Modified Omission of Prescriptions and Inappropriate Prescriptions (POPI) Criteria to Assess the Quality of Prescriptions to Pediatric Patients

Background: In pediatrics, many drugs are used without marketing authorization. Recommendations are often based on clinical experience. Therefore, the risk of inappropriate prescription (IP) is high. It is necessary to have a tool for pediatric IP detection. Objectives: This study was performed to develop and validate a Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions (POPI) screening tool to facilitate its use in pediatric practice in Iran. Methods: Using forward- and backward-translation procedures, an efficient and effective tool was provided in the current study and clinical settings. The two-round Delphi technique established content validity. The criteria were then piloted in a cross-sectional study in the pediatric patients of Khorasan Razavi and East Azerbaijan in Iran. Results: A total of 104 explicit criteria (79 IPs and 25 omissions) were obtained and submitted to an 18-member expert panel (including 8 pharmacists, 2 clinical pharmacists, and 8 pediatricians working in a hospital or the community). Then, 98 out of the 104 criteria submitted to the experts were selected after two Delphi rounds (75 IPs and 23 omissions). The content validity and reliability of the tool were obtained by expert assessment (Cronbach’s alpha for the entire criteria: 0.60). At least, the rate of one inappropriate prescribed medication was 69% in Mashhad, almost twice that of Tabriz (35%). Conclusions: The modified POPI criteria comprise the first screening tool to assess rational prescriptions for pediatric patients in hospital and outpatient settings. Clinical validation and reliability studies are needed and planned by the authors to evaluate the usability and reliability of this tool.