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Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units

Authors : Lucas Miyake Okumura, Daniella Matsubara da Silva, Larissa Comarella



Clinical Pharmacy Services (CPS) are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU).


This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with <18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention.


Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs) which were solved within clinicians (89% acceptance of all interventions). The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21%) and a composite of inadequate doses (17% due to low, high and non-optimized doses). Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs.


Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications.

Citation: Lucas Miyake Okumura, Daniella Matsubara da Silva, Larissa Comarella Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units doi:10.1016/j.rppede.2016.04.001

Received: 15 January 2016 Accepted: 17 March 2016 Available online: 16 April 2016

Copyright: © 2016 Sociedade de Pediatria de Sao Paulo. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (


LMO receives a monthly scholarship from the Brazilian Ministry of Education. By the time of CPS implementation, he was a sixth year pharmacy student.

Conflicts of interest

The authors declare no conflicts of interest.


We would like to thank Dr. Leonardo Cavadas Soares (Former Clinical Director), who provided an outstanding preceptorship, scientific and clinical support among Clinical Pharmacy Services implementation. The service reported in this manuscript was supported by all health care professionals from Waldemar Monastier Children's Hospital, especially those dedicated to critically ill children.

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