scholarly journals Evaluation of Stress Ulcer Prophylaxis Guideline in the Intensive Care Units of a Teaching Hospital: A Cross Sectional Study

2020 ◽  
Author(s):  
Afsaneh Vazin ◽  
Seyed Ruhollah Mousavinasab ◽  
Golnar Sabetian
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Stress Ulcer ◽  
Mucosal Damage ◽  
Stress Ulcer Prophylaxis ◽  
Major Risk Factor ◽  
Cross Sectional ◽  
Ulcer Prophylaxis

Background: One of the complications of critical ill patients admitted to intensive care unit (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis (SUP) should be administered to all critically ill patients with at least one major risk factor and two or more minor criteria. Methods: This study was performed during 6 months from October 2013 to December 2013 in Namazi Hospital intensive care units to assess the appropriate administration of SUP, according to American Society of Health-System Pharmacists (ASHP) protocol. Candidate for SUP according the ASHP guideline is considered if there is a at least one major risk factor or two or more minor risk factors. Results: Ninety-four patients were enrolled (46 men and 48 women). The mean age of study subjects was 51.5 years. The most major risk factor to stress ulcer found to be mechanical ventilation more than 48 hours (53%). The most minor risk factor for stress ulcer was ICU admission for less than one week (23.5%). Most prescribed medication for stress ulcer prophylaxis was intravenous Pantoprazole (44.7%). Our results have shown that about 74% patients were candidate for SUP according the ASHP guideline. 13(13.8%) of patients had only major risk factors. 5 (5.3%) of patients received SUP while they did not have at least one major risk factor or two or more minor risk factors. Conclusion: Our results have shown that 76.2% of the total SUP administrations were compliant with the ASHP guideline. Among the prescribed medication for SUP, intravenous pantoprazole had the highest percentage of administration (44.7%) and oral omeprazole had the lowest percentage of administration (7.4%). According to the results of our study, 72% of the route administrations are compliant with the ASHP guideline.

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.

scholarly journals Implementation of Stress Ulcer Prophylaxis (SUP) in an Intensive Care Unit (ICU)

2019 ◽  
pp. 1-7
Author(s):  
Foroud Shahbazi ◽  
Hasanali Karimpur ◽  
Elham Hosseini
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Stress Ulcer ◽  
Tertiary Hospital ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Bleeding ◽  
Cross Sectional ◽  
Ulcer Prophylaxis

Background: Critically ill patients are at high risk for developing stress ulcer bleeding, which may increase the length of hospitalization and mortality rate. Stress ulcer prophylaxis could be done either with PPIs or with H2 receptor blockers, which were prescribed in critically ill patients. Aim: This cross-sectional study was accomplished in an intensive care unit to implement new stress ulcer prophylaxis.  Methods: This study was conducted in a tertiary hospital of Kermanshah province, west of Iran. Patients who were hospitalized for at least 72 hours and received SUP prophylaxis, were included in our study. Updated ASHP guideline was used for calculating SUP risk score. Patients received either PPIs or H2RA (intravenously or enteral). Efficacy and safety of early changes to enteral route were evaluated in one year and cost was calculated in three years’ period.  Results: This study was conducted on 150 patients with a mean age of 58 ± 18 years old. More than half of patients (53.3%) were male. Stress ulcer prophylaxis was prescribed for all critically ill patients, regardless of the risk of GI bleeding while only 76.6% of patients had an appropriate indication for receiving SUP protocol. Six patients in the PPIs group (4 in intravenous and 2 in enteral) experienced gastrointestinal bleeding. Changing the route of administration from intravenous to intravenous over a three-year period resulted in a decrease in the mean use of pentoprazole vials from 12 to 4 per patient. Conclusion: Early changing (within 72 hours) SUP from IV to enteral is safe and cost-saving approach.

Stress ulcer prophylaxis in pediatric intensive care units

2010 ◽  
Vol 86 (6) ◽  
pp. 525-530 ◽  
Author(s):  
Taisa E. Araujo ◽  
Sandra M. G. Vieira ◽  
Paulo R. A. Carvalho
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Stress Ulcer ◽  
Pediatric Intensive Care ◽  
Stress Ulcer Prophylaxis ◽  
Pediatric Intensive Care Units ◽  
Ulcer Prophylaxis

scholarly journals A survey of stress ulcer prophylaxis in Intensive Care Units in the UK

Anaesthesia ◽  
2007 ◽  
Vol 62 (4) ◽  
pp. 421-422 ◽  
Author(s):  
A. P. Gratrix ◽  
S. M. Enright ◽  
H. A. O'Beirne
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Prophylaxis ◽  
The Uk

An Interprofessional Approach to Reducing the Overutilization of Stress Ulcer Prophylaxis in Adult Medical and Surgical Intensive Care Units

2014 ◽  
Vol 48 (4) ◽  
pp. 462-469 ◽  
Author(s):  
Chelsea L. Tasaka ◽  
Cindy Burg ◽  
Sherilyn J. VanOsdol ◽  
Lynne Bekeart ◽  
Andrew Anglemyer ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Surgical Intensive Care ◽  
Ulcer Prophylaxis

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

2019 ◽  
Vol 47 (6) ◽  
pp. 503-509 ◽  
Author(s):  
Matthew H Anstey ◽  
Edward Litton ◽  
Robert N Palmer ◽  
Sneha Neppalli ◽  
Benedict J Tan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Intensive Care Units ◽  
Stress Ulcer ◽  
Cost Savings ◽  
Economic Benefits ◽  
Stress Ulcer Prophylaxis ◽  
Prescribing Patterns ◽  
Ulcer Prophylaxis

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.

scholarly journals Adequacy of stress ulcer prophylaxis prescription in the intensive care unit: an observational study

2020 ◽  
Author(s):  
Marilena Franchitti ◽  
Jitka Piubellini ◽  
Farshid Sadeghipour ◽  
Philippe Eckert ◽  
Pierre Voirol ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Prophylaxis
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