A Standardized, Structured Approach to Identifying Drug-Related Problems in the Intensive Care Unit: FASTHUG-MAIDENS

Pharmacy practice in the intensive care unit (ICU) is complex, because of the high acuity of patients’ conditions and the large number of medications prescribed. Therefore, many pharmacists, especially those not familiar with ICU care, may feel overwhelmed and apprehensive in this setting. There is currently no standardized, structured approach to help pharmacists provide pharmaceutical care in the ICU. For that reason, routine tasks such as identifying drug-related problems are much harder to perform, and drug therapy is not always optimized. In 2005, the FASTHUG mnemonic was proposed as a standardized approach to help ICU physicians ensure that all essential aspects of care for critically ill patients are met. Implementation of the FASTHUG approach in a surgical ICU was subsequently shown to decrease the rates of ventilator-associated pneumonia. Although the mnemonic has been generally well received, some clinicians have modified it to better augment their particular ICU practices. Notably, the FASTHUG mnemonic was not designed to identify drug-related problems commonly seen in the ICU. Therefore, we developed a modified mnemonic, FASTHUG-MAIDENS, as a standardized, structured approach to identifying drug-related problems in the ICU (Table 1).