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.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Pharmaceutical Care Network Europe (PCNE). PCNE classification of drug-related problems (V6.2). 2010. http://www.pcne.org/upload/files/11_PCNE_classification_V6-2.pdf. Accessed on 1 June 2015.
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.
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.
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.
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].
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.
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.
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.
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.
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.
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.
Joint Commission on Accreditation of Healthcare Organization (JCAHO). Hospital accreditation standards: standards, intents: HAS. Chicago: Joint Commission; 2005.
Pollack M, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16(11):1110–6.
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.
Trissel LA. Handbook on injectable drugs. 15th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2009.
Micromedex® 2.0, (electronic version). Truven Health Analytics, Greenwood Village, Colorado, USA. http://www-micromedexsolutions-com.ez67.periodicos.capes.gov.br/. Accessed between July 2015 and June 2016.
UpToDate Inc. http://www.uptodate.com. Accessed between July 2015 and June 2016.
Institute for Safe Medication Practices ISMP list of high-alert medications in acute care settings. 2014. www.ismp.org/tools/institutionalhighAlert.asp. Accessed between July 2015 and June 2016.
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.
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.
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.
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.
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.
We thank all the members of the FMEA team for their participation in this study.
This study did not receive any specific funding support.
Conflicts of interest
The authors have no conflicts of interest to disclose.
About this article
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). https://doi.org/10.1007/s11096-018-0632-x