Pharmacist-Initiated De-Prescribing Efforts Reduce Inappropriate Continuation of Acid-Suppression Therapy Initiated in the ICU

Cascone, Ava E.; Sullivan, Jessica; Ackerbauer, Kimberly; Patel, Shyam A.; Lindale, Danielle Kebadjian; Tatro, Hayley; Feeney, Megan

doi:10.1016/j.amjmed.2022.09.003

Cited by 2 publications

(6 citation statements)

References 12 publications

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“…16 Furthermore, a single-center, quality improvement initiative performed in the medical, trauma/surgical/ neurosciences, and cardiac ICUs at a tertiary academic medical center found a 55% decrease in acid-suppressive therapy discharge prescriptions after the implementation of an electronic handoff tool in the electronic medical records; although, no change was observed in the percentage of agents continued upon discharge with an inappropriate indication. 15 Our study found a 20% decrease in the number of acid-suppressive agents inappropriately continued at ICU discharge [50 (44.6%) vs. 16 (24.6%); p = 0.01] and a 5.1% decrease in the number of acid-suppressive agents inappropriately continued at hospital discharge [16 (14.3%) vs. 6 (9.2%); p = 0.33]. These studies support our findings that the electronic handoff tool may be useful for alerting critical care pharmacists regarding temporary medications versus pharmacists covering stepdown units.…”

Section: Discussionmentioning

confidence: 99%

“…14 More recent studies have demonstrated the utility of an electronic handoff tool in reducing the inappropriate discontinuation of acid-suppressive agents and antipsychotics. 15,16 Pharmacist-led interventions may help prevent the inappropriate continuation of acid-suppressive agents and antipsychotics; however, limited data exist pertaining to other agents initiated in the ICU, such as stimulants for wakefulness, benzodiazepines, and melatoninreceptor agonists. This study evaluated the impact of a pharmacistled intervention utilizing an electronic handoff tool on the number of medications inappropriately continued upon ICU and hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, a prospective, observational study found that critical care pharmacists involved in a post‐intensive care syndrome clinic led to the discontinuation of medications in 39% of patients 14 . More recent studies have demonstrated the utility of an electronic handoff tool in reducing the inappropriate discontinuation of acid‐suppressive agents and antipsychotics 15,16 . Pharmacist‐led interventions may help prevent the inappropriate continuation of acid‐suppressive agents and antipsychotics; however, limited data exist pertaining to other agents initiated in the ICU, such as stimulants for wakefulness, benzodiazepines, and melatonin‐receptor agonists.…”

Section: Introductionmentioning

confidence: 99%

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Pharmacist‐led intervention to reduce inappropriate continuation of targeted medications initiated in the acute care setting at hospital and ICU discharge

Patel,

Dannemiller,

Kovacevic

et al. 2024

J Am Coll Clin Pharm

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Pharmacist‐led interventions may reduce the inappropriate continuation of acid‐suppressive agents and antipsychotics temporarily initiated in the intensive care unit (ICU), but limited data exist for other medications. This study evaluated the impact of a pharmacist‐led intervention on the number of medications inappropriately continued upon ICU and hospital discharge. This was a single‐center, pre‐post intervention analysis conducted in the medical and surgical ICUs at a tertiary academic medical center. The pre‐ and post‐intervention groups included adults who were newly initiated on medications used for stress ulcer prophylaxis, delirium, agitation, wakefulness, sedation, and insomnia from December 1, 2021 to January 31, 2022 and December 12, 2022 to February 13, 2023, respectively. In the post‐intervention group, pharmacists identified patients who were newly initiated on a medication of interest and documented in patients' charts via an electronic handoff tool utilizing a standardized template. The appropriateness of those medications was assessed daily, and pharmacists intervened when necessary. The number of medications inappropriately continued at ICU and hospital discharge and ICU and hospital lengths of stay were compared. Overall, 399 encounters were included in the final analysis, and a total of 459 medications were newly initiated in the ICU. There was no significant difference in the number of medications inappropriately continued at hospital discharge [22 (8.4%) vs. 10 (5.1%); p = 0.17]. Significantly fewer medications were inappropriately continued at ICU discharge in the post‐intervention group [85 (32.3%) vs. 37 (18.9%); p < 0.01]. The median ICU length of stay was significantly greater in the post‐intervention group [4 (2–8) vs. 2 (1–6) days; p < 0.01]. No significant difference was found in the median hospital length of stay [14 (7–26.5) vs. 16 (9–33.75) days; p = 0.08]. Use of an electronic handoff tool was associated with a significant reduction in the number of medications inappropriately continued at ICU discharge.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pharmacist‐led intervention to reduce inappropriate continuation of targeted medications initiated in the acute care setting at hospital and ICU discharge

Patel,

Dannemiller,

Kovacevic

et al. 2024

J Am Coll Clin Pharm

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“…Acid suppressive medications should still be administered to patients who are at high-risk for clinically important bleeding even when enteral nutrition is administered. www.co-clinicalnutrition.com inappropriate use [16][17][18][19][20] and exploration of alternative strategies for SUP [21,22].…”

Section: Key Pointsmentioning

confidence: 99%

“…Pooled analyses, however, have been inconsistent [5 ▪ ,11 ▪ ,15]. Nevertheless, the overuse of acid suppressive therapy and their resultant adverse effects has led to programs designed to minimize inappropriate use [16–20] and exploration of alternative strategies for SUP [21,22].…”

Section: Medications Used For Stress Ulcer Prophylaxismentioning

confidence: 99%

Prophylactic acid suppression and enteral nutrition

Barletta¹

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewStress ulcer prophylaxis (SUP) is routinely administered to critically ill patients who are at high-risk for clinically important gastrointestinal bleeding. Recent evidence however has highlighted adverse effects with acid suppressive therapy, particularly proton pump inhibitors where associations with higher mortality have been reported. Enteral nutrition may provide benefits in reducing the incidence of stress ulceration and may mitigate the need for acid suppressive therapy. This manuscript will describe the most recent evidence evaluating enteral nutrition for the provision of SUP.Recent findingsThere are limited data evaluating enteral nutrition for SUP. The available studies compare enteral nutrition with or without acid suppressive therapy rather than enteral nutrition vs. placebo. Although data exist demonstrating similar clinically important bleeding rates in patients on enteral nutrition who receive SUP vs. no SUP, these studies are underpowered for this endpoint. In the largest placebo-controlled trial conducted to date, lower bleeding rates were observed with SUP and most patients were receiving enteral nutrition. Pooled analyses had also described benefit with SUP vs. placebo and enteral nutrition did not change the impact of these therapies.SummaryAlthough enteral nutrition may provide some benefit as SUP, existing data are not strong enough to validate their use in place of acid suppressive therapy. Clinicians should continue to prescribe acid suppressive therapy for SUP in critically ill patients who are at high risk for clinically important bleeding even when enteral nutrition is being provided.

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Pharmacist-Initiated De-Prescribing Efforts Reduce Inappropriate Continuation of Acid-Suppression Therapy Initiated in the ICU

Cited by 2 publications

References 12 publications

Pharmacist‐led intervention to reduce inappropriate continuation of targeted medications initiated in the acute care setting at hospital and ICU discharge

Pharmacist‐led intervention to reduce inappropriate continuation of targeted medications initiated in the acute care setting at hospital and ICU discharge

Prophylactic acid suppression and enteral nutrition

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