Pharmacotherapeutic follow-up and predictors factors of problems related to the use of medications in pediatric intensive care

Abstract

Objectives: To describe and analyze the results of the pharmacotherapeutic follow-up service for patients admitted to the Pediatric Intensive Care Unit - PICU of a public hospital in Minas Gerais. Methods: Cross-sectional study, with data collection and analysis of patients treated by the clinical pharmacy service, from June to November 2020. The criteria for selection were use of antimicrobials, mechanical ventilation, sedoanalgesia, vasoactive amines, intravenous corticosteroids, anticonvulsants, and participation in the lines of care: diabetes, sickle cell anemia, cystic fibrosis, and palliative care. Patients were monitored at wards, and the identification and classification of Problems Related to the Use of Medicines (PRM) followed the Pharmacoterapy Workup method, using institutional protocols and health databases: UpToDate®, and MICROMEDEX® 2.0 as reference. For the identified PRM, pharmaceutical interventions were proposed through direct verbal contact with the target professional. Clinical pharmacists monitored outcomes. The collected data were compiled in Microsoft Excel 2019 and analyzed in EpiInfo 7.2.4.0. Results: 283 PRM were identified, with a predominance of PRM 4 (underdose, 26,9%), followed by PRM 5 (adverse drug reaction, 18,7%). Antimicrobials (23,0%) and proton pump inhibitors (17,0%) were the main drugs involved in PRM. The use of more than nine drugs OR 3,7706 [2,0999-6,7704], longer than ten days hospital stay OR 10,8672 [5,5486-21,2839], and presence of more than two comorbidities OR 1,9091 [1,0882-3,3493] were associated with PRM occurrence. Sex, age, weight, prescribed MPP, and kidney/liver failure were not statistically significant. Among the 284 proposed interventions, the most frequent change was pharmacotherapy (81.3%), and the acceptability rate was 68,3%. Most of the identified PRM were resolved (68,9%). Conclusion: the expressive rate of resolution of PRM points to a relevant contribution of clinical pharmacists in improving the quality and safety of care in the PICU.