Frequency of Inappropriate Continuation of Acid Suppressive Therapy After Discharge in Patients Who Began Therapy in the Surgical Intensive Care Unit

Murphy, Catherine; Stevens, Alison; Ferrentino, Nicholas; Crookes, Bruce; Hebert, James C.; Freiburg, Carter; Rebuck, Jill A.

doi:10.1592/phco.28.8.968

Cited by 46 publications

(53 citation statements)

References 25 publications

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“…Chang et al 6 showed that 74 of 206 patients received bronchodilators during mechanical ventilation without clinical indications, but they did not follow patients to discharge. The published literature [7][8][9][10][11][12][13][14][15][16] on inappropriate acid blockade is much larger, and the relationship with ICU stay has been previously described in community and tertiary centers nationally and internationally. Of 357 ICU patients given acid blockers, 24% were discharged on them with no clinical indication.…”

Section: Discussionmentioning

confidence: 99%

“…15 Of 248 consecutive patients treated in a surgical ICU, 237 began acid blockers in the unit, 60 were discharged from the hospital with them, and only 3 "had a compelling risk factor." 16 We can only surmise that such perseverant treatment with bronchodilators and acid blockers is a medication error, an unintended artifact of critical care, most likely mechanical ventilation, where risks and costs are not offset by proven benefits.…”

Section: Discussionmentioning

confidence: 99%

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Inappropriate Discharge on Bronchodilators and Acid-Blocking Medications After ICU Admission: Importance of Medication Reconciliation

et al. 2014

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BACKGROUND: Previous studies suggest that some medications, including proton pump inhibitors and ␤-agonist inhalers, are administered to hospitalized patients and sometimes continued without indications. Medication reconciliation has been offered as one mechanism to reduce the frequency of such medication errors and is now mandated by the Joint Commission (NPSG.03.06.01). We hypothesized that (1) ␤ agonists and acid-blocking medications are prescribed following critical illness without indications, and (2) medication reconciliation can reduce the frequency of inappropriate continuation of these agents. The study was carried out in a 414-bed community teaching hospital affiliated with the University of Connecticut Medical School. All subjects were admitted to the ICU between February and April 2012 (physician-driven reconciliation) and between July and September 2012, just following implementation of pharmacy technician-driven medication reconciliation. This was a retrospective cohort study. METHODS: Medical records of all subjects were reviewed using a uniform data extraction tool. Demographic information, clinical data, in-patient and out-patient medications (before and following hospital discharge), and outcomes were recorded. RESULTS: Prior to pharmacy technician-administered, physician-confirmed medication reconciliation, 253 ICU subjects were compared to 291 subjects admitted to the ICU after initiation of this process. There were no differences in admission type, stay, history of coronary artery disease, requirements for mechanical ventilation, or length of mechanical ventilation between groups. Rates of discharge on bronchodilators (8.9 vs 4.2%, P ‫؍‬ .09) or acid blockers (19.1 vs 11.2%, P ‫؍‬ .05) without clinical indications were lower with pharmacy technician-driven, physician-confirmed medication reconciliation than with routine physician-driven medication reconciliation. Multiple logistic regression analyses demonstrated a significant association of mechanical ventilation with inappropriate discharge on both bronchodilators and acid blockers. Pharmacy technician-driven medication reconciliation tended to reduce these errors. CONCLUSIONS: In our hospital, acid blockers and bronchodilators were often continued inappropriately following critical illness. The specific pharmacy technician-driven method of medication reconciliation deployed in our hospital reduced by half but did not eliminate this medication error.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inappropriate Discharge on Bronchodilators and Acid-Blocking Medications After ICU Admission: Importance of Medication Reconciliation

et al. 2014

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“…A prospective case series of 248 consecutive patients admitted to a surgical ICU at a single institution evaluated the continuance of AST after the ICU discharge [Murphy et al 2008]. Patients were excluded if they received AST prior to ICU admission, had an appropriate indication for AST, had a gastroenterology consultation associated with the index admission, or died.…”

Section: Stress Ulcer Prophylaxis In the Critical Care Settingmentioning

confidence: 99%

Overutilization of proton-pump inhibitors: what the clinician needs to know

Heidelbaugh

Kim

Chang

et al. 2012

Therap Adv Gastroenterol

261

206

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Proton-pump inhibitors (PPIs) remain the leading evidence-based therapy for upper gastrointestinal disorders, including gastroesophageal reflux disease, dyspepsia, and peptic ulcer disease. The effectiveness of PPIs has led to overutilization in multiple treatment arenas, exposing patients to an increasing number of potential risks. The overutilization of PPIs in ambulatory care settings is often a result of failure to re-evaluate the need for continuation of therapy, or insufficient use of on-demand and step-down therapy. PPI overutilization in the inpatient setting is often a result of inappropriate stress ulcer prophylaxis (SUP) in nonintensive care unit patients, and failure to discontinue SUP prior to hospital discharge. Potential consequences of prolonged PPI therapy include hypergastrinemia, enterochromaffinlike cell hyperplasia, and parietal cell hypertrophy, leading to rebound acid hypersecretion. PPIs have been linked via retrospective studies to increased risk of enteric infections including Clostridium difficile-associated diarrhea, community-acquired pneumonia, bone fracture, nutritional deficiencies, and interference with metabolism of antiplatelet agents. Reducing inappropriate prescribing of PPIs in the inpatient and outpatient settings can minimize potential for adverse events, and foster controllable cost expenditure.

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“…5,[10][11][12] We found much lower baseline levels of discharge with inappropriate AST prescriptions. Although having pharmacy students on the patient care teams may have reduced the number of patients discharged with inappropriate AST prescriptions, this finding would be incidental.…”

Section: Discussionmentioning

confidence: 70%

Pharmacy Student Impact on Inappropriate Prescribing of Acid Suppressive Therapy

Carey

Cross

Silva

et al. 2011

American Journal of Pharmaceutical Education

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Objective. To examine the impact that having pharmacy students on internal medicine patient care teams had on inappropriate prescribing of acid suppressive therapy (AST). Methods. In this observational cohort study, internal medicine patients who received care from teams with a pharmacy student were compared to patients who received care from teams without a pharmacy student. The primary endpoint was proportion of patients on inappropriate AST. Results. The overall proportion of patients receiving inappropriate AST was 24.4%. There was no significant difference between patients seen by teams with a pharmacy student and those seen by teams without a pharmacy student. The proportion of patients discharged with new inappropriate AST prescriptions was lower after pharmacy student review, though not significantly (6.1% vs. 9.4%, p 5 0.07). Pharmacy student reviews shortened the median duration of inappropriate AST by 1.5 days (6 vs. 8.5 days, p 5 0.025). Conclusions. Patient care teams on which pharmacy students performed medication reviews had a reduced duration of inappropriate use of AST in patients.

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Frequency of Inappropriate Continuation of Acid Suppressive Therapy After Discharge in Patients Who Began Therapy in the Surgical Intensive Care Unit

Cited by 46 publications

References 25 publications

Inappropriate Discharge on Bronchodilators and Acid-Blocking Medications After ICU Admission: Importance of Medication Reconciliation

Inappropriate Discharge on Bronchodilators and Acid-Blocking Medications After ICU Admission: Importance of Medication Reconciliation

Overutilization of proton-pump inhibitors: what the clinician needs to know

Pharmacy Student Impact on Inappropriate Prescribing of Acid Suppressive Therapy

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