health in Qatar as a member for Pharmacy & Drug Control Department team in 2014. He is holding the title of Supervisor, Pharmaceutical Regulatory Compliance – in Registration & Pricing section, with all responsibilities of ensuring smooth process flow of registration requests for pharmaceutical and biological products along with supervising any related activity, as well as liaising with different stakeholders in relation to strategic projects.

Omar Alsoukhni

Omar Alsoukhni is a highly skilled and accomplished pharmacist with a strong background in clinical pharmacy, pharmacy technology and pediatric care. He received his PharmD degree from Jordan University of Science and Technology in 2008, followed by American board certification in 2012. In 2017, Omar completed a Master's degree in Pharmacoeconomics and Health Economy from UPS Pompeu Fabra University. With a passion for patient safety, Omar holds a certification in medication safety in 2022, demonstrating his commitment to ensuring optimal medication management practices. He has amassed valuable experience throughout his career, having served as a Clinical Pharmacist in Saudi Arabia from 2008 to 2013. Following this, he worked as a Clinical Pharmacy Specialist and Adjunct professor in Pediatric Care in Qatar from 2013 to 2018, where he developed expertise in providing specialized pharmaceutical care to young patients. In addition to his clinical practice, Omar serves as an Adjunct Professor at multiple prestigious institutions including MBRU, Qatar University, Sharjah University, and DPCG. In 2018, Omar joined the prestigious Al Jalila Children's Hospital as a Clinical Pharmacy Specialist and Head of Pharmacy. In this role, he leads a team of professionals, world class pharmaceutical operations, and contributes to the development and implementation of evidence based pharmacy programs.

Moza Al Hail

Dr. Moza Al Hail is the Executive Director of Pharmacy at Hamad Medical Corporation. She has a distinguished career, serving in various clinical and administrative roles.Dr. Al Hail has been instrumental in initiating key projects, including establishing different units at Women’s Hospital, such as the Unit Dose system, IV unit, and Clinical Pharmacy services. Her contributions extend to various Corporate Pharmacy activities, where she played a pivotal role in establishing the Medication Safety and Quality Office and the Office of Continuing Professional Development (CPPD) at HMC. Noteworthy achievements include securing international and national accreditations for the Pharmacy Department from organizations like the Accreditation Council for Pharmacy Education (ACPE) and Qatar Council for Healthcare Practitioners (QCHP). Dr. Al Hail has also introduced the Pharmacy Residency Program, aligning its quality with international medical training programs. In addition to her administrative roles, Dr. Moza Al Hail is a prolific researcher, authoring over 50 research articles. Her professional interests encompass interprofessional education, medication safety, pharmacovigilance, leadership development, and mentorship within the pharmaceutical profession. Dr. Al Hail actively participates in various national and international committees, chairing some of them. Her current research strategy focuses on pharmaceutical care, safe medication use, effectiveness, and safety. She collaborates strongly with national and international universities, significantly advancing pharmacy practice and research.

Palli Valapila Abdulrouf

Dr. Palli Valapila Abdulrouf is the Assistant Director of Pharmacy Department Corporate Pharmacy services-HMC. He received both B.Pharma & M.Pharma degrees from K.L.E‘s Dharwad University India and the MSc Clinical Pharmacology and Ph.D. from the University of Aberdeen, U.K. and received hands on training in Pharmacovigilance from Uppsala Monitoring Center - WHO, Sweden. He underwent certification programs related to Epidemiology and Biostatistics (UK), Research to Publication (BMJ-UK), and Drug Information & Toxicology (USA and MENA). In addition to his extended role, he specializes in Medication safety practices including Adverse Drug Reactions, Medication Error. Dr. Abdul Rouf has authored in several publications and serves as reviewer for the numerous international high impact journals. He served as a speaker, presenter and scientific committee member in several conferences. He also supervises PhD students based in both India and the UK. Currently, he is involved in research related to Pharmacy prescribing, antimicrobial stewardship, Patients reporting ADR’s, Medication waste, COVID19 Vaccination advocacy, Pregnancy registry relayed to COVID19, Formulary adherence, Toxicology and Poison epidemiology and registries, and few quality projects looking at medication safety.

