Erros de medicação e eventos adversos relacionados a medicamentos são comuns em pacientes hospitalizados. O risco de ocorrer problemas com a população pediátrica é cerca de três vezes maior do que com a população adulta, especialmente em unidades de terapia intensiva, onde os pacientes são submetidos a grande número de prescrições de medicamentos intravenosos, com baixo índice terapêutico e formas farmacêuticas adaptadas. A farmácia clínica tem como objetivo introduzir o farmacêutico clínico junto à equipe multidisciplinar de saúde no sentido de intervir, prevenindo problemas relacionados a medicamentos à farmacoterapia (PRF), otimizando-a e contribuindo para a segurança do paciente. O presente estudo teve como objetivo avaliar a implantação e o impacto das intervenções da farmácia clínica no Centro de Terapia Intensiva-Pediátrico (CTIP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Trata-se de estudo prospectivo, observacional e descritivo que incluiu crianças de zero a dezoito anos, no período de um ano. Foi aplicada a ferramenta Failure Mode and Effects Analysis (FMEA - Análise dos Modos de Falha e seus Efeitos) no início do estudo para avaliar os riscos relacionados aos medicamentos no CTIP e orientar a atuação da farmácia clínica, em que o farmacêutico avaliou as prescrições diárias e realizou intervenções junto à equipe multidisciplinar. Foram acompanhadas 162 crianças e avaliadas 1586 prescrições com uma taxa de PRF de 12,42% (IC95% 10,50-14,04). Foram realizadas 197 intervenções com custo salvo de R$15.118,73. Os principais tipos de intervenções foram relacionados à indicação e necessidade do medicamento. A partir destas, os grupos foram divididos em pacientes com PRF e sem PRF. Foram detectadas diferenças significativas nas seguintes variáveis: peso, idade, tempo de internação, tempo de acompanhamento, custo total, custo salvo pelas intervenções, gravidade dos pacientes avaliada pelo escore PRISM e PELOD, quantidade total de medicamentos utilizados e quantidade de medicamentos potencialmente perigosos e endovenosos contínuos. Além disso, houve diferenças significativas na taxa de óbito e nas categorias diagnósticas entre os grupos. A implantação do serviço de farmácia clínica no CTIP mostrou impacto positivo na redução de riscos relacionados a todo o processo de utilização de medicamentos. As intervenções do farmacêutico clínico identificaram e preveniram PRF, promovendo o uso racional de medicamentos e contribuindo para a redução de custos associados à prescrição médica. / Medication errors and adverse events related to drugs are common in hospitalized patients. The potential risk for medication errors in pediatric patients is about three times higher than in adults, especially in intensive care units, where patients are subjected to a large number of intravenous drug prescriptions, with low therapeutic index and adapted pharmaceutical forms. Clinical pharmacy aims to introduce the clinical pharmacist in a multidisciplinary health team in order to intervene, preventing drug-related problems (DRPs) and optimize pharmacotherapy, contributing to patient safety. This study aimed to assess the implementation and the impact of clinical pharmacy interventions in the Pediatric Intensive Care Unit (PICU) of Hospital das Clinicas of Ribeirao Preto Medical School, University of São Paulo (HCFMRP-USP). This was a prospective, observational and descriptive study which included children from zero to eighteen years of age, over a one year period. Failure Mode and Effects Analysis Tool (FMEA) was applied at the beginning of the study to assess the risks related to medicines in the PICU and to guide clinical pharmacy work, where the pharmacist evaluated daily prescriptions and made interventions along with a multidisciplinary team. One thousand five hundred and eighty-six prescriptions of 162 children were assessed, and a DRPs rate of 12.42% (95% CI - 10.50 to 14.04) was found. One hundred ninety-seven interventions were performed, with a cost saving of R$ 15,118.73. The main types of interventions were related to indication and necessity of the drug. From these, the groups were divided in patients with DRPs and without DRPs. Significant differences were found in weight, age, time of hospitalization, time of follow-up, total cost, costs saved by interventions, severity of patients assessed by PRISM and PELOD scores, total amount of medications used, and number of potentially dangerous and continuous intravenous medications. In addition, there were significant differences in mortality rate and diagnostic categories between groups. The implementation of clinical pharmacy service in the PICU showed a positive impact on patients\' treatment. The clinical pharmacist interventions identified and prevented DRPs, promoting the rational use of medications and contributing to the reduction of costs associated with medical prescription.

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Drug abuse is becoming an increasing problem in Kenya. A number of studies carried out in the country show that almost every Kenyan youngster at one time or another experiments with drugs, especially beer and cigarettes. The major cause of concern is that a significant proportion of these young people eventually get addicted posing a threat to their own health and safety, while creating difficulties for their families and the public at large into difficulties. This study sought to establish the current trend of drug abuse among students in Kenyan secondary schools, and to analyze the strategies used to address the problem. The ultimate aim was to propose a programme for prevention and intervention. The study is a descriptive survey. In view of this, the field survey method was adopted to collect quantitative and qualitative data, using questionnaires and interviews. Both qualitative and quantitative approaches were used in data analysis, thus there was a mixed model research design approach to data analysis. The analysis of structured items was mainly done using the Statistical Package for Social Sciences (SPSS). The key findings from the study were that drug abuse among students is common; both boys and girls have abused drugs with the majority being in boys‟ schools; the greatest ratio of drug abusers to non-abusers among the sampled schools are aged between 20 and 22 years; there is a significant relationship between drug abuse and age, use of drugs by other family members and easy access to drugs. A variety of factors contribute to drug abuse with the majority of students citing curiosity, acceptance by peers and ignorance as to the dangers of drug abuse as the main reasons. Both the school administrators and teachers face a number of challenges in an attempting to curb drug abuse in schools. The study makes a number of recommendations for policy and further research. A number of guidelines are proposed for developing a programme for prevention and intervention. / Educational Studies / D. Ed. (Socio-Education)

Drug abuse is becoming an increasing problem in Kenya. A number of studies carried out in the country show that almost every Kenyan youngster at one time or another experiments with drugs, especially beer and cigarettes. The major cause of concern is that a significant proportion of these young people eventually get addicted posing a threat to their own health and safety, while creating difficulties for their families and the public at large into difficulties. This study sought to establish the current trend of drug abuse among students in Kenyan secondary schools, and to analyze the strategies used to address the problem. The ultimate aim was to propose a programme for prevention and intervention. The study is a descriptive survey. In view of this, the field survey method was adopted to collect quantitative and qualitative data, using questionnaires and interviews. Both qualitative and quantitative approaches were used in data analysis, thus there was a mixed model research design approach to data analysis. The analysis of structured items was mainly done using the Statistical Package for Social Sciences (SPSS). The key findings from the study were that drug abuse among students is common; both boys and girls have abused drugs with the majority being in boys‟ schools; the greatest ratio of drug abusers to non-abusers among the sampled schools are aged between 20 and 22 years; there is a significant relationship between drug abuse and age, use of drugs by other family members and easy access to drugs. A variety of factors contribute to drug abuse with the majority of students citing curiosity, acceptance by peers and ignorance as to the dangers of drug abuse as the main reasons. Both the school administrators and teachers face a number of challenges in an attempting to curb drug abuse in schools. The study makes a number of recommendations for policy and further research. A number of guidelines are proposed for developing a programme for prevention and intervention. / Educational Studies / D. Ed. (Socio-Education)

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital. Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate. Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated. Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced. / Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen