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PACULit Literature Updates September 2025: Emergency Medicine & Critical Care

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  1. Use of a drug-related problem oriented medical record in the medication review of critically ill patients Randomized clinical trial
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Daily Literature Update

Use of a drug-related problem oriented medical record in the medication review of critically ill patients Randomized clinical trial

Santos TNGdA, Macieira GMdC, Silva RdeOS, et al. Res Social Adm Pharm. 2025;21(4):268-276. doi:10.1016/j.sapharm.2025.01.010.

Drug-related problems are a significant concern in ICU patients, with potential to worsen outcomes and prolong hospitalization. This trial evaluated a DRP-focused medical record approach.

Study Type: Randomized controlled clinical trial

Population: 150 critically ill ICU patients

Intervention: DAM medical record model targeting DRPs

Outcomes: Hospital stay length; mortality; SOFA score changes

Key Findings

  • Reduced hospital stay: 7.08 vs 10.7 days (intervention vs control)
  • Lower mortality: 6.58% vs 25.68%
  • Improved SOFA scores: -4.63 vs +1.88, indicating better organ function

Context & Related Research

  • Puxty et al., 2025: Pharmacist-led multifaceted interventions reduce medication errors and harms in adult ICUs (PMID:36297654), supporting structured pharmacist roles.
  • Kane-Gill et al., 2016: Clinical decision support systems help prevent drug-related events in critical care (PMID:27872614), conceptually similar to DAM documentation.

Clinical Implications:

  • Incorporate DRP-oriented medical records like DAM for ICU medication review to improve outcomes.
  • Support pharmacist-led systematic approaches to identify and resolve medication issues.
  • Promote organizational adoption and training for structured documentation tools.
Strengths Limitations
Randomized controlled design with relevant clinical endpoints Limited generalizability with only two Brazilian ICUs
Robust sample size and measured organ function (SOFA scores) Potential variability in pharmacist intervention implementation

Further multicenter trials should replicate these findings and compare DRP-oriented documentation to electronic clinical decision support systems for optimizing ICU medication safety.

Implementation of the DAM structured medical record model significantly reduces hospital stay and mortality among critically ill patients, supporting systematic medication review in ICU care.

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