Wessam El-Kassem

Dr. Wessam El-Kassem is a highly accomplished and devoted healthcare professional. In 2015, he completed a Doctor of Pharmacy (PharmD) degree from Qatar University in Doha, Qatar. This accomplishment was preceded by completing a Master of Business Administration (MBA) program at the same institution in 2008. With a robust foundation in pharmacy, Dr. Wessam has undertaken diverse roles and responsibilities throughout his career. Presently, he serves as the pharmacy assistant director at HMC Corporate Pharmacy. Additionally, he holds the positions of Co-Head of the Medication Safety and Quality Center and HMC Pharmacy Residency Coordinator. Dr. Wessam has an extensive publication record, with over 40 peer-reviewed publications, and contributed to two book chapters. Furthermore, he has actively participated in several regional and international conferences.

Fouad Abounahia

My name is Fouad Abounahia, currently working as attending neonatologist in the Neonatal Intensive Care Unit (NICU) of Women's Wellness and Research Center (WWRC), Qatar. I graduated from college of medicine at Aleppo university in Syria 1996, then worked as GP in private hospitals for one year. Jan 1st, 1997, I joined HMC as medical intern, completed my residency in Pediatrics, and then became NICU specialist until May 2006. Jun 2006, I went to Canada as neonatal fellow and neonatal transport fellow. In which both were completed the year of 2010. Since then, rejoined HMC and I am leading Qatar’s neonatal transport program as well as an attending neonatologist. After the completion of my residency and neonatology fellowship training, I became an attending neonatologist that can lead and conduct clinical rounds. I lead the neonatal neurodevelopmental follow up program between 2012 – 2020 that helped to follow high risk neonates after NICU discharge. Since 2010 I began to prepare for the neonatal transport program which was launched officially on October 2014. As a director of the Qatar neonatal transport program, my focus was to have the program be a model for the region and Middle East (in which is in the process). Currently leading and directing Qatar Neonatal Transport simulation workshop that provides an extensive training for NICU healthcare professionals to become transport experts. (a full day workshop that includes practical stations). I had worked in many research projects as primary investigator or Co-author that published as an abstracts or full paper. In many research activities, some of my research work was presented as a poster and oral presentation.

Rasha Kaddoura

Rasha Kaddoura, MSc (Pharm), Pharm D, is a clinical pharmacy specialist at the Heart Hospital, serving in the in-patient and out-patient settings including acute and intensive care units, Advanced Heart Failure Clinic and Anticoagulation Clinic. In addition to COVID-19 facilities during the pandemic. Rasha received her Post-Graduate Doctor of Pharmacy degree from the University of Toronto and her Masters Degree in Clinical Pharmacy from Albert Saint Gyorgyi Medical University – Faculty of Pharmacy – Hungary. Currently, a Master’s study candidate to pursue a degree in clinical research. Licensed and practised in Hungary, Canada and Qatar. In addition to being a pharmacy board-certified in Lebanon. Her practice expertise also includes drug information, drug utilization review, and medication therapy management. Served in three hospital committees, involved in preparing, updating and reviewing clinical practice guidelines, and variety of pharmacy and non-pharmacy related projects. She has many published papers and served as a preceptor for pharmacy undergraduate, Masters’ and Pharm D students, as well as a preceptor for PGY-1 pharmacy residents.

Dina Abushanab

Dina Abushanab is a Drug Information Pharmacist at the Corporate Hamad Medical Corporation. She completed her bachelor in Pharmacy and Master in Pharmacoeconomics and Outcomes Research from the College of Pharmacy (CPH) at Qatar University (QU). She is also a Board-Certified Pharmacotherapy Specialist, a Pharmacy Preceptor for Doctor of Pharmacy Students, and an invited instructor at CPH-QU. Currently, Ms. Dina is a PhD Candidate in Health Economics and Epidemiology at Monash University, Australia. To date, she has published over 35 peer reviewed research papers, received several competitive grants as principal investigator, and supervised several research assistants. She also serves as member of master supervisory committees at CPH-QU and subcommittee member of the ISPOR Victoria and Tasmania Student Chapter. She is the current Secretary/Treasurer of the Qatar Chapter of ISPOR. Her research focuses on: health economics, including cost-effectiveness, cost-benefits and modellings, burden of diseases, epidemiology, and meta-analyses.