Application of FASTHUG-MAIDENS mnemonic and evaluation of its impact in pharmaceutical intervention in an adult intensive care unit

Abstract

Objective: To evaluate the impact of the application of the FASTHUG-MAIDENS mnemonic by clinical pharmacists to optimize critically ill patients’ pharmacotherapy. Methods: Cross-sectional study performed on an adult intensive care unit of an University Hospital, between august and november 2019, where 155 patients were followed by three clinical pharmacists during hospital stay. Patients who stayed less than 24 hours in the hospital or whose stay was during weekends or holidays were excluded. The interventions were performed together with a multidisciplinary team using FASTHUG-MAIDENS, as well as technical analysis of medical prescription and patients’ clinical evaluation. The clinical evaluation included analysis of laboratory tests, nursing records and medical prescription, all registered in an institutional spreadsheet. The pharmaceutical interventions were registered in the pharmaceutical section of both physic and electronic medical records, and the data were later evaluated, classified, and submitted to descriptive analytical analysis. Results: 1.145 pharmaceutical interventions were performed, with an acceptance rate of 99,3%. The number of pharmaceutical interventions were increased by 104,4% with the application of the FASTHUG-MAIDENS mnemonic, compared to the period before the research. The main interventions performed were: inclusion of a drug (25,2%), exclusion of a drug (17,9%), dose adjustment (12,2%), change of the administration timetable to avoid intravenous incompatibility (11,4%), inclusion of infusion rate (7,3%), dilution adequacy (5,8%), inclusion of reconstitution (3,5%), microbiological culture request (3,4%), drug interaction monitoring (2,7%), adequacy of infusion rate (2,6%) and others (7,4%).Pharmaceutical interventions showed clinical (96,9%), preventive (99,3%) and economic (21,6%) impact. Conclusion: The application of the FASTHUG-MAIDENS mnemonic extended the pharmaceutical care to critically ill patients, enabling an accurate evaluation of the pharmacotherapy, clinically impacting critical patient care and reducing errors and adverse drug events.