T1086 Stress Ulcer Prophylaxis out of Intensive Care Setting: Prospective Evaluation of a Common Practice

BACKGROUND: In the intensive care unit at Royal Victoria Hospital, we noted that drugs prescribed for stress ulcer prophylaxis were not always indicated or optimal. Accordingly, we implemented an algorithm for stress ulcer prophylaxis to guide the medical team in their decisions. The agents selected for the algorithm were intravenous famotidine and omeprazole suspension or tablets, depending on the available administration route. OBJECTIVE: To evaluate the impact of a treatment algorithm on the appropriateness of prescriptions for stress ulcer prophylaxis. METHODS: A quasi-experimental—type evaluative study was conducted based on a pre-/post-intervention design without a concurrent control group. A total of 555 complete admissions met the selection criteria; 303 patients formed the pre-intervention group, and 252 made up the post-intervention group (exposed to the treatment algorithm). RESULTS: After implementation of the algorithm, the proportion of inappropriate prophylaxis was decreased (95.7% vs 88.2%; p = 0.033). The number of days of inappropriate prophylaxis was also reduced significantly (p = 0.013), as was the cost per patient (p = 0.003) for all admissions. However, no difference was observed when the subgroup of patients who received prophylaxis alone was studied (p = 0.098 and p = 0.918). The presence of bleeding was similar in both groups. CONCLUSIONS: Introduction by pharmacists of a treatment algorithm for stress ulcer prophylaxis in intensive care units allows a reduction of inappropriate prescriptions and thus a reduction in the cost of drugs. The use of omeprazole suspension seems to be an alternative to intravenous histamine2-inhibitors; however, a large-scale study is necessary to confirm the efficacy and safety of proton-pump inhibitors administered by an enteral tube.

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FACTORS AFFECTING THE OVERUSE OF STRESS ULCER PROPHYLAXIS IN PATIENTS IN THE INTENSIVE CARE UNIT

CHEST Journal ◽

10.1378/chest.132.4_meetingabstracts.564 ◽

2007 ◽

Vol 132 (4) ◽

pp. 564A

Author(s):

William W. Hope ◽

Thomas Schmelzer ◽

Aram Kim ◽

Jonathan Salashour ◽

M.C. Barrett ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Stress Ulcer ◽

Stress Ulcer Prophylaxis ◽

Factors Affecting ◽

Ulcer Prophylaxis

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Stress ulcer prophylaxis in the intensive care unit

Advances in Digestive Medicine ◽

10.1016/j.aidm.2014.04.002 ◽

2014 ◽

Vol 1 (2) ◽

pp. 36-37 ◽

Cited By ~ 1

Author(s):

Fu-Chen Kuo ◽

Deng-Chyang Wu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Stress Ulcer ◽

Stress Ulcer Prophylaxis ◽

Ulcer Prophylaxis

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INTENSIVE CARE UNIT PRESCRIPTIONS MUST FIT RISK FACTORS TO PREVENT STRESS ULCER BLEEDING

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020210003e1587 ◽

2021 ◽

Vol 34 (3) ◽

Author(s):

Rodolfo Castro Cesar de OLIVEIRA ◽

Osvaldo MALAFAIA ◽

Fernando Issamu TABUSHI ◽

Carlos Roberto NAUFEL JUNIOR ◽

Elora Sampaio LOURENCO ◽

...

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Intensive Care ◽

Stress Ulcer ◽

Stress Ulcer Prophylaxis ◽

Ulcer Bleeding ◽

Digestive Bleeding ◽

Cord Injury ◽

Ulcer Prophylaxis ◽

Stress Ulcer Bleeding

ABSTRACT Background: The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. Aim: To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. Methods: Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. Results: One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). Conclusion: The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.

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