Impact of targeted educational interventions on appropriateness of stress ulcer prophylaxis in critically ill adults

Abstract

Background:Acid suppression therapy (AST) is routinely used in critically ill patients to prevent stress-related mucosal bleeding (SRMB).Objective:Our objective was to determine the impact of a structured educational intervention on AST used for prevention of SRMB on appropriateness of AST.Methods:A single-center, retrospective, cohort study of appropriate use of AST in critically ill patients admitted to the medical intensive care unit (ICU) at an academic medical center between January to June of 2014 (no intervention) and January to June of 2015 (intervention) was conducted. The percentage of patients prescribed inappropriate AST, inappropriate AST at ICU transfer and hospital discharge, doses of inappropriate AST, and adverse effects associated with AST use were compared between periods using chi-square tests.Results:Patients in the intervention group (n=118) were 5 years older than patients in the no intervention group (n=101). AST was inappropriately initiated more frequently in the no intervention group (23% vs. 11%, p=0.012). Continuation of inappropriate AST at ICU transfer and hospital discharge was similar between groups (60% vs. 53%, p=0.277 and 18% vs. 14%, p=0.368, respectively).Conclusion:Patients had appropriate AST initiated and inappropriate AST withheld more frequently when formal education was provided. This low-cost intervention strategy can be implemented easily at institutions where pharmacists interact with physicians on rounding services and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.

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

“…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. 22,47 This difference may be because our study was conducted at a non-ICU setting where mechanically ventilated patients were less likely to be admitted. In line with our finding, studies by Farsaei et al 19 and Mousavi et al 29 reported that no patient was indicated for SUP due to mechanical ventilation and burn, respectively.…”

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

“…The PRISMA flowchart of study inclusion is illustrated in Fig 1 [55]. After screening and determination of eligibility of 14,422 citations, 17 articles published between 2007 and 2019 were ultimately included in the meta-analysis [63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79]. These 17 publications resulted in 16 studies since Buckley et al [65] reported data for both the ICU and non-ICU settings in a single publication and two authors published results of pre-and post-intervention data in separate articles; in the ICU setting: Wohlt et al (pre-implementation) [75] and Hatch et al (post-implementation) [68]; in the non-ICU setting: Khudair et al (pre-implementation) [71] and Khudair et al (post-implementation) [70].…”

“…Pavlov et al and Martz et al did not provide any specific exclusion criteria [72,73]. Sample size calculations were conducted by Buckley et al, Hammond et al and Zeigler et al, and all studies included the sample sizes required to determine statistical significance of their respective primary outcomes [65,67,77]. Primary outcomes for each study are listed on Table 1.…”

“…Observation periods varied between studies. Tasaka [68,72,73,75] and Hammond et al [67] collected six months of pre-post data. In studies that provided data [65,67,68,73], patients' mean age ranged from 51 to 65.5 years, and the percentage of males ranged from 51.7% to 65.9%.…”

“…guidelines developed via consensus of several medical and surgical hospital committees and/or published the guideline/algorithm used to guide appropriate prescribing [65,67,68,74,77]. Martz et al reported using a pharmacist-driven medication discontinuation protocol [72] and Pavlov et al did not report use of a specific SUP guideline or protocol [73].…”