Cross-sectional analysis of drug-related problems in an intensive care unit
what do they say about the clinical pharmacist's performance?
DOI:
https://doi.org/10.30968/jhphs.2025.163.1295Abstract
Objective: To analyze the evolution of the profile of drug-related problems (DRPs) identified by clinical pharmacists in an Intensive Care Unit (ICU), considering the implementation of pharmaceutical care services in the hospital. Methods: Cross-sectional study focusing on the analysis of DRP records that required pharmaceutical interventions in a clinical/surgical adult ICU of a tertiary teaching hospital in Southern Brazil, within two distinct periods: from July 2019 to April 2020 (Period A), and from April to October 2024 (Period B). The analysis included a description of DRP characteristics, the pharmacological categories involved and the acceptance of pharmaceutical interventions. Results: During Period A, 239.5 DRPs/1,000 patient-days were identified, whereas 425.6 DRPs/1,000 patient-days were recorded in Period B, indicating an increasing trend in the identification of potential problems. In Period A, the primary DRPs were related to effectiveness (61.8%), whereas Period B showed greater diversification, with an increased representation of problems classified as “others” (38.5%), including unnecessary treatment. The most frequent causes of DRPs included drug selection and dosing, with a possible increase in problems related to treatment duration in Period B. Regarding pharmaceutical interventions, most were conducted at the drug level (94.0% in Period B compared to 53.6% in Period A) and had a good acceptance rate by the multidisciplinary team (92.2% in Period A and 97.0% in Period B). Conclusion: These findings reflected the consolidation of pharmaceutical care as an essential tool for the safety and effectiveness of drug therapies, highlighting the positive impact of pharmaceutical practice in the ICU over the years.
Downloads
References
Storpirtis S, Melo AC, Noblat LACB, et al. A Origem Da Farmácia Clínica No Brasil, A Sociedade Brasileira de Farmácia Clínica e A Harmonização de Conceitos e Nomenclatura. Infarma - Ciênc Farm. 2023;35(3):351-363. doi:10.14450/2318-9312.v35.e3.a2023.pp351-363.
Chiang LH, Huang YL, Tsai TC. Clinical pharmacy interventions in intensive care unit patients. J Clin Pharm Ther. 2021;46(1):128-133. doi:10.1111/jcpt.13265
Pharmaceutical Care Network Europe Association. Classification for drug-related problems. Available in: https://www.pcne.org/upload/files/334_PCNE_classification_V9-0.pdf. Accessed on: 12 Nov 2023.
Lee H, Ryu K, Sohn Y, et al. Impact on Patient Outcomes of Pharmacist Participation in Multidisciplinary Critical Care Teams: A Systematic Review and Meta-Analysis. Crit Care Med. 2019;47(9):1243-1250. doi:10.1097/CCM.0000000000003830
Tharanon V, Putthipokin K, Sakthong P. Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital. SAGE Open Med. 2022;10:20503121221090881. doi:10.1177/20503121221090881
Colin SL, Nutti C. Intervenção Farmacêutica: descrição do papel do farmacêutico clínico em unidades de terapia intensiva. J Hosp Pharm Health Serv. 2022;13(2):766-766. doi: 10.30968/rbfhss.2022.132.0766.
Rech MA, Gurnani PK, Peppard WJ, et al. PHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARMCRIT Study. Crit Care Explor. 2021;3(12):e0594. Published 2021 Dec 10. doi:10.1097/CCE.0000000000000594
Tavares AL, Brasil LX, Javarini HV, et al. Implantação de serviços clínicos providos por farmacêuticos em hospitais brasileiros: uma revisão de escopo. Rev Bras Farm Hosp Serv Saúde. 2024;15(1):1072. doi: 10.30968/rbfhss.2024.151.1072.
Kirchner JE, Smith JL, Powell BJ, et al. Getting a clinical innovation into practice: An introduction to implementation strategies. Psychiatry Res. 2020;283:112467. doi:10.1016/j.psychres.2019.06.042
Rafferty A, Walthery P, King-Hele S. Analysing change over time: repeated cross sectional and longitudinal survey data. Available in https://dam.ukdataservice.ac.uk/media/455362/changeovertime.pdf. Accessed 12 Nov 2023.
Empresa Brasileira de Serviços Hospitalares. Plano Diretor Estratégico 2021-2023 Hospital Universitário Professor Polydoro Ernani de São Thiago. Florianópolis: Ebserh;2023.
Mabasa VH, Malyuk DL, Weatherby EM, et al. A Standardized, Structured Approach to Identifying Drug-Related Problems in the Intensive Care Unit: FASTHUG-MAIDENS. Can J Hosp Pharm. 2011;64(5):366-369. doi:10.4212/cjhp.v64i5.1073.
