Attachment to stress ulcer prophylaxis guideline in the neurology wards of two teaching and non-teaching hospitals: A retrospective survey in Iran

Foroughinia, Farzaneh; Madhooshi, Mohammad

doi:10.4103/2279-042x.179582

Cited by 7 publications

(20 citation statements)

References 10 publications

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“…Our claim was supported by many studies which revealed SUP usage in academic centers was more compliant with the guidelines than nonacademic hospitals. 18,26,30…”

Section: Discussionmentioning

confidence: 99%

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Assessment of pharmacologic prophylaxis use against stress ulcer in the medical wards of University of Gondar Hospital

2019

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Background:Critically ill patients with moderate-to-severe physiologically stressful event are at high risk of developing stress ulcers. The use of pharmacological prophylaxis significantly reduces the incidence of stress ulcer in high-risk patients.Objective:The aim of this study was to assess the use of pharmacological prophylaxis for stress ulcer in the medical wards of University of Gondar Hospital.Methods:A cross-sectional study design was used. In total, 234 patients were selected through simple random sampling technique. The risk of stress ulcer development was assessed using Evidence-Based Medicine Guideline for stress ulcer prepared by Orlando Regional Medical Center. SPSS version 21 was used for data analysis.Result:The most common acute risk factor to stress ulcer was coagulopathy (18.4%), followed by hypoperfusion (9.8%). The concomitant non-steroidal anti-inflammatory drug use (16.7%), mild-to-moderate brain or spinal cord injury (11.1%), and concomitant or recent corticosteroid use (9.4%) were frequently seen risk factors that necessitate administration of a prophylaxis. In total, 82 (35%) study participants were given stress ulcer prophylaxis, among which 52 (63.4%) were given without indication. The most commonly used drug class in the prevention of stress ulcer was proton pump inhibitors (76/82, 92.7%). In total, 43 (18.4%) study subjects were not given stress ulcer prophylaxis while there was clear indication. Patients with a long hospital stay and a diagnosis of central nervous system disorders had significant risk for inappropriate stress ulcer prophylaxis use.Conclusion:In this study, inappropriate use of prophylaxis for stress ulcer was common. The higher proportion of inappropriateness was due to the use of stress ulcer prophylaxis while there was no enough indication. We recommend future researchers to assess the cost and impact of inappropriate stress ulcer prophylaxis use, and the physicians should be adherent to the standard guidelines.

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“…Our claim was supported by many studies which revealed SUP usage in academic centers was more compliant with the guidelines than nonacademic hospitals. 18,26,30…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with other studies. 19,22,29 According to Foroughinia and Madhooshi, 18 coagulopathy was the only absolute indication for SUP. Mechanical ventilation and burn were not found as an indication for SUP in the this study, while some other studies reported so far found mechanical ventilation as a common indication for SUP use.…”

Section: Discussionmentioning

confidence: 99%

Assessment of pharmacologic prophylaxis use against stress ulcer in the medical wards of University of Gondar Hospital

2019

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“…According to ASHP guideline and recent performed studies, patients who had 1 absolute indications or at least 2 of the relative indications were eligible for SUP administration in non-ICU setting ( Table 1 ). 8 , 12 , 16 , 17 …”

Section: Methodsmentioning

confidence: 99%

Variables Associated with Adherence to Stress Ulcer Prophylaxis in Patients Admitted to the General Hospital Wards: A Prospective Study

2017

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Purpose: The dramatic increase in stress ulcer prophylaxis (SUP) prescribing patterns over the past several years has raised concerns regarding to their appropriate utilization. This prospective study attempted to evaluate the trend of adherence to stress ulcer prophylaxis from admission until discharge in non- Intensive care unit (ICU) setting. Additionally, we attempted to find those variables associated with appropriate SUP administration. Methods: Data collection was performed prospectively to evaluate 195 randomly selected adult patients who received SUP or had indication for that in non-ICU wards of one of the largest referral center in Iran, during 6 months. Adherence was studied according to widely accepted American Society of Health system Pharmacists (ASHP) guideline. Univariate and multivariate logistic regression was also performed to detect associations related to misuse of SUP. Results: We recognized total inappropriate use of SUP upon admission, during hospital stay and at discharge were somewhat identical at different time points (61%, 80% and 77.4% respectively). On the other hand, since small number of patients experienced SUP underutilization, unfortunately this was not possible to elucidate factors that may have effect on this flawed behavior. However, increasing age was identified to be significant variable in SUP overutilization. Conclusion: This prospective study highlighted inappropriate overutilization of SUP within non-critically ill patients and found factors which predicted this behavior. Adherence during hospital stay was also calculated for the first time in this study, which was related to SUP adherence upon hospital admission.

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“…These results were consistent with earlier studies. [1622] We relatively identified a large number of patients continuing SUP medication with lack of risk factors in emergency department than the patients admitted to the internal medicine department. These findings are similar to those obtained by Mohamad et al .,[23] who observed that approximately 57.8% of patients had no risk factors and received unjustified prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…A study in Iran reported that almost 85% of the SUP agents administered to hospitalized patients were inappropriately prescribed. [16] Another prospective study reported that ASTs had been prescribed for SUP to 44.4% of patients without an appropriate indication. [17] Herzig et al .…”

Section: Introductionmentioning

confidence: 99%

Appropriateness of acid-suppressing agents for stress ulcer prophylaxis in non-intensive care unit setting in Saudi Arabia

et al. 2019

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Objective: To investigate the appropriateness of acid-suppressive therapy (AST) for stress ulcer prophylaxis (SUP) in noncritically ill hospitalized patients. Materials and Methods: A prospective, observational study with 384 subjects was conducted between October and December 2017 in the emergency and internal medicine departments. The Herzig clinical risk scoring system and the guidelines of the American Society of Health-System Pharmacists guidelines were used to assess risk factors and determine risk scores for gastrointestinal (GI) bleeding. Results: The mean age of subjects was 51.9 ± 19.4 years, and 220 (57.3%) of them were males. Among the absolute risk factors, coagulopathy was observed in 2 (0.5%) patients, mechanical ventilation in 15 (3.9%), and a history of GI bleeding in 1 (0.3%). Of 384 patients with SUP, 370 (96.4%) had a clinical risk score ≤ 9 and 14 (3.6%) had a risk score between 10 and 12 for nosocomial GI bleeding. A statistically significant relationship was found between the risk factor indication and demographics. Conclusion: SUP is frequently administered to noncritically ill hospitalized patients lacking risk factors for GI bleeding. Proton pump inhibitors are the overwhelming first choice of AST among prescribers. Practitioners should follow international guidelines when prescribing ASTs outside the critical-care setting.

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Attachment to stress ulcer prophylaxis guideline in the neurology wards of two teaching and non-teaching hospitals: A retrospective survey in Iran

Cited by 7 publications

References 10 publications

Assessment of pharmacologic prophylaxis use against stress ulcer in the medical wards of University of Gondar Hospital

Assessment of pharmacologic prophylaxis use against stress ulcer in the medical wards of University of Gondar Hospital

Variables Associated with Adherence to Stress Ulcer Prophylaxis in Patients Admitted to the General Hospital Wards: A Prospective Study

Appropriateness of acid-suppressing agents for stress ulcer prophylaxis in non-intensive care unit setting in Saudi Arabia

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