Skip to main content

Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit


Background Problems related to pharmacotherapy are common in patients admitted to the paediatric intensive care unit (PICU) and are associated with increased healthcare costs. Data on the impact of clinical pharmacist interventions to prevent pharmacotherapy-related problems and to minimize costs in the PICU are limited. Objectives To evaluate the number and type of clinical pharmacist interventions in the PICU and to determine cost savings associated with them. Setting a ten bed PICU of a tertiary-care university hospital in Brazil. Method This was a prospective, observational study conducted over 1-year. The Failure Mode and Effects Analysis (FMEA) tool was applied at the beginning of the study to assess drug-related risks in the PICU and to guide clinical pharmacist interventions. Main outcome measure Number and type of clinical pharmacist interventions and healthcare-related costs. Results One hundred sixty-two children were followed-up by the clinical pharmacist and 1586 prescriptions were evaluated; pharmacotherapy-related problems were identified in 12.4% of them. Sixteen of 75 failure modes identified by FMEA were potentially reduced by the clinical pharmacist interventions. There were 197 interventions with a cost saving of R$ 15,118.73 (US$ 4828.00). Clinical pharmacist interventions were related to drug interaction and therapeutic monitoring (34.5%), drug selection (22.3%), dosing and frequency (16.8%), prescription (13.2%) and administration (13.2%). Ninety-seven per cent of the clinical pharmacist interventions were accepted by the medical team. The interventions with larger cost savings were related to administration (39%). Conclusion The clinical pharmacist interventions minimized the risks of pharmacotherapy-related problems and contributed to the reduction of costs associated with medical prescription.

This is a preview of subscription content, access via your institution.


  1. Pharmaceutical Care Network Europe (PCNE). PCNE classification of drug-related problems (V6.2). 2010. Accessed on 1 June 2015.

  2. Alagha HZ, Badary OA, Ibrahim HM, Sabri NA. Reducing prescribing errors in the paediatric intensive care unit: an experience from Egypt. Acta Paediatr. 2011;100(10):e169–74.

    Article  PubMed  Google Scholar 

  3. Cunningham KJ. Analysis of clinical interventions and the impact of pediatric pharmacists on medication error prevention in a teaching hospital. J Pediatr Pharmacol Ther. 2012;17(4):365–73.

    PubMed  PubMed Central  Google Scholar 

  4. Rudis MI, Brandl KM, for the Society of Critical Care Medicine and American College of Clinical Pharmacy Task Force on Critical Care Pharmacy Services. Position paper on critical care pharmacy services. Crit Care Med. 2000;28(11):3746–50.

    Article  PubMed  CAS  Google Scholar 

  5. Ministério da Saúde (BR). Agência Nacional de Vigilância Sanitária. Resolução RDC/ANVISA: n° 7, de 24 de fevereiro de 2010. Diário Oficial da República Federativa do Brasil, Brasília, DF, 25 fev 2010. [Ministry of Health (Brazil). National Health Surveillance Agency. Resolution RDC/ANVISA: number 7, from February 24, 2010. Official Gazette of the Federative Republic of Brazil, Brasilia, Federal District, February 25, 2010].

  6. Ferracini FT, Almeida SM, Locatelli J, Petriccione S, Haga CS. Implementation and progress of clinical pharmacy in the rational use of medicines in large tertiary-care hospital. Einstein (Sao Paulo). 2011;9(4):456–60.

    Article  Google Scholar 

  7. LaRochelle JM, Ghaly M, Creel AM. Clinical pharmacy faculty interventions in a pediatric intensive care unit: an eight-month review. J Pediatr Pharmacol Ther. 2012;17(3):263–9.

    PubMed  PubMed Central  Google Scholar 

  8. Prot-Labarthe S, Di Paolo ER, Lavoie A, Quennery S, Bussières J-F, Brion F, et al. Pediatric drug-related problems: a multicenter study in four French-speaking countries. Int J Clin Pharm. 2013;35(2):251–9.

    Article  PubMed  Google Scholar 

  9. Okumura LM, Da Silva DM, Comarella L. Relation between safe use of medicines and clinical pharmacy services at pediatric intensive care units. Rev Paul Pediatr. 2016;34(4):397–402.

    PubMed  PubMed Central  Google Scholar 

  10. Lago P, Bizzarri G, Scalzotto F, Parpaiola A, Amigoni A, Putoto G, et al. Use of FMEA analysis to reduce risk of errors in prescribing and administering drugs in paediatric wards: a quality improvement report. BMJ Open. 2012;2(6):e001249.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Manrique-Rodríguez S, Sánchez-Galindo AC, López-Herce J, Calleja-Hernández MÁ, Iglesias-Peinado I, Carrillo-Álvarez A, et al. Risks in the implementation and use of smart pumps in a pediatric intensive care unit: application of the failure mode and effects analysis. Int J Technol Assess Health Care. 2014;30(2):210–7.

    Article  PubMed  Google Scholar 

  12. Joint Commission on Accreditation of Healthcare Organization (JCAHO). Hospital accreditation standards: standards, intents: HAS. Chicago: Joint Commission; 2005.

    Google Scholar 

  13. Pollack M, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16(11):1110–6.

    Article  PubMed  CAS  Google Scholar 

  14. Leteurtre S, Martinot A, Duhamel A, Proulx F, Grandbastien B, Cotting J, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicenter study. Lancet. 2003;362(9379):192–7.

    Article  PubMed  Google Scholar 

  15. Trissel LA. Handbook on injectable drugs. 15th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2009.

    Google Scholar 

  16. Micromedex® 2.0, (electronic version). Truven Health Analytics, Greenwood Village, Colorado, USA. Accessed between July 2015 and June 2016.

  17. UpToDate Inc. Accessed between July 2015 and June 2016.

  18. Institute for Safe Medication Practices ISMP list of high-alert medications in acute care settings. 2014. Accessed between July 2015 and June 2016.

  19. Apkon M, Leonard J, Probst L, DeLizio L, Vitale R. Design of a safer approach to intravenous drug infusions: failure mode effects analysis. Qual Saf Health Care. 2004;13(4):265–71.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Krupicka MI, Bratton SL, Sonnenthal K, Goldstein B. Impact of a pediatric clinical pharmacy in the pediatric intensive care unit. Crit Care Med. 2002;30(4):919–21.

    Article  PubMed  Google Scholar 

  21. Tripathi S, Crabtree HM, Fryer KR, Graner KK, Arteaga GM. Impact of clinical pharmacist on the pediatric intensive care practice: an 11-year tertiary center experience. J Pediatr Pharmacol Ther. 2015;20(4):290–8.

    PubMed  PubMed Central  Google Scholar 

  22. Fernández-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Pérez-Sanz C, Duran-García E, Sanjurjo-Saez M. Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child. 2012;97(6):564–8.

    Article  PubMed  Google Scholar 

  23. Glanzmann C, Frey B, Meier CR, Vonbach P. Analysis of medication prescribing errors in critically ill children. Eur J Pediatr. 2015;174(10):1347–55.

    Article  PubMed  Google Scholar 

Download references


We thank all the members of the FMEA team for their participation in this study.


This study did not receive any specific funding support.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ana Carlotti.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to disclose.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Malfará, M., Pernassi, M., Aragon, D. et al. Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit. Int J Clin Pharm 40, 513–519 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: