Inappropriate Continuation of Stress Ulcer Prophylactic Therapy After Discharge

Wohlt, Paul; Hansen, Lizbeth A.; Fish, Jeffrey

doi:10.1345/aph.1k227

Cited by 75 publications

(100 citation statements)

References 17 publications

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“…[4][5][6][7][8][9][10] There was no difference in error rates between patients cared for by hospitalists or cardiology attendings and those cared for by house staff, suggesting that clinical experience and expertise are not adequate protections against medication errors at discharge. By contrast, a recent study of an electronic medication reconciliation intervention demonstrated a reduction in provider errors.…”

Section: Discussionmentioning

confidence: 99%

“…3 A further set of errors can be made at the time of hospital discharge. [4][5][6][7][8][9][10] Errors include unintentional discontinuation of medication on discharge, [4][5][6][7] inappropriate retention of inpatient medications on discharge, 7,8 and inaccurate changes in dosing or frequency. Medication reconciliation inaccuracies accumulating at all these points of transition create substantial risk for medication errors on hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

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Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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BACKGROUND: Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE: To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN: Prospective cohort study SUBJECTS: Patients over 64 years of age admitted with heart failure, acute coronary syndrome or pneumonia and discharged to home. MAIN MEASURES:We assessed medication reconciliation accuracy by comparing admission to discharge medication lists and reviewing charts to resolve discrepancies. Medication reconciliation changes that did not appear intentional were classified as suspected provider errors. We assessed patient understanding of intended medication changes through post-discharge interviews. Understanding was scored as full, partial or absent. We tested the association of relevance of the medication to the primary diagnosis with medication accuracy and with patient understanding, accounting for patient demographics, medical team and primary diagnosis. KEY RESULTS: A total of 377 patients were enrolled in the study. A total of 565/2534 (22.3 %) of admission medications were redosed or stopped at discharge. Of these, 137 (24.2 %) were classified as suspected provider errors. Excluding suspected errors, patients had no understanding of 142/205 (69.3 %) of redosed medications, 182/223 (81.6 %) of stopped medications, and 493 (62.0 %) of new medications. Altogether, 307 patients (81.4 %) either experienced a provider error, or had no understanding of at least one intended medication change. Providers were significantly more likely to make an error on a medication unrelated to the primary diagnosis than on a medication related to the primary diagnosis (odds ratio (OR) 4.56, 95 % confidence interval (CI) 2.65, 7.85, p<0.001). Patients were also significantly more likely to misunderstand medication changes unrelated to the primary diagnosis (OR 2.45, 95 % CI 1.68, 3.55), p<0.001). CONCLUSIONS: Medication reconciliation and patient understanding are inadequate in older patients postdischarge. Errors and misunderstandings are particularly common in medications unrelated to the primary diagnosis. Efforts to improve medication reconciliation and patient understanding should not be diseasespecific, but should be focused on the whole patient.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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“…Nevertheless, a large number of patients (n = 120), mainly in the "candidates" group, was discharged on AST. This practice is unjustified, and there is no evidence-based data that support the continuation of AST at discharge [57,58] . Furthermore, long-term use of acid-suppression medications was associated with an increase in unnecessary expenses [47,57] , and most importantly with an increased risk of pneumonia [59] , hip fracture [60] and Clostridium difficile colitis [61,62] .…”

mentioning

confidence: 99%

“…This practice is unjustified, and there is no evidence-based data that support the continuation of AST at discharge [57,58] . Furthermore, long-term use of acid-suppression medications was associated with an increase in unnecessary expenses [47,57] , and most importantly with an increased risk of pneumonia [59] , hip fracture [60] and Clostridium difficile colitis [61,62] . In order to explore whether teaching hospitals are more compliant with SUP guidelines, patients were stratified into two groups, resulting in statistically significant differences: a higher proportion of inpatients in teaching healthcare centers received adequate prophylaxis compared to patients in non-teaching hospitals.…”

mentioning

confidence: 99%

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

Zeitoun

Zeineddine²,

Dimassi³

2011

WJGPT

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AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers. METHODS:A multi-center prospective chart review study was conducted over 8 mo. A questionnaire was distributed to pharmacy students who collected data on demographics, SUP medications, dose, route, duration and associated risk factors. The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines. Institutional review board approval was obtained from each hospital center. RESULTS:A total of 1004 patients were included. 67% of the patients who received prophylaxis did not have an indication for SUP. The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications. Overall, the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample. This misuse was mainly observed in nonteaching hospitals. CONCLUSION:This study highlighted the need, in Lebanese hospitals, to establish clinical practice guidelines for the use of SUP; mainly in non-critical care settings.

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“…All these data on prescriptions are higher than those found in our population. Although most of these studies are old and based on evidence available at the time, the new scientific information on recommended use of antiulcer medications is one strength of this research regarding previous ones (20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

An economic analysis of inadequate prescription of antiulcer medications for in-hospital patients at a third level institution in Colombia

Machado‐Alba

Castrillón-Spitia

Londoño-Builes³

et al. 2014

Rev. esp. enferm. dig.

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Introduction:The prescription and costs of antiulcer medications for in-hospital use have increased during recent years with reported inadequate use and underused.Aim: To determine the patterns of prescription-indication and also perform an economic analysis of the overcost caused by the non-justified use of antiulcer medications in a third level hospital in Colombia.Materials and methods: Cross-sectional study of prescription-indication of antiulcer medications for patients hospitalized in "Hospital Universitario San Jorge" of Pereira during July of 2012. Adequate or inadequate prescription of the first antiulcer medication prescribed was determined as well as for others prescribed during the hospital stay, supported by clinical practice guidelines from the Zaragoza I sector workgroup, clinical guidelines from the Australian Health Department, and finally the American College of Gastroenterology Criteria for stress ulcer prophylaxis. Daily defined dose per bed/day was used, as well as the cost for 100 beds/day and the cost of each bed/drug. A multivariate analysis was carried out using SPSS 21.0.Results: 778 patients were analyzed, 435 men (55.9 %) and 343 women, mean age 56.6 ± 20.1 years. The number of patients without justification for the prescription of the first antiulcer medication was 377 (48.5 %), and during the whole in-hospital time it was 336 (43.2 %). Ranitidine was the most used medication, in 438 patients (56.3 %). The cost/month for poorly justified antiulcer medications was € 3,335.6. The annual estimated cost for inadequate prescriptions of antiulcer medications was € 16,770.0 per 100 beds.Conclusion: A lower inadequate prescription rate of antiulcer medications was identified compared with other studies; however it was still high and is troubling because of the major costs that these inadequate prescriptions generates for the institution.

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Inappropriate Continuation of Stress Ulcer Prophylactic Therapy After Discharge

Abstract: Gastric acid suppressant medications initially prescribed for stress ulcer prophylaxis are frequently prescribed inappropriately on discharge for patients who were initially admitted to the medical/surgical ICU.

Cited by 75 publications

References 17 publications

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

An economic analysis of inadequate prescription of antiulcer medications for in-hospital patients at a third level institution in Colombia

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