Analysis of the use and cost of stress ulcer prophylaxis for surgical inpatients

2020 ◽  
Vol 30 (6) ◽  
Author(s):  
Dhani Wijaya ◽  
Elfri Padolo ◽  
Chrismawan Ardianto ◽  
Fendy Matulatan ◽  
Chris Alderman ◽  
...  
Keyword(s):  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Drug Costs ◽  
Ulcer Bleeding ◽  
Hospital Data ◽  
Stress Ulcers ◽  
Inappropriate Use ◽  
Ulcer Prophylaxis ◽  
American Society ◽  
The Cost

AbstractBackgroundStress ulcer is a superficial and asymptomatic lesion and causes bleeding. As many as 50% of death cases are reported as the result of stress ulcer bleeding. Stress ulcer prophylaxis (SUP) is a drug used to prevent gastrointestinal tract injuries due to stress ulcers. The inappropriate use of SUP drugs can cause adverse drug reactions, and thus SUP drugs are only given to patients in accordance with guidelines in order to avoid the overuse of SUP drugs. The aim of this present study is to analyse the suitability of SUP drug usage based on the criteria from the American Society of Health-System Pharmacists (ASHP) and the drug costs of SUP overuse.MethodsAn observational descriptive study was conducted from April 24, 2019, to May 17, 2019, in the inpatient surgical ward of Dr. Soetomo General Hospital. Data were obtained from patient medical health records.ResultsOne hundred fifty-two patients used 1404 SUP drugs. Approximately 48% of usage did not suit the ASHP criteria and was considered as medication overuse. The cost of excessive SUP usage during the study period was more than US $65, which is 30.08% of the total drug cost of prescribed stress ulcer drugs.ConclusionsThe present study suggests that the relatively high excessive drug costs for SUP show a need for monitoring of the application of SUP therapy guidelines.

Impact of Stress Ulcer Prophylaxis Algorithm Study

2005 ◽  
Vol 39 (5) ◽  
pp. 810-816 ◽  
Author(s):  
Christian J Coursol ◽  
Sabrina E Sanzari
Keyword(s):  
Intensive Care ◽  
Stress Ulcer ◽  
Treatment Algorithm ◽  
Intervention Group ◽  
Stress Ulcer Prophylaxis ◽  
Control Group ◽  
Post Intervention ◽  
Ulcer Prophylaxis ◽  
The Cost ◽  
The Impact

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.

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

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.

Analysis of stress ulcer prophylaxis drug regimentation in surgical patients

2021 ◽  
Vol 32 (4) ◽  
pp. 645-649
Author(s):  
Dhani Wijaya ◽  
Suharjono ◽  
Fendy Matulatan ◽  
Elfri Padolo
Keyword(s):  
Stress Ulcer ◽  
Frequency Standard ◽  
Cross Sectional Study ◽  
Stress Ulcer Prophylaxis ◽  
World Health ◽  
Cross Sectional ◽  
Injection Dose ◽  
Ulcer Prophylaxis ◽  
American Society ◽  
Health Organization

Abstract Objectives The World Health Organization (WHO) estimated that more than 50% of drugs were prescribed incorrectly, including stress ulcer prophylaxis (SUP) drugs. Prescribing SUP drugs in incorrect doses and frequencies are considered irrational, and may affects to the effectivity of the therapy. This research aimed to assess the appropriateness of the SUP drugs regimentation in the inpatient surgery room at Dr. Soetomo Hospital, Surabaya, Indonesia. Methods This research was cross-sectional study and conducted for 4 weeks in 2019 in the inpatient surgery room of Dr. Soetomo Hospital. The population was SUP drugs that were prescribed in inpatient surgery room. Those SUP drugs with indications for the prevention of stress-induced ulcers that complied to the terms listed on the American Society of Health-System Pharmacists (ASHP) were included as the samples, and vice versa. The samples then assessed for their regimentation appropriateness using the dose and frequency standard of ASHP. Results There were 224 dose units taken as sample, from the total population of 1,404 SUP drugs. The result showed that as much as 48.2% of SUP medications were given to the patients in inappropriate regimentation. Of that number, all ranitidine injection were inappropriately regimented. On the contrary all omeprazole injection dose units were appropriately regimented, meanwhile the amount of appropriate regimentation of sucralfate suspension were 74.6%. Conclusions According to ASHP standard, the SUP drugs in the inpatient surgery room at Dr. Soetomo Hospital were mostly given in inappropriate regimentation. Further research is needed to explore how will those inappropriate regimentation affect on the efficacy of therapy in the patients.

12: THE OVERUSE OF STRESS ULCER PROPHYLAXIS ON ADMISSION AND DISCHARGE AT A TERTIARY CARE TEACHING HOSPITAL: AN OBSERVATIONAL STUDY

2016 ◽  
Vol 64 (3) ◽  
pp. 804.1-804 ◽  
Author(s):  
J Jackson ◽  
JM Okun ◽  
N Paddu
Keyword(s):  
New York ◽  
Teaching Hospital ◽  
Stress Ulcer ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Stress Ulcer Prophylaxis ◽  
High Rate ◽  
Clinical Indication ◽  
Inappropriate Use ◽  
Ulcer Prophylaxis

Purpose of StudyStudies have linked the use of anti-secretory agents to nosocomial complications including Clostridium difficile–induced pseudomembranous colitis and hospital acquired pneumonia. Although there are comprehensive evidence-based guidelines for the initiation of stress ulcer prophylaxis, there are no universally accepted approaches. This has caused nationwide disorganization in current practice, which has led to their overuse. While many studies have shown the pervasiveness of stress ulcer prophylaxis overuse in the hospital setting, none have demonstrated its effect on the community through the improper discharge of patients on these medications.Methods UsedA retrospective review of patient data at a major teaching hospital in New York City was performed. During a 2 month study period, adult non-intensive care patients were randomly selected to determine the incidence of inappropriate initiation of stress ulcer prophylaxis on admission, as compared to the incidence of appropriate use. A follow-up assessment was then completed to determine the incidence of patients that were inappropriately discharged on these medications.Summary of ResultsA total of 100 randomly selected patients throughout the inpatient medicine service were analyzed. The results showed a high rate of inappropriate initiation and discharge of patients on anti-secretory agents. The study showed a 50% (n=50) incidence of overall stress ulcer prophylaxis use. Of the patients on stress ulcer prophylaxis, a 76% (n=38) incidence of inappropriate use was found. Of the patients inappropriately on stress ulcer prophylaxis, there was a 53% (n=19) incidence of inappropriate discharge home on these medications.ConclusionsThis study highlights the continued inappropriate initiation and discharge of patients on anti-secretory agents, despite mounting evidence and advisories against this practice. The use of an electronic medical record could provide an additional resource to improve quality of care. Electronic prescriptions allow for prompts that ask for a clinical indication during the prescription process. The advent of this technology may yield even more promising improvements in clinical practice, and its implementation is the current focus of a continuing study.

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