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PACUPod is your trusted source for evidence-based insights tailored to advanced clinical pharmacists and physicians. Each episode dives into the latest primary literature, covering medication-focused studies across critical care and many more. We break down study designs, highlight key findings, and objectively discuss clinical implications—without the hype—so you stay informed and ready to apply new evidence in practice. Whether you’re preparing for board certification or striving for excellence in patient care, PACUPod helps you make sense of the data, one study at a time.
Britany: Welcome back to PACULit. Today, we’re discussing a randomized clinical trial evaluating a drug-related problem oriented medical record, or DAM, in medication review for critically ill patients. Seth, this study caught my eye because it addresses a persistent challenge in intensive care unit pharmacotherapy—systematically identifying and managing drug-related problems, or DRPs, in a high-risk population.
Seth: Absolutely, Britany. Drug-related problems are common in the ICU due to factors like polypharmacy, organ dysfunction, and rapidly changing patient status. What stood out to me was how this study tackled the lack of structured documentation tools for DRPs. Pharmacists play an integral role in ICU care but often lack standardized frameworks to document and guide interventions effectively.
Britany: Right. Drug-related problems increase morbidity, mortality, and hospital length of stay, which in turn drive up healthcare costs. Santos and colleagues, in a 2025 publication, examined whether implementing a DAM model could improve outcomes such as hospital length of stay and mortality in critically ill adults.
Seth: ICU patients are particularly vulnerable because of their complex medication regimens and organ dysfunction. While medication reviews are standard practice, without structured tools, interventions can vary widely. This study addressed that gap with a prospective, randomized controlled trial conducted in two Brazilian ICUs.
Britany: The study enrolled 150 critically ill adults who were randomized to either the DAM model intervention or standard medication review without DAM documentation. Inclusion criteria focused on adults likely to require mechanical ventilation or with organ dysfunction, although specific exclusion criteria were not detailed.
Seth: It is likely that patients with very short ICU stays or contraindications were excluded. The intervention consisted of the DAM medical record—a structured tool designed to identify, categorize, and track drug-related problems systematically during medication review.
Britany: The control group received standard practice, which involved medication review and documentation without the DAM framework. The primary outcome was hospital length of stay, while secondary outcomes included in-hospital mortality and changes in Sequential Organ Failure Assessment, or SOFA, scores.
Seth: Follow-up continued through discharge or death, capturing meaningful clinical endpoints. The investigators compared mean length of stay and SOFA score changes, analyzed mortality using relative risk, and conducted subgroup and safety analyses, which added robustness to their findings.
Britany: The results were striking. The DAM group experienced a significantly reduced hospital length of stay—seven point zero eight days compared to ten point seven days in the control group. That is over three and a half days shorter, which is clinically meaningful in the ICU setting.
Seth: Mortality was also notably lower in the DAM group—six point five eight percent versus twenty-five point six eight percent in controls. This represents a relative risk reduction of nearly seventy-five percent. Additionally, SOFA scores improved in the DAM group with a mean change of negative four point six three, indicating better organ function, compared to a worsening of positive one point eight eight in the control group.
Britany: Those SOFA score changes highlight the impact on organ dysfunction, suggesting that systematic identification and resolution of drug-related problems improves patient physiology, not just surrogate markers.
Seth: The DAM model likely enabled more timely and targeted pharmacist interventions, which explains these improvements. This aligns with findings from Puxty and colleagues in 2025, who demonstrated that pharmacist-led multifaceted interventions reduce medication errors and harms in adult ICUs.
Britany: Puxty’s review emphasized that structured, pharmacist-driven approaches improve medication safety. Similarly, Kane-Gill and colleagues in 2016 showed that clinical decision support systems prevent drug-related events in critical care. While the DAM model is a manual tool, it similarly systematizes drug-related problem identification and management.
Seth: Both approaches highlight how structured frameworks enhance pharmacists’ effectiveness. The focused documentation provided by DAM likely improves multidisciplinary communication and ensures that drug-related problems are not overlooked.
Britany: Regarding the patient population, although demographics were not detailed, these were adults with complex medication regimens and organ dysfunction, placing them at high risk for drug-related problems due to altered pharmacokinetics, polypharmacy, and critical illness.
