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

BACKGROUND

The identification and reduction of drug-related problems (DRPs) through DRP-oriented medical records during the hospitalization of critically impatients can optimize health indicators, such as length of hospital stay.

OBJECTIVE

To determine the effect of medical records focused on drug-related problems on the duration of stay for patients in intensive care units.

METHOD: A randomized controlled clinical trial was conducted with patients assigned to intervention or the usual care groups involving clinical pharmacists. This trial occurred between March 2018 and March 2019 and was completed in two intensive care units within two hospitals in Brazil. Exploratory secondary outcomes included the mortality rate and reductions in Sequential Organ Failure Assessment (SOFA) and Δ SOFA scores.

RESULTS

A total of 150 patients participated-54.6 % were women, most being white (77.3 %). Further, the main diagnosis was Acute Coronary Syndrome (22.6 %), followed by Congestive Heart Failure (12.6 %) and Heart Failure (10 %). A significant difference was observed in the length of stay between the intervention group and the control group, respectively 7.08 days (±4.38) and 10.7 days (±6.32). Among the secondary outcomes, a significant difference was observed in the mortality rates between the two groups: (6.58 %) in the intervention group and 25.68 % in the control group. Regarding Δ SOFA, the intervention group exhibited a reduction of 4.63 in the SOFA score during hospitalization. The control group showed an increase of 1.88 in the score during the same period.

CONCLUSION

This study demonstrated that the use of Diagnoses - Adverse Clinical Findings - Medications (DAM), a medical record model aimed at resolving drug-related problems, reduced the length of hospital stay and mortality rates among patients. Furthermore, this model proved to be more effective than the usual care provided by clinical pharmacists.