Clinical and economic benefits of de-escalating stress ulcer prophylaxis therapy in the intensive care unit: A quality improvement study

Abstract

Stress ulcer prophylaxis is commonly prescribed in the intensive care unit but can be inappropriately commenced or continued on discharge, exposing patients to potential harm. We aimed to evaluate whether a prescribing guideline, education program and pharmacist oversight would reduce inappropriate continuation of stress ulcer prophylaxis. This was a multicentre pre- (2014) and post- (2016) quality improvement study across five Australian intensive care units. Cost data were estimated using local information about prescribing patterns, and the relationship between long-term use and adverse events. A total of 531 patients were included in the pre- and 393 in the post-implementation periods. The proportion of hospital survivors inappropriately continued on stress ulcer prophylaxis reduced from 78/184 (42.4%) to 11/143 (7.7%) in the post-implementation period (odds ratio = 8.83; 95% confidence interval 4.47–17.45; P < 0.0001). Clostridium difficile–associated disease reduced from 10 patients to one in the pre- to post-implementation groups. The extrapolated direct savings to all Australian intensive care units from reduced proton pump inhibitor prescribing are relatively small (AUD$2.08 million/year), but the reduction in complications has both benefits for patients and indirect savings of AUD$16.59 million/year nationally. In patients admitted to the intensive care unit, the introduction of a simple, bundled intervention resulted in a significant decrease in inappropriate continuation of stress ulcer prophylaxis at hospital discharge and a reduction in recognised complications, and substantial cost savings.

Impact of interventions targeting the inappropriate use of proton‐pump inhibitors by clinical pharmacists in a hepatobiliary surgery department

“…However, the results illustrated that patients treated with PPIs had a higher risk of nosocomial pneumonia. This is consistent with the findings of Anstey et al 18 The clinical pharmacist intervention targeting the rational use of PPIs did not deteriorate the quality of clinical care. On the contrary, such interventions can prevent the occurrence of adverse drug reactions.…”

“…Many studies have demonstrated that clinical pharmacist interventions have a significant role in the rational use and costs of PPIs 17‐23 . To date, little research has examined the effects of clinical pharmacist interventions on PPI use in hepatobiliary surgery wards.…”

Pharmacist-Led Intervention on the Inappropriate use of Stress Ulcer Prophylaxis Pharmacotherapy in Intensive Care Units: A Systematic Review

“…We included 8 studies from 9 articles in the narrative synthesis. [14,[23][24][25][26][27][28][29][30] All studies were cohort studies, of which 6 (75.0%) were retrospective and the other 2 (25.0%) were prospective.…”

“…Four (50%) studies clari ed the indication for the initiation and discontinuation of SUP pharmacotherapy by developing locally SUP pharmacotherapy guidelines/protocol or algorithm. [14,23,27,29] Four (50%) studies provided the medical staff with an educational intervention and/or supplied a pocket card of SUP pharmacotherapy indications for reference. [24,25,27,28] In 3 (37.5%) studies, pharmacists reviewed each patient on SUP pharmacotherapy during medical ICU rounds.…”

“…initiate, continue, discontinue, or modify the route of medication administration) for SUP pharmacotherapy only. [14,23,24,27,28] Effects on inappropriate use of SUP pharmacotherapy To clarify the de nition of 'inappropriate', we rst clari ed the indication of SUP pharmacotherapy in all studies. Based on the most recent published guidelines and the latest evidence at the time of the study's initiation, the indications for and cessation of SUP pharmacotherapy were different in each study (Appendix Table 2,3).…”