Seth: Renal or hepatic impairment affects drug metabolism and clearance, increasing the risk of toxicity or subtherapeutic dosing. The DAM tool probably helped pharmacists systematically assess these factors and adjust therapy accordingly.
Britany: A key clinical pearl here is that structured tools like DAM prompt thorough evaluation of organ function and drug interactions. The ICU environment is rife with interactions among sedatives, vasopressors, and antimicrobials, which complicate medication management.
Seth: DAM likely facilitated the identification of such interactions and adverse effects, enabling timely interventions. Unrecognized interactions can worsen organ dysfunction or prolong ICU stay.
Britany: Additionally, DAM may standardize pharmacist interventions across providers and shifts. Variability in documentation and intervention quality is a known challenge in ICU pharmacy practice.
Seth: By providing a structured template, DAM reduces variability and improves continuity of care, which is crucial in busy ICUs with rotating clinicians and pharmacists.
Britany: Of course, there are limitations. The study was conducted in only two Brazilian ICUs, which may limit generalizability. Implementation fidelity of pharmacist interventions could also vary, potentially affecting outcomes.
Seth: Still, the randomized design and sample size strengthen the validity of the findings. Future multicenter trials could confirm these results and compare the DAM model to electronic clinical decision support systems.
Britany: Integrating DAM-like documentation into electronic health records could combine structured documentation with real-time alerts and decision support, enhancing medication safety further.
Seth: Training and organizational support are essential for successful adoption. Pharmacists need both the tool and the clinical authority to act on identified drug-related problems.
Britany: Before we wrap up, Seth, I think it’s worth emphasizing how this study reinforces the evolving role of pharmacists in critical care. Beyond dispensing medications, pharmacists are becoming central members of multidisciplinary teams, actively shaping therapeutic decisions.
Seth: Absolutely, Britany. The complexity of ICU pharmacotherapy demands specialized knowledge. Pharmacists trained in critical care can identify subtle drug-related problems that might otherwise be missed, such as dosing adjustments during renal replacement therapy or early signs of drug toxicity.
Britany: And with tools like the drug-related problem oriented medical record, pharmacists have a structured way to communicate these findings to physicians, nurses, and other team members. This shared understanding can accelerate interventions and improve patient safety.
Seth: That is a great point. Communication is often a bottleneck in busy ICUs. When documentation is inconsistent or incomplete, important medication issues can fall through the cracks. DAM’s standardized approach helps ensure that critical information is clearly recorded and accessible.
Britany: Looking ahead, integrating DAM with electronic health records could further enhance this process. Imagine automated alerts triggered by documented drug-related problems, prompting immediate review or consultation.
Seth: Yes, combining human expertise with technology could create a powerful synergy. However, as you mentioned earlier, successful implementation depends on adequate training and institutional support. Without buy-in from the entire care team, even the best tools can fail.
Britany: Training is key. Pharmacists need to be proficient not only in clinical knowledge but also in using documentation tools effectively. Likewise, physicians and nurses should understand the value of these records to fully engage with the process.
Seth: Another consideration is workload. ICU pharmacists often manage large patient loads. Structured tools like DAM can streamline their workflow by focusing attention on high-risk drug-related problems, potentially improving efficiency.
Britany: That is true. By prioritizing interventions based on systematic assessments, pharmacists can allocate their time more effectively, targeting patients who will benefit most.
Seth: Finally, this study reminds us that improving medication safety is a continuous process. Regular audits, feedback, and updates to documentation tools like DAM will be necessary to adapt to evolving ICU practices and emerging therapies.
Britany: Well said, Seth. Continuous quality improvement ensures that tools remain relevant and effective. It also fosters a culture of safety and accountability within critical care teams.
Seth: To sum up, the drug-related problem oriented medical record model represents a promising advance in ICU pharmacotherapy. It empowers pharmacists, enhances communication, and ultimately improves patient outcomes.
Britany: Thanks again for the great discussion, Seth. And to our listeners, we encourage you to explore how structured medication review tools can be integrated into your practice settings.
Seth: Absolutely, Britany. Stay engaged with the latest evidence and keep pushing for safer, more effective care. Until next time, take care everyone!
Britany: Thanks for tuning in to PACULit. Stay curious, stay informed, and keep advancing patient care through evidence-based practice.