The Pharmacist’s Role in the Implementation of FASTHUG-MAIDENS, a Mnemonic to Facilitate the Pharmacotherapy Assessment of Critically Ill Patients: A Cross-Sectional Study

Abstract

FASTHUG is a mnemonic used by intensive care physicians to ensure the proper management of patients admitted to an Intensive Care Unit (ICU). FASTHUG-MAIDENS is a modified version that incorporates key pharmacotherapeutic elements such as delirium management, drug dosing, and drug interactions for an appropriate medication assessment of critically ill patients. An analytical cross-sectional study of hospitalized patients was carried out to determine aspects related to the pharmacotherapeutic management of critically ill patients that required to be optimized, to design and implement a protocol based on the FASTHUG-MAIDENS mnemonic. A total of 435 evaluations were performed to assess the status of current critical patient management. The main parameters with opportunities to be improved were analgesia, feeding, and sedation. With the implementation of MAIDENS, the parameters of analgesia, sedation, and thromboprophylaxis showed an increase in the percentage of optimal management. Furthermore, 103 drug-related problems were detected, and most of them were associated with feeding (21.3%), glucose control (11.7%), and delirium (9.7%). The FASTHUG MAIDENS protocol implementation allows for the evaluation of more vital aspects in the management of critically ill patients. The daily review of patients admitted to the ICU by a clinical pharmacist (CP) using the FASTHUG-MAIDENS checklist instead of the FASTHUG mnemonic facilitates the identification of DRPs for the performance of possible interventions by the CP to improve the pharmacotherapeutic management.

Use of the daily FAST HUG mnemonic technique in the care of patients in critical care units, a systematic review

“…(28) The (21,3 %), control de glucosa (11,7 %) y delirium (9,7 %). (29) FASTHUG-MAIDENS permite evaluar más aspectos vitales en el manejo de pacientes críticos La revisión diaria con este mnemotécnico facilita la identificación de PRM para realizar intervenciones farmacéuticas que mejoren el manejo farmacoterapéutico. (29) https://doi.org/10.56294/saludcyt2024708 Las intervenciones farmacéuticas más comunes fueron: optimización de frecuencia de administración (24,3 %), adición de medicación necesaria (11 %) y suspensión de medicación innecesaria (10,3 %).…”

“…Una de las principales modificaciones es la incorporación de elementos para generar el FAST HUGS BID, agregando la evaluación de pruebas de respiración espontánea, cuidado intestinal, retiro de catéteres permanentes y desescalada de antibióticos. (17,20,29) Esto permite una valoración más amplia y específica de los pacientes críticos, considerando aspectos frecuentemente olvidados como el soporte nutricional, el manejo del tubo digestivo y la deprescripción de medicamentos innecesarios. (34) Otra adaptación relevante es la conversión a FAST HUGS COVID propuesta por Kumar et al, enfocándose en necesidades particulares de los pacientes con COVID-19 e incorporando la oxigenoterapia, las complicaciones trombóticas, el soporte renal y el manejo de la coagulación.…”

Is a FASTHUG enough? Going beyond mnemonics for the next generation of pharmacy learners

“…Meanwhile, FASTHUG alone lacks major emphasis on medication‐related interventions 4 . This was underscored by Chaverri‐Fernandez and colleagues, who found that the addition of MAIDENS in clinical pharmacist workflow improved identification of more than 5.5 drug‐related problems per patient 30 . Only one of the mnemonics highlighted in Table 1, FASTHUG MAIDENS, was specifically created for and by pharmacists.…”

“…In total, 120 patients were retrospectively evaluated using FASTHUG-MAIDENS, which led to the identification of areas of improvement for feeding, analgesia, and sedation. 30 The most common issues identified were inadequate nutrition compared with the recommended daily caloric intake, sedation levels not being recorded, and use of non-validated tools to monitor pain and sedation. Based on these initial findings, the researchers then initiated a second phase of their experiment.…”

“…Another retrospective, cross‐sectional study evaluated the use of FASTHUG‐MAIDENS to review ICU patients by a pharmacist. In total, 120 patients were retrospectively evaluated using FASTHUG‐MAIDENS, which led to the identification of areas of improvement for feeding, analgesia, and sedation 30 . The most common issues identified were inadequate nutrition compared with the recommended daily caloric intake, sedation levels not being recorded, and use of non‐validated tools to monitor pain and sedation.…”