Work

Breaking the safety barrier: Risk factors for unjustified non-acceptance of pharmaceutical interventions in the PICU and their association with mortality

Year: 2026

Type: article

Abstract: Background While pharmaceutical interventions (PIs) serve as safety barriers in Pediatric Intensive Care Units (PICU), their effectiveness relies on acceptance by the multidisciplinary team. Objective Therefore, this study sought to identify factors associated with the acceptance and refusal of PIs in a PICU, with focus on identifying risk factors for non-acceptance PIs and their association with mortality. Methods A retrospective analytical study was conducted in a PICU. Zero-Inflated Negative Binomial (ZINB) and standard Negative Binomial (NB) regression models were applied to determine independent predictors of total PIs, accepted PIs (PIa), and Non-Accepted PIs (‘PIna)—stratified into Justified (PInaJ) and Unjustified (PInaUJ) refusals. Results Of 864 admissions, 565 patients with identified PIs were included with 3091 PIs. The acceptance rate was 72.2%. PInaUJ accounted for 6.8% ( n = 209). Multivariate analysis identified medication errors (ME) (IRR 3.08; 95% CI 2.66–3.56), length of stay (LOS) >17 days (IRR 3.20; 95% CI 2.69–3.81), and surgical status (IRR 1.48; 95% CI 1.28–1.70) as the strongest independent predictors of PI incidence. Notably, admission severity (Pediatric index of mortality - PIM-2) lost statistical significance after adjustment. Surgical patients were associated with higher rates of PIna across all subtypes (IRR 2.13; p < 0.001). PInaUJ were independently associated with age > 10 years (IRR 1.70; p = 0.016) and mortality (IRR 1.78; p = 0.040). Conclusion Pharmacotherapeutic risk reflects process complexity and surgical status, not severity. The PInaUJ-mortality link signals team dysfunction during deterioration, supporting risk-based screening and mandatory refusal justification in prescribing systems.

Source: Exploratory Research in Clinical and Social Pharmacy

DOI: 10.1016/j.rcsop.2026.100792

Authors: Mônica Cristina Dutra Rodrigues, Victor Kaneko Matsuno, Fernando Wladimir Silva Rivas, Leonardo Régis Leira Pereira

Institution: Universidade de São Paulo

Language: English

Topic: Patient Safety and Medication Errors

Subfield: Emergency Medical Services

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,140