Inappropriate Use of Intravenous PPI for Stress Ulcer Prophylaxis in an Inner City Community Hospital

Perwaiz, Muhammad; Posner, Gerald; Hammoudeh, Fadi; Schmidt, Frances; Neupane, Narayan; Enriquez, Danilo; Gulati, Neerja

doi:10.4021/jocmr447w

Cited by 10 publications

(8 citation statements)

References 8 publications

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“…An enormous drug cost burden on patients and insurances relates to inappropriate PPI administration for SUP purposes . Clinical pharmacist participation in patient management may decrease SUP‐related expenditures without having a detrimental impact on quality of care . In the present study, pharmacists' intervention reduced relative the SUP cost by about 70%.…”

Section: Discussionmentioning

confidence: 59%

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency

Mousavi

Dashti‐Khavidaki

Khalili

et al. 2012

International Journal of Pharmacy Practice

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Section: Discussionmentioning

confidence: 59%

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency

Mousavi

Dashti‐Khavidaki

Khalili

et al. 2012

International Journal of Pharmacy Practice

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“…However, the proportion of inappropriate SUP prescription in this study was less than what was reported in other studies, which indicated 60%–80% of inappropriate SUP use. 19,26–29 This difference may be because our study was conducted at a teaching hospital where standard guidelines may be better practiced. Our claim was supported by many studies which revealed SUP usage in academic centers was more compliant with the guidelines than nonacademic hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…The result of this study is in agreement with previous reports. 27,33–36 According to Farsaei et al, 19 70.3% of patients received SUP when it was not indicated. In addition, overuse of AST in non-critically ill patients has been reported by several investigators.…”

Section: Discussionmentioning

confidence: 99%

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

2019

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Background:Critically ill patients with moderate-to-severe physiologically stressful event are at high risk of developing stress ulcers. The use of pharmacological prophylaxis significantly reduces the incidence of stress ulcer in high-risk patients.Objective:The aim of this study was to assess the use of pharmacological prophylaxis for stress ulcer in the medical wards of University of Gondar Hospital.Methods:A cross-sectional study design was used. In total, 234 patients were selected through simple random sampling technique. The risk of stress ulcer development was assessed using Evidence-Based Medicine Guideline for stress ulcer prepared by Orlando Regional Medical Center. SPSS version 21 was used for data analysis.Result:The most common acute risk factor to stress ulcer was coagulopathy (18.4%), followed by hypoperfusion (9.8%). The concomitant non-steroidal anti-inflammatory drug use (16.7%), mild-to-moderate brain or spinal cord injury (11.1%), and concomitant or recent corticosteroid use (9.4%) were frequently seen risk factors that necessitate administration of a prophylaxis. In total, 82 (35%) study participants were given stress ulcer prophylaxis, among which 52 (63.4%) were given without indication. The most commonly used drug class in the prevention of stress ulcer was proton pump inhibitors (76/82, 92.7%). In total, 43 (18.4%) study subjects were not given stress ulcer prophylaxis while there was clear indication. Patients with a long hospital stay and a diagnosis of central nervous system disorders had significant risk for inappropriate stress ulcer prophylaxis use.Conclusion:In this study, inappropriate use of prophylaxis for stress ulcer was common. The higher proportion of inappropriateness was due to the use of stress ulcer prophylaxis while there was no enough indication. We recommend future researchers to assess the cost and impact of inappropriate stress ulcer prophylaxis use, and the physicians should be adherent to the standard guidelines.

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“…High morbidity and mortality of stress ulcer-related bleeding and concerns about cost and adverse effects of SUP administrations such as pneumonia and Clostridium difficile infections, provoked different studies to determine the pattern of SUP prescription in ICU and non-ICU patients. [ 2 3 4 5 6 7 8 9 10 11 12 13 ]…”

Section: Introductionmentioning

confidence: 99%

Adherence to stress-related mucosal damage prophylaxis guideline in patients admitted to the Intensive Care Unit

Rafinazari¹,

Abbasi²,

Farsaei³

et al. 2016

J Res Pharm Pract

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Objective:Concern about adverse effects of the inconsistent use of stress-related mucosal damage prophylaxis in intensive care unit (ICU) is increasing. Hence, this study was designed to prospectively evaluate the rate of inappropriate stress ulcer prophylaxis (SUP) administration upon ICU admission, at ICU discharge and determine the adherence to American Society of Health-System Pharmacists (ASHP) guideline during ICU stay.Methods:In this study, 200 patients were randomly selected from all ICU admissions during 9 months. Risk factors of stress ulcer were recorded daily during ICU stay and appropriateness of SUP administration was assessed according to the ASHP criteria.Findings:Of all 160 (80%) patients who received SUP, 44.4% did not have indication; and among 95 patients with an indication for SUP administration, 6.3% did not receive it upon ICU admission. Consequently, 77 (38.5%) of 200 patients received inappropriate prophylaxis on ICU admission. In addition, 53.5% of patients had appropriate adherence to ASHP guideline during all days of ICU stay (44% and 2.5% of patients received SUP more than 120% and <80% of appropriate SUP duration, respectively). Moreover, 81.2% were continued on inappropriate prophylaxis upon transfer from the ICU.Conclusion:We concluded that although SUP administration included both overutilization and underutilization in this ICU, but high prevalence of SUP overutilization caused unnecessary hospital costs, personal monetary burden, and may increase adverse drug reactions. Therefore, educating physicians and cooperation of clinical pharmacists regarding implementing standard protocols could improve patterns of SUP administration.

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Inappropriate Use of Intravenous PPI for Stress Ulcer Prophylaxis in an Inner City Community Hospital

Cited by 10 publications

References 8 publications

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency

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

Adherence to stress-related mucosal damage prophylaxis guideline in patients admitted to the Intensive Care Unit

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