Albayrak A, Başgut B, Bıkmaz GA, et al. Clinical pharmacist assessment of drug-related problems among intensive care unit patients in a Turkish university hospital. BMC Health Serv Res. 2022;22(1):79. doi:10.1186/s12913-022-07494-5
Martins RR, Silva LT, Lopes FM. Impact of medication therapy management on pharmacotherapy safety in an intensive care unit. Int J Clin Pharm. 2019;41(1):179-188. doi:10.1007/s11096-018-0763-0
Jiang SP, Chen J, Zhang XG, et al. Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital. Ther Clin Risk Manag. 2014;10:861-866. doi:10.2147/TCRM.S69585
Spezia IA, Cimarosti HI. Identification of drugs-related problems and pharmacists’ interventions in a hospital in Southern Brazil. Rev Bras Farm Hosp Serv Saúde. 2022;13(2):794. doi:10.30968/rbfhss.2022.132.0794.
Richter A, Bates I, Thacker M, et al. Impact of the introduction of a specialist critical care pharmacist on the level of pharmaceutical care provided to the critical care unit. Int J Pharm Pract. 2016;24(4):253-261. doi:10.1111/ijpp.12243
Morales Castro D, Dresser L, Granton J, et al. Pharmacokinetic Alterations Associated with Critical Illness. Clin Pharmacokinet. 2023;62(2):209-220. doi:10.1007/s40262-023-01213-x
Lindén-Lahti C, Kivivuori SM, Lehtonen L, et al. Implementing a New Electronic Health Record System in a University Hospital: The Effect on Reported Medication Errors. Healthcare (Basel). 2022;10(6):1020. doi:10.3390/healthcare10061020.
Meneguin S, Torres EA, Pollo CF. Fatores associados à infecção por Staphylococcus aureus resistente à meticilina em unidade de terapia intensiva. Rev Bras Enferm. 2020;73(6):e20190483. doi:10.1590/0034-7167-2019-0483
Callejo-Torre F, Eiros Bouza JM, et al. Risk factors for methicillinresistant Staphylococcus aureus colonisation or infection in intensive care units and their reliability for predicting MRSA on ICU admission. Infez Med. 2016;24(3):201-209.
Blot S, Ruppé E, Harbarth S, et al. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs. 2022;70:103227. doi:10.1016/j.iccn.2022.103227
Dinçel S, Demirpolat E. Evaluation of the appropriateness of vancomycin therapeutic drug monitoring in the intensive care unit with a clinical pharmacy approach, a cross-sectional study. Eur J Hosp Pharm. 2024 (ahead of print). doi:10.1136/ejhpharm-2023-004073
SurmeliȮ glu N, Berber M. Evaluation of Vancomycin Therapeutic Drug Monitoring in Intensive Care Units of a University Hospital. Cukurova Anestezi Ve Cerrahi Bilim Derg. 2023;6(2):300-303. doi:10.36516/jocass.1341016.
Gomes MF, Guidoni CM. An analysis of pharmaceutical care for critical patients of an adult intensive care unit. Braz J Pharm Sci. 2023;59:e21345. doi:10.1590/s2175-97902023e21345.
Dighriri IM, Alnomci BA, Aljahdali MM, et al. The Role of Clinical Pharmacists in Antimicrobial Stewardship Programs (ASPs): A Systematic Review. Cureus. 2023;15(12):e50151.doi:10.7759/cureus.50151
Martinez YG, Tran M, Roduta T, et al. The Impact of an Antimicrobial Stewardship Clinical Pharmacy Specialist on Antimicrobial Days of Therapy through Education Driven Policies, Procedures, and Interventions. Pharmacy (Basel). 2023;11(5):137. doi:10.3390/pharmacy11050137
Li Q, Qu HJ, Lv D, et al. Drug-related problems among hospitalized patients with COPD in mainland China. Int J Clin Pharm. 2019;41(6):1507-1515. doi:10.1007/s11096-019-00913-4
Calisto KDR, Avila ES, Matheus FC. Pharmaceutical interventions arising from the review of pharmacotherapy in hospital patients with COVID-19. Braz J Pharm Sci. 2024;60:e23694. doi:10.1590/s2175-97902024e23694.
Leite BL. Resolução de problemas relacionados a medicamentos em uma unidade de terapia intensiva. J Assist Farm E Farm. 2022;1(s.2). doi:10.22563/2525-7323.2022. v1.s2.p.30.
Garin N, Sole N, Lucas B, et al. Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions. Sci Rep. 2021;11(1):883. doi:10.1038/s41598-020-80560-2
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors hereby transfer, assign, or otherwise convey to JHPHS : (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print republish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to JHPHS with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Serlf-archiving policy
This journal permